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Insurance - Coastal Traffic Systems Inc. - 2012-02-23Av °® CERTIFICATE OF LIABILITY INSURANCE 2/23/20112"' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER James G Parker Insurance Associates License #0554959 1753 E Fir Ave Fresno CA 93720 CONTACT Debbie Eilby PHONE (559)222 -7722 FAX AIC No (559)222 -1'124 Mhftrbb.eKilby@jgparker.com INSURERS AFFORDING COVERAGE NAIC # AWestern World Insurance Company 13196 INSURED Coastal Traffic Systems Inc FEB 2 7 2110 2602 S Halladay H,' ,A{^J```�A, �y ,t r� UUNIA I''1. AJAN(IAN Santa And CA 92705 INSURER B National Union Fire Cc of 19445 URERC: EACH OCCURRENCE INSURER D: PREMISES Ea occurrence E: MUD EXP(my one person) INSURER F: PERSONAL &ADV INJURY COVERAGES CERTIFICATE NUMBER:12 -13 Gl & Excs REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADOL all POLICY NUMBER MMIDDYEFF MMLIDY�Y LIMITS A GENERAL LIABILITY • COMMERCIAL GENERAL LIABILITY I CLAIMS -MADE OCCUR • X C U Included PGP0733920 /17/2012 /17/2013 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 MUD EXP(my one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES X PRa ECT PER: LOC PRODUCTS - COMP /OPAGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL ONRJED F7SCHEDLIUBD AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT accide Ea nt BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ B UMBRELLALIAB EXCESS LIAR OCCUR CLAIMS -MADE E086671505 /17/2012 /17/2013 EACH OCCURRENCE $ 5,000,000 X N AGGREGATE IS 5,000,000 LED RETENTION $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETOWPARTNEWEXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC STATU- DTH- $ E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is named as Additional Insured as per form WW180 0310 attached Costa Mesa Sanitary District �\`I 628 W 19th Street \ Costa Mesa, CA 92627 n„ ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Parker III /CARRIE ©1988 -2010 ACORD CORPORATION. All riohts reset INS025 on1nmmni Th. AcnPrl ,e— ...d Inns pro ro,.i.t —d —orkc of ACnRn This Endorsement Modifies Your Policy (Effective At Inception Unless Another Date Shown Below) ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The insurance afforded by this policy for "bodily injury," "property damage" andlor "personal and advertising injury" shall also apply to the "additional insured listed below for claims, suits, andlor damages made against the "additional insured," but only to the extent the "additional insured is being held responsible for the acts, omissions and or negligence of the "named insured." This insurance afforded shall not apply to claims, suits and or damages arising out of the acts, omissions and or negligence of the "additional insured(s)." The inclusion of the "additional insured(s)" shall not operate to increase the Limits of Insurance. To the extent, if any, that this policy affords coverage to an "additional insured," the "additional insured is subject to all of the terms of the policy. Our obligation to provide coverage to an "additional insured is further limited by the interest of the "additional insured as defined below. Interest of the Additional Insured(s) Defined: Traffic Control Operations For the purpose of this endorsement, the "named insured is the person(s) and or party(ies) designated on the Declarations Page of the policy or on any endorsement. The "additional insured" is the person(s) and or party(ies) identified below. Identity of Additional Insured(s): Blanket as required by written contract (Complete this section if endorsement is added after policy Is Issued.) PGP0733920 02/17/2012 Policy Number Endorsement Number Endorsement Effective Date Signature of Authorized Representative Producer Number WW180 (03/10) ,a� ECtt 'CthTIFICATE OF LIABILITY INSURANCE B /LizolzYYY) THIS CERTIFIC�1 GI CERTIFICATE ����$$ NOT AFFIRMATIVELY BELOW. xj;I &q$p tEPRESE 'l?IY� S A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES AND THE DOES N CERTIFICATE HOLDER. CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER James G Parker Insurance Associates License #0554959 1753 E Fir Ave Fresno CA 93720 CONTACT Debbie Kilby PHONE (559)222 -7722 FAX INC No: (559) 222 -1]24 ADDRESS: DebbieKilby @jgparker. corn INSURERS AFFORDING COVERAGE NAICN INSURER A:Praetorian Insurance CompanV 37257 INSURED Coastal Traffic Systems Inc 2602 S Halladay Santa Ana CA 92705 INSURERS:TOPA Insurance Company 18031 INSURER C:Travelers Property Casualty Co 25674 INSURER D: $ INSURER E It INSURER F: $ COVERAGES CERTIFICATE NUMBER:12 -13 BA EX BA IM REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBIR POLICY NUMBER POLICY EFF MMIDDNYYY ) POLICY EXP JMMIDDfYYYYJ LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—I OCCUR EACH OCCURRENCE $ DAMA E T RENT PREMISES Ea occurrence $ MED EXP (Any one person) It PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE POLICY LIMIT APPLIES PER PRO LOC IFQT PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED X AH010000601 6/1/2012 6/1/2013 EO eBINE�DtSINGLE LIMIT 1,000,000 X BODILY INJURY (Per person) $ IAUTOS BODILY INJURY (Per accident) $ Y` PROPERTY DAMAGE fps raccidenl $ Medical payments $ 5,000 B UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE IM66016702 6/1/2012 6/1/2013 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVE F-1 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below MIA _ WC STATU- OTH- E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ C C Contractors Equipment Rented /Leased Equipment T6605446BO38TIL32 2T6605446BO38TIL12 6/1/2012 6/1/2012 6/1/2013 6/1/2013 $1,000 deductible Per Schedule $1,000 deductible $100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Costa Mesa Sanitary District 628 W 19th Street Costa Mesa, CA 92627 ACORD 25 (2010/05) INS025 mmnns m SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Parker III /DKILBY ���"� 07""'� °� Thn ArnPn nvmn and Innn orc raniefcrnrl mnr4e n6 ACr1Rn All rights reserved.