Insurance-Interface Security Systems Holdings Inc. The Greater Alarm Company IncOP ID: DC
"" CERTIFICATE OF LIABILITY INSUi%ANCE
F bATE(MMIDOnYYYI
09127!12
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
B21-OW. - THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
,PORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(las) must be endorsed. If SUBROGATION IS WAIVED, subject to
the tones and conditions of the pglipy,+-_e q(irles, mtly require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such ondorseme V t U
PRODUCER 636. 537 -5000
Charles L. Crane AgCyy-W- County OCT 009
406 Chesterfield CtrSuile 320 2 3 Z012 636 - 5375
ChesterfiDid, MO 63017
Butch James GU01A 1110A AWRY 0QRI9I
NAMEA r
PRONE
No' E A/C No:
4MA
ADDRESS'
C , 14$YOMER l0 n: INTER06
INSURER (% AFFORDING COVERAGE
NAIL A
INSURED Interface Security Systems
Holdings Inc., The Greater
Alarm Co., Inc, dba Interface
Systems
INSURERA: Everest Indemnity Company
126921
INSURER a: Liberty Mutual Fire Ins Cc
23035
INSURER C: Everest National Ins Co 10120
INSURER 0: I
3750 Schaufele Ave„ #1251200
_
INSURER E:
S 1,000,00
Long Beach, CA 90608
INSURER F
Errors & Omission
COVERAGES CERTIFICATE NUMBER: REVISION NLIMBFR•
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 DR 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
POLICY NUMBER
MMA)O
LIMITS
GENERAL
A � X
LIA6ILITY
COMMERCIAL GENERI�AyL LIweILnY
CLAIMS -MADE EI OCCUR
X
SIGLOO2100
10/01112
10/01113
EACH OCCURRENCE
S 1,000,00
P Ml &ES_(EtLacwrrenrs 15 60,00
MED EXP (My pea p0nae) 6 5,00
X
Errors & Omission
PERSONAL A AOV INJURY
S 1,000,00
GENERAL A00RECATE
$ B,DDO,DO
GEN'L AGGREGATE PER
PRODUCTS - COMPrOP AGG
S 2,000,00
EAPPLIES
X POLICY PRO. LOC
S
AUTOMOBILE
B X
LIABILITY
ANY AUTO
�AS27-91460038012
10/01112
10101/13
COMOWEO SINGLE LIMIT
Me ecddeml
S 1,000,00
BODILY INJURY (Per ppr:ml
E
AL OVuN
L OWNED AUTOS
BODILY INJURY (Per eccltleM)
4 �
l
�IXHIRED
X
LL
ED AUTOS
AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Pe 9.1dent)
S
S
I
4
X
UMBRELLA LIAR
X OCCUR
EACROCCURRENCE
4 51000,00
AGGREGATE
$ 6,000,OD
A
EXCESS LIAR
CLAIMS -MADE
51CC000674
10101112
10101113
DEDUCTIBLE
$
$
X
RETENTION S 10000
C
WORKER9COMPEN9ATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER,EXECUTIVE YIN
OFFICERM0ARER EXCLUDED? O
(M.hdAlw, In NHI
NfA
5300000006
10fl
101D1113
X WC STATU- OTH-
LOftY_LIMLT•S- I...ER_
___
E.L. EACH ACCIDENT
8 1,000,00
E.L. b10EASE- EAEMPLOYEE
$ 1,DOO,)0
,(yyes, describe uW
DESCRIPTION OF OPERATIONS balmy
E. L. DISEASE - POLICY LIMIT
$ 1,000,00
I
i
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES lAeaeh ACORD 101, AOLlemal Remark, Schedule, II more eyece le mQuIred)
soo attachod
CERTIFICATE HOLDER CANCELLATION
COSTAME
SHOULD ANY OF THE ABOVE DESCRIBED POLIGIES BE CANCELLED BEFORE
Costa Mesa Sanitary District ,.(
o
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
628 W. 19th St. \�
IIU
Costa Mesa, CA 92627 -2716 r�
\� o
AUTHORIZED REPRESENTATIVE
W Urrat f-t-C GO
ACORD 26 (2009109)
01988 -2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
OCT -23 -2012 14:33 99% P.01
Lnterface Security Systems LLC COMMERCIAL GENERAL LIABILITY
Policy #51GL002100,
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS (FORM D)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIRE &FY COVERAGE PART.
SCHEDULE
Name of person or Organization: .
Costa_ Mesa Sanitary District and its officers, agents, and employees are
additional insureds on. general liability as required by written contract.
Re: work performed by named insured
Of no entry apppears above, information required to eomplet� this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO is AN INSURED (Section 11) is amended to Include as an insured the person or organization shown in the
'schedule, but oNy with respect to liability arising out of "your work" for that Insured by or for you.
CG 20 10 11'85 Copyright insurance Services Office, Inc., 19e4
6CT -23 -2812 14 33 99% P.02