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Insurance - Professional - Occupational Safety Training Systems - 2015-10-15ACiORO® CERTIFICATE OF LIABILITY INSURANCE `� DATE (MMIDD YYYV) 10/15/2015 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 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(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 does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 657-667-0225 657-667-0227 Professional Insurance Associates Inc. Pacific Lighthouse Insurance Agency (V2) PO Bax 1266 San Carlos CA 94070 NAME:�T Erica Hernandez FAX Na: 657-667-0227 Flc° Nq : 657-667-0225 n DESS: Erica@Pacificlighthouseins.com INSURERS AFFORDING COVERAGE NAICN INSURERA: Liberty Mutual Insurance 23043 INSURED (677) 404-6787 Occupational Safety and Training Systems, Inc. Karmik Enterprises, LLC 14650 Central Ave ChinoCA 91710 INSURER B: AmTrust North America 15954 INSURERC: Continental Casualty Company 20443 INSURER D: INSURER E : INSURER F: 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. (NSR LTR TYPE OF INSURANCE ADDLSUSR POLICYNUMBER MM/LODYIYYYY MMIDDYIY EXP YYY LIMITS GENERAL LIABILITY ✓ EACH OCCURRENCE $1,000,000 A COMMERCIAL GENERAL LIABILITY HENItU PREMISES Ea..unence ;500,000 CLAIMS -MADE Z OCCUR BKS (16) 55 90 32 65 04/17/2015 04/17/2016 MED EXP (Any one person) $5,000 PERSONAL &ADV INJURY $1000000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGO $2000000 $ POLICY FV JECT PRC- LOC AUTOMOBILE LIABILITY EO a BIN CED OMIT a_1,000,000 BODILY INJURY (Per person) $ ANY AUTO BAO (16) 55 90 32 65 04/17/2015 04/17/2016 BODILY INJURY (Per accident) $ A ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS PROPERTY DAMAGE $ Per accident $ UMBRELLA UAB OCCUR 04/17/2015 04/17/2016 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE USA (16) 55 90 32 65 DED %/ I RETENTION$ 10,000 prod -Com /O agg $ 2,000,000 1 B WORKERS COMPENSATIONOTH- AND EMPLOYERS' LIABILITYYIN OANY FFICER/MEMBERIEXCLUEE ,ECUTIVE (Mandatory in NH) MIA YI S•WC1069262 04/17/2015 04/17/2016 • T ER L.L. EACH ACCIDENT $1,000,000 E . DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 (DESCRIPTION OF OPERATIONS below C Professional Liability 596607630 08/31/2015 08/31/2016 $1,000,000 limit/aggregate Claims Made: Retro Date: 08/31/2005 $10,000 deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AKach ACORD 101, AEEklonal Remarks Schedule, U more space Is mqulm0) The Costa Mesa Sanitary District, a sanitary district, its directors, officials, officers, employees, agents, and volunteers are named as additional insured with respects to the policy terms and conditions of the Commercial General Liability policy. Coverage is primary and non-contributory. Waiver of Subrogation in favor of the Costa Mesa Sanitary District, a sanitary district, its directors, officials, officers, employees, agents, and volunteers applies to the workers compensation insurance policy. CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District, a sans ary Is rlc 628 W. 19th Street Costa Mesa, C,A1r SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. )92627 Q AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD