Insurance Professional Liability-RBH-2014-09-18R03I13HA -01 LEEELI
1A4C4r:>REY CERTIFICATE OF LIABILITY INSURANCE
�snsnoDia
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HQLQER. Thl$
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 EETWEEN TnE Isau,ne rnaurtere(el, AMTYloroter
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, me pollcy(les) 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 time not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER License # 0664249
,Heffernan 8 Insurance en e Brokers
Menlo Park, CA 94026
CONTACT
NAME:
PHONE .1 660 642.5200 'F=AX, .,:1 (960) 842 -5201
EMAIL'
ADDRESS:
INSURERSAFFORDIND COVERAGE
NAIC0
LIMITS
INWRERA: Travelers Property Casualty Company of America
26674
COMMERCIALGENERALLIABILITY
INSURED
INSURERS; Hanover American Insurance Company
36064
INSURER D:Atlantic Specialty Insurance Company
27154
Robin B. Hamers & ASSOCIataa,
INSURER 0:
234 E. 17th Street, Suite 205
Costa Mesa, CA 92627
INSURER E:
INSURER F:
0810112014
06I0112015
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 RESPECTTO 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
U
POLICY NUMBER
M�$tILICY EFF
POLICY EXP
LIMITS
A
X
COMMERCIALGENERALLIABILITY
EACH OCCURRENCE
$ 1,000,00
CLAIMS MADE T OCCUR
X
080829INS02
0810112014
06I0112015
PREMISES EaO Tnncu)
$ 1,000,0()
MEDEXP(An one Perron)
$ 10,00
_
PERSONAL B ADV INJURY
$ 1,000,00
GEN'L AGGREGATE LI MIT APPLIES PER:
GENERALAGGREGATE
S 2,000,00
POLICY JEOT F7 LOC
PRODUCTS- COMP/OP AGG
$ 2,000,00
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ee a.den
$ 1,000,00
BODILY INJURY(Perperedn)
$
A
ANYAUTO
80829IN502
09/01/2014
0610U2015
ALL CANED SCHEDULED
X AUTOS X NONCOWNED
HIHED AUi05 AUTOS
BOOILV INJURY (ParacGtlent)
4
PROPERTYDAMAGE
Paraddtle
S
S
UMBRELLA LI
OCCUR
EACHOCCARRENCE
$
AGGREGATE
5
EXCESS LIAR
CJAIMS�MADE
CEO
I I RETENTIONS
S
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOWPARTNERI ECUTIVE YIN
OFFICERNEMBER EXCLUDED]
(Myy>1nEMOry In III
NIA
WZF901252903
03/23/2014
0312312015
X P TH.
STATUTE ER
E.L. EACH ACCIDENT
4 1,000,00
E.L. DISEASE - EA EMPLOYE
S 1,000,00
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMr
S 1,000,00
C
Professional Llab.
DPL362614
0712712014
0712712016
Per Claim 1,000,00
C
Professional Llab.
DPL362614
07/2712014
0712712015
Aggregate 1,000,00
DESCRIPTION OFOPERATIONSILOCATIONS /VEHICLES (ACORD 101, AddlEddtl RAmuSA SeMdWe, may M Reached IF mom Apo. Is nNtulmd)
Re: As Per Contractor Agreement on File with Insured.
Costa Mesa Sanitary District is named as additional insured on the General Liability policy, if required by written contract per the attached endorsement.
Costa Mesa Sanitary District
628 W. 19th Street JyV
Costa Mesa, CA 92627
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
/W/ - "
L91U38- 2014AUOKUU1UKYUKAIIVN. AlingnteresemeO.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD