Loading...
Insurance - Charles King Co. Inc. - 2014-05-30RECEIVED CHAKIN -001 LODE d►cd!!k °201t" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIYYYY) 5/3012014 T D 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 policylies) 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 endorsement(s). PRODUCER (888) 825 -4322 Bowermaster & Associates P.O. Box 6026 10805 Holder Street - Suite 350 Cypress, CA 90630 NAME: Denise Lopez PHONE FAX WC. No. :714- 733 -6200 219 ac No): 714- 252 -8253 E MA ADDRESS: dlopez@bowermaster.com INSURERIS) AFFORDING COVERAGE NAIC # INSURER A : Valley Forge Insurance Company X INSURED Charles King Company, Inc. 2841 Gardena Avenue Signal Hill, CA 90755 INSURER B: Continental Casualty Co. 3/30/2014 INSURER C: Torus National Insurance Company EACH OCCURRENCE INSURERD:AIG Specialty Insurance Company DAMA E PREMISES Ea occurrence INSURER E, MED EXP (Any one person) INSURER F: PERSONAL B ADV INJURY 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 LTR TYPE OF INSURANCE A DL N BR MD POLICYNUMBER POLICY EFF MMIDDNYYV POLICY EXP MMIDDIVVVV LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 191 OCCUR X Deductible'. $5,000 X 4034952911 3/30/2014 313012015 EACH OCCURRENCE S 1,000,00 DAMA E PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 X PropertyDamage /Subsidence GENERAL AGGREGATE $ 2,000,00 GENT, AGGREGATE LIMIT APPLIES PER POLICY X PRO LOG ECT PRODUCTS - COMP /OP AGG $ 2,000,00 $ B AUTOMOBILE LIABILITY JX AN Y AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIREDAUTOS X NON -OWNED AUTOS 5091114974 3/3012014 3/3012015 COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 5091114988 3/30/2014 3130/2015 EACH OCCURRENCE $ 10,000,00 AGGREGATE $ 10,000,000 DED I X I RETENTION$ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNERIEXECUTIVEY OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA T10140030 6/212014 6/2/2015 X I WC STATU- I OTH- TORY LIMITS ER EL EACH ACCIDENT $ 1,000,00 E. L. DISEASE - EA EMPLOYEE $ 1,000,000 IE.L. DISEASE - POLICY LIMIT $ 1,000,000 D Pollution Liability CPL3850939 3/30/2014 313012015 iDed: $10,000 $5,000,000 Agg i DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Costa Mesa Sanitary District is an Additional Insured with respects to General Liability per attached endorsement form G140331 D. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary ��I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN rY District 1/j 628 W. 19th Street ACCORDANCE WITH THE POLICY PROVISIONS. /y'x' .v Costa Mesa, CA 92627 - �� /VI AUTHORIZED REPRESENTATIVE C � V 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD The enclosed Certificate issued to your company is for the renewal of COMMERCIAL WORKERS COMPENSATION ONLY. The Certificates and Endorsements that you received reflecting the Liability coverages with effective dates of 3130/14 — 3/30/15 for Charles King Company, Inc., are still active and valid. For questions concerning the enclosed document, please contact: Denise J. Lopez, CISR Account Manager Bowermaster & Associates (714) 733 -6219 Direct Line dlopez _bowermaster.com THANK YOU.