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Insurance - Technology Resource Center - 2012-09-25_P4�:rFivFFI A`ORib a CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) THIS CER({, A ISWEDj(A�SS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CELOU�INT BI�IIL%IMLR�S INSURANCE DOES NEGATIVELY THE THE AFFORDED BY CONSTITUTE A ALTER THE COVERAGE AUTHORIZED .(EPRESENTATIVE 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 endomement(s). PRODUCER Garrett/Mosier /Griffith /Sistrunk Risk Management & Insurance Services 12 Truman Irvine, CA 92620 wwW.gmgs.com OB84519 CONTACT NAME: PHONE INC. No: E-MAIL ADDRESS, INSURERS AFFORDING COVERAGE NAIC If INSURER A: Insure ce Company of the West 2ZB47 INSURED Technology Resource Center, Inc. 601 N. Par center Drive, Suite 209 Santa Ana CA 92705 INSURER B: INSURER C: EACH OCCURRENCE INSURER D: PREMISES Ee occurrence INSURER E: MED EXP(my one person) INSURER F: PERSONAL &ADV INJURY COVERAGES CERTIFICATE NUMBER: 14181477 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. IN$R LTR TYPE OF INSURANCE ADOL INSR SUER 25a POLICY NUMBER MWDDYIV/YY MWDDNYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 71OCCUR EACH OCCURRENCE $ PREMISES Ee occurrence $ MED EXP(my one person) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP /OP AGO $ $ AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Pat Person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE Paracclid $ $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ Is A WORKERS COMPENSATION BILITY AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOWPARTNER/EXECUTIVE D OFFICERIMEMBER EXCLUOED9 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WSD500697801 10/1/2012 10/1/2013 WCSTATU- o - TORY LIMITS E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1000000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) All operations of the named insured subject to the terms and conditions of the policies. CERTIFICATE HOLDER CANCELLATION All Operations Costa Mesa Sanitary District I q 1� 628 W. 19th Street V V Costa Mesa CA 92627 04�, e 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 Griff Griffith ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CERT NO.'. 191e19]7 Charice Eberhard 9/25/2012 2:35:39 PM Page 1 of 1 Garrett/Mosier /G riffth /Sistrunk Risk Management & Insurance Services 12 Truman Irvine, CA 92620 Costa Mesa Sanitary District 628 W. 19th Street Costa Mesa CA 92627 MAIL DOCUMENT Certificate of Insurance Delivery by ecertsonline TM Sender: Charise Eberhard Phone: (949)559 -6700 Subject: ACORD 25 05/10) Certificate of Liability: Technology esource Center, Inc. Date: 9/25/2012 No. of Pages: 2 URL: www.gmgs.com The attached or linked document(s) contain certification of insurance coverage for the insured named in the sub act above. Your company is listed as the organization requesting receipt of these document If this document is sent via e-mail, you must click on the link below. This document is in a pdf format, and you must have Adobe Acrobat Reader installed on your system. To download the Adobe Reader for free, visit www.Adobe.com. If you have any questions regarding the attached, please contact Garrett Mosier Insurance Services, 1-111 ,_ Thank you and have a great day! THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPUCABLE LAW. IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT, OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US IMMEDIATELY BY TELEPHONE, AND RETURN HE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE. 0 2002 Certificate of Insurance Delivered by ecertsonlmeT Insurance Visions, Inc. All rights reserved. CE�VED WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLE WC 04 00 01 A DEC 0 7 2012 (Ed. 7-98) INFORMATION PAGE GUJIAIYItJNJNVII Y _ Security National Insurance Company Policy No. SWC1012910 Insurer ID No(s). Prior Policy No. SWC1005787 1, Named Insured: TOM MOFFETT PLUMBING (a corp) F—] Individual LLC Mailing Address: FT] Corporation LLP P.O. BOX 5413 Partnership F—] Other: ORANGE CA 92863 FEIN: 721559307 Intra /Interstate Risk ID No. Other workplaces not shown above: See Extension of Information Page 2. The policy period is from 1012912012 to 10/29/2013 12:01 A.M. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: California B. Employers Liability Insurance: Part Two of the policy applies to work in each stated listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 1,000, 000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1,000,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states except ND, OH, WA, WY and State(s) Designated in Item 3A. D. This policy includes these endorsements and schedules: See Extension of Information Page 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. See Extension of Information Page Total Estimated Annual Premium $ 19,873 Minimum Premium $ 500 eposit Premium $ 2,835 Premium Adjustment Period: Annual Countersigned by: Producer Information: BUILDERS & TRADESMEN'S INSURANCE SERVICES, INC., 6610 COL E BLVD, ROCKLIN CA 95677 -0000 Servicing /Issuing Office: Cleveland Date: 9/4/2012 ?,a& /0