Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Insurance - Kaplan - 2014-02-14
SAP' Z—� CERTIFICATE OF LIABILITY INSURANCE 8054 DATE (MM/DD/YYYY7 2/13/2014 THIS CERTIFICATEIS 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 SUBROGATIONIS 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 endorsement(s). PRO BIN INSURANCE HOLDINGS LLC /PHS 505500 P: (866) 467 -8730 F: (888) 443 -6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: INCNo.Re): (866) 467 -8730 (Fac.Nep (888) 443 -6112 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL# INSURERA: Sentinel Ins Co LTD LIMITS INSURED FRANCENE KAPLAN DBA KAPLAN CONSULTING PO BOX 10263 COSTA MESA CA 92627 INSURERS: COMMERCIAL GENERAL LIABILITY INSURER C: INSURERD: INSURERE: EACH OCCURRENCE INS,IRERE 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. INSR TYPE OF INSURANCE ADDL INSR SUBR OLD, POLICYNUMBER POLICYEXP LIMITS COSTA MESA, COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1, 000, 000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES fee occurrence) $1 000 OOO / / X x MED EXP (My one Person) $10, 000 A General Liab 46 SBM BP1549 r02/08/2014 02/08/2015 PERSONAL &ADV INJURY $1, 000, 000 AGGREGATE LIM IT APPLIES PER GEN'L GENERALAGGREGATE 52, 000, 000 POLICY JET � LOC PRODUCTS- COMPIOP AGO 52, 000, 000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (EaacudenU $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Peraccidenp $ HIRED AUTO NON -OWNED AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE OE RETENTION$ $ WORMERS COMPENSATION gNDEMPGOYERS'GIA82RY PER OTH- STANTE ER E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Manda rryln NH) ❑ NIA E. L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Certificate Holder is an Additional Insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Costa Mesa Sanitary District Y ` y BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRESENTATIVE ` Attn: Anna Sanchez \ \ 628 W 19TH ST COSTA MESA, CA 926274 © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ti 0. 0 00 00 o. M N ti 0 0 0 0 0 0 N ti 0 o. N 0 0 • 0 Insurance,. POLICY NUMBER: A2513988 A Lt My Alatuai Ct pany SAFECO INSURANCE COMPANY OF AMERICA AUTOMOBILE POLICY DECLARATIONS (CONTINUED) NAMED INSURED: MARK SODEN FRANCENE KAPLAN PO BOX 10263 COSTA MESA CA 92627 -0106 AGENT: CONSOLIDATED OC INS AGENCIES 101 PACIFICA STE 255 IRVINE CA 92618 -4692 RENEWAL POLICY PERIOD FROM: SEPT 26 2013 TO: SEPT 26 2014 at 12:01 A.M. standard time at the address of the insured as stated herein. AGENT TELEPHONE: 1 -866- 472 -3326 RATED DRIVERS MARK SODEN, FRANCENE KAPLAN Each Person 2010 HONDA 2001 FORD INSIGHT EX F150 4 4 DOOR DOOR PICK -UP ID# JHMZE2H72AS015464 ID# 1FTRX18L91NB45694 Insurance is afforded only for the coverages for Which limits of liability or Premium charges are indicated. LIABILITY: BODILY INJURY $500,000 Each Person $500,000 PROPERTY DAMAGE Each Occurrence $100,000 Each Occurrence MEDICAL PAYMENTS $2,000 UNINSURED AND UNDERINSURED MOTORISTS: BODILY INJURY $500,000 Each Person $500,000 Each Accident COMPREHENSIVE Actual Cash Value Less $250 Deductible COLLISION Actual Cash Value Less $1000 Deductible WAIVER OF COLLISION DEDUCTIBLE ADDITIONAL COVERAGES: ANTI FRAUD FEE 1.80 TOTAL $ 543.80 $ 155.90 $500,000 $ 237.00 Each Person $500,000 Each Occurrence 104.90 $100,000 145.50 Each Occurrence 14.30 $2,000 18.70 82.50 $500,000 90.50 Each Person $500,000 Each Accident 34.40 Actual Cash Value Less $250 Deductible .31.50 138.90 Actual Cash Value 140.60 Less $1000 Deductible 11.10 11.30 1.80 TOTAL $ 676.90 POLICY NUMBER: 46 SBM BP1544 THIS ENDORSEMENT CHANGES THE POLICN, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON- ORGANIZATION COSTA MESA SANITARY DISTRICT 628 W 19TH STREET ° COSTA MESA CA 92627 0 .i a w �o a ry O O ri t Form IH 12 001185 T SEG. NO. 0 01 Process Date: ,11/26/13 Printed in U.S.A. Page 001 INSURED COPY Expiration Date: 02/08/15