Loading...
Insurance-Bartel Associates-2013-09-01AcoRE® CERTIFICATE OF LIABILITY INSURANCE 111.� DAM(MMIDONYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 09/0112013 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 polic"s rCepilp@r 0vement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). L V L NJ PRODUCER SEP CONTACT ROBERT B RICE, JR. JSI FINANCIAL SERVICES, INC 0 2013 PHOR o Ext: (818) 547 -1975 FAX AIC No: (818) 436 -5988 JOHN SARGEANT INSURANCE AGENCY E- MAILSS, mbert@Jsargeantinsurance.com (rUJIN IYICJN JNNIIARY DI 300 WEST GLENOAKS BLVD. SUITE 104 INSURER 5 AFFORDING COVERAGE NAIC k INSURER A: AMERICAN STATES INSURANCE COMPANY 19704 GLENDALE r CA 91202 -2985 INSURED INSURERS: INDIAN HARBOR INSURANCE COMPANY 36940 BARTEL- ASSOCIATES, LLC INSURER C: $ 1,000,000 INSURER D: $ 10,000 411 BOREL AVENUE SUITE 101 INSURER E: SAN MATEO - CA 94402 -3525 INSURER F: 09/01/2014 COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE AODLS ASR R WVD POLICY NUMBER MMIDDY/YYYY MMOD� LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000000 X COMMERCIAL GENERAL LIABILITY DIAIMSMADE I OCCUR PREMISES Me oo -Ter. $ 1,000,000 MED EXP(My one person) $ 10,000 A 25CC12442980 09/01/2013 09/01/2014 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGO $ 2,000,000 X POLICY r PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ANYAUTO A ALL OWNED SCHEDULED 25CC12442980 09/0112013 09/01/2014 BODILY INJURY (Per accitlent) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CI-AIMS-MADE DED I I RETENTION$ $ WORKMSCOMPENSATION TORY OTH- A AND EMPLOYERS' LIABILITY OFFICER/MEMSER EXCLUDED ECUTIVE YIN (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below MIA 01 -WC- 14518380 09/0112013 09/01/2014 EL. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 B MISC. PROFESSIONAL LIABILITY MPPOO1715209 09/0112013 09/01/2014 $2.000,000 PER CLAIM $4,000,000 ANNUAL AGGREGATE DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Much ACORD 101, Additional R nuift Schedule, if more space u required) CERTIFICATE HOLDER IS HEREBY NAMED AN ADDITIONAL INSURED ON POLICY #25CC124429 -8 AS RESPECTS OPERATIONS OF THE NAMED INSURED ONLY. SEE ATTACHED FORMS CG8672. COVERAGE UNDER POLICY #25CC124429 -8 IS PRIMARY & NON - CONTRIBUTORY ABOVE ANY OTHER INSURANCE THE CERTIFICATE HOLDER(S) MAY CARRY. 30 DAY NOTICE OF CANCELLATION. COSTA MESA SANITATION DISTRICT (N l ATTN: ANNA SANCHEZ, ADMINISTRATIVE SERVICES MANAGER 628 WEST 19TH STREET 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 COSTA MESA CA 92627 ROBERT B. RICE, JR. 25 (2010/05) © 1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Bartel- Associates, LLC CG 86 72 10 02 POLICY NUMBER: 25CC124429 -8 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Oraanizatfon: COSTA MESA SANITATION DISTRICT Location and Description of Completed Operations: All operations of the Named Insured Additional Premium: Included (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) SECTION 11 — WHO IS AN INSURED is amended to include as an insured the person or organization shown in the Schedule, but only to the extent you are held liable due to myour work° at the location designated and described in the schedule of this endorsement for That insured and included in the 'product- completed operations hazard".