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Insurance - Kilbride - 2013-10-304coR° CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYVI 1 0/3 012 01 3 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()es) 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 endomement(s). PRODUCER Phone: (760) 8373626 Fax: (760) 837 -3898 M. L. ADAMS INSURANCE SERVICES 42 -280 BEACON HILL, SUITE D -7 PALM DESERT CA 92211 -5168 CNAMEoNrAcT Linda : ac "N, (760) 837.3626 FAX Nnt. (760) 837 -3896 A DDa EA linda @mladamsins.com PRODUCER CUSTOMER ID: 3128 INSURERS) AFFORDING COVERAGE NAIC M RE C E I VAVwU: 0608232 INSURED q 7 MIKE KILBRIDE, LTD. NOV 0 / 203 P.O. BOX 3341 INSURER Gemini Insurance Co VOGPOO1126 INSURER : State Compensation Insurance Fund $ 58,000 MED. EXP (Any one person) $ 5,000 NEWPORT BEACH CA 92659 COSTA MESA SANITARY DISTRICT INSURERC GENERAL AGGREGATE $ 2,000,000 INSURER O: PRODUCTS - COMPIOP AGG INSURERE $ INSURER F AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CERTIFICATE NUMBER! 1444:5 REVISION NUMBER; COVERAGES 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 P ITS SHOWN M Ry PAin r.1 AIMR INSR LTR TYPE OF INSURANCE ADD'L INSR SUER MD POLICY NUMBER POUCYEFF 0 10130113 POLICY EXP MMIDUIYYYY 10130 /14 LIMITS EACH OCCURRENCE $ 1,008,000 A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE /e OCCUR VOGPOO1126 DAMAGE TO RENTED PREMISES tEa occurenw) $ 58,000 MED. EXP (Any one person) $ 5,000 PERSONALS ADV INJURY $ 1,000,009 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOC PRODUCTS - COMPIOP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Par accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $. DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATOR AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVE OFFICER/MEMSER EXCLUDED? _ (Mandatory in NH) Nye, descdee under DESCRIPTION OF OPERATIONS Nelvx NIA 9073044 -13 10/01113 10/01114 X "'csrnm- oTU TORY LIMITS $ 1,900,00E E.L. EACH ACCIDENT $ 1,009,000 E.L. DISEASE -EA EMPLOYEE $ N/A E.L. DISEASE - POLICY LIMIT $ N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) TEN DAY NOTICE OF CANCELLATION WILL BE GIVEN FOR NON PAYMENT OF PREMIUM. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED PER FORM CG 20 10 10 01 ATTACHED. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. COSTA MESA SANITATION DISTRICT AN ITS OFFICERS, AGENTS AND EMPLOYEES h AUTHORIZED REPRESENTATIVE 628 W. 19TH STREET ,,�'T COSTA MESA CA 92627.2718 Attention: `l C y •/� \\ "p / gdy4 j — CORD 25 (2009109) ©1988 - d. 2009 ACORD CORPORATION. All rights reserve Th. ArnRn name and Innn are registered marks of ACORD Policy Number: VOGP001125 Insured Name:MIKE KILBRIDE LTD CG 201010 01 $ffeetive Date: 10 -30 -2013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ. IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS- SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person Or Organization: PER CERTIFICATE ATTACHED: AS REQUIRED BY WRITTEN CONTRACT; COMMERCIALPROJEC,1S ONLY, INCLUDING APARTMENTS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement:) A. Section 11— Who is An Insured is amended to include as air ins tued the person or organization shown in the Schedule, but only with respect to liability arising out of your-ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily injury" or "property damage" occurring after; (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage. arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 2010 10 01 Page I of I