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Insurance- Technology Resource Center - 2012-03-20JRECE1VED A'W °MAR 22 9DERTIFICATE OF LIABILITY INSURANCE FDA TE (MM DDIVYYY) THIS INFORMATION RIGHTS CERTIFICATE I VE Y C E CERTIFI YOR NEGATIVELY AMEND, OR ALTER THE COVERAGE AFFORDED BY THE POLIC ES IELOW. 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 endomement(s). PRODUCER Garrett/Mosier /Griffith /Sistrunk Ins. Services 12 Truman Irvine, CA 92620 CONTACT NAME: PHONE AIC No: A GENERAL LIABILITY E -MAIL ADDRESS: INSURER (S) AFFORDING COVERAGE NAIC 0 3120/2012 INSURER A: Scottsdale EACH OCCURRENCE www.garrett- mosier.com OB84519 INSURED Technology Resource Center, Inc. 601 N. Parkcenter Drive, Suite 209 INSURER B: Golden Eagle Insurance Corporation INSURER C: Insurance Company Qf The D!mf INSURER D: Santa Ana CA 92705 INSURER E: MED EKE (My one person) $ Excluded INSURER F: CLAIMS -MADE LV] OCCUR CnVFRArFB CERTIFICATE NUMBER: 19RB1R49 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 TR rypE OF INSURANCE ADDLSU9R INSR Mn POLICY NUMBER MM/DOV� MD 5 //YYYY LIMITS A GENERAL LIABILITY BCS0027221 3120/2012 3/20/2013 EACH OCCURRENCE $ 1,000,000 PREMISETO a RENTED $ 100,000 4/ COMMERCIAL GENERAL LIABILITY MED EKE (My one person) $ Excluded CLAIMS -MADE LV] OCCUR PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2.000,000 $ POLICY F PE RO- LOO AUTOMOBILE LIABILITY BA8831788 3/2012012 3/20/2013 Ee adentSINGLE LIMIT $ 1,000,00 BODILY INJURY (Per person) $ ANV AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS ✓ AUTOS Physical Damage $1,000 Comp Ded. $1,000 Coll Ded . PeOaca Z)AMAGE $ $ a UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEO Li RETENTION$ $ $ G WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANV PROPRIETORJPARTNEWEXECUTIVE 71 WSD500697800 10/1/2011 1011/2012 1 ORVUMITS DJ E.L. EACH ACCIDENT $ 1000000 OFFICEWMEMBER EXCLUDED'/ (Mandatory In NH) N/A E.L. DISEASE - EA EMPLOYEE $ 1,000.00 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N mom apace Is required) All operations of the named insured subject to the terms and conditions of the policies. As respects General Liability coverage, Costa Mesa Sanitary District , its officers, agents, officials, employees and volunteers are added as Additional Insured per CG20330704 attached. - CERTIFICATE HOLDER CANCELLATION All Operations SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District \� 628 W. 19th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa CA 92627 a AUTHORIZED REPRESENTATIVE _. Griff Griffith ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD CENT NO.: 12631842 Charise Ebecha[d 3/20/2012 1:09:14 PM Page 1 of 2 Technology Resource Center, Inc. Policy No. BCS0027221 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or or- ganization for whom you are performing opera- tions when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with re- spect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. A person's or organization's status as an addi- tional insured under this endorsement ends when your operations for that additional insured are completed. CG 20 33 07 04 B. With respect to the insurance afforded to these additional insureds, the following additional exciu- sions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the ren- dering of, or the failure to render, any profes- sional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sured(s) at the location of the covered operations has been completed; or b. 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 subcon- tractor engaged in performing operations for a principal as a part of the same project. © ISO Properties, Inc., 2004 CERT NO.: 12631842 Chaziae Ebezhaid 3/20/2012 1:09:14 PM Page 2 of 2 Page 1 of 1 ❑ GarrettlMosier /Griffith /Sistrunk Ins. 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 Sender: Charise Eberhard Phone: (949)559 -6700 Subject: ACORD 25 (05/10) Certificate of Liability: Technology Resource Center, Inc. Date: 3/20/2012 No. of Pages: 3 UPI.: www.garrett- mosier.com The attached or linked document(s) contain certification of insurance coverage for the insured named in the subject above. Your company is listed as the organization requesting receipt of these documents. 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, Inc. at (949)559 -6700. 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 UNDERAPPLICABLE LAW. IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT, OR THE EMPLOYEE GRADIENT 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 ecertsonlme— Insurance Visions, Inc. All rights reserved.