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Insurance - GEO-ETKA 2016-12-22GEO-INC-01 RMORE CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYV') 12/22/2016 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(ies) must have ADDITIONAL INSURED provisions or 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 License # 0795135 CONTACT Armstrong/Robitaille/Riegle Business and Insurance Solutions PHONE FAX can e..se.,.,R mnaevnn .(AIC, No, _Ert):(714 ) 221-3900 (AIC, No):(714) 221-2277_ INSURED GEO-ETKA, Inc P.O. Box 6670 Orange, CA 92863 INSURERS) AFFORDING COVERAGE NAIC A A:SentinelInsurance Company, Ltd 11000 B: Hartford Accident and Indemnity Insurance Company 22357 COVERAGES rFRTIFIreTF NHMRFR- 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 CONTRACTOR 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 AODL SUER POLICY EFF POLICY EXP TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDO ADD(YYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR 72SBALIWO690 11/06/2016' 11/Ofi/2017 X EACH OCCURRENCE DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 $ 1,000,000 MED EXP (Any one person) 10,000 $ PERSONAL S ADV INJURY $ 1'000'000 GENT AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S 2'000'000 PRODUCTS - COMP/OP AGO $ 2,000'000 POLICY JUCQT LOC $ OTHER' B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO 72UECKB2507 11/06/2016 11/0612017 BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS _BODILY INJURY jeer accident) $ X AUTOS ONLY X AUTOS ONLY (�PPROPERTYrrcetDAMAGE $ - - — S A X UMBRELLA LIAB X OCCUREACH OCCURRENCE $ 2'000'000 EXCESS LIAB (CLAIMS -MADE( 72SBAUW0690 11106/2016 11/06/2017 AGGREGATE $ 2,000,000 DED X RETENTION$ 70,0001 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER ERH- AAgN�Y PROPRIETOR/PARTNER/E%ECUTIVE (Man cRR2ENH)EARTNEI E NIA EL EACH ACCIDENT E L. DISEASE - EA EMPLOYEE S S If yes, describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT S DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached HE more space is required) Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees are named additional insured per the attached forms as required by written contract. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa SanitaryDistrict THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 290 Paularino Ave. __X7 ,ala a, U Costa Mesa, CA 92626 'TI✓Tl✓h / AUTHORIZED RREPRESENTATIVES !M ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Geo-Etka Inc. PoI# 72BAUW0690 (6) When You Are Added As An Additional Insured To Other Insurance That is other insurance available to you covering liability for damages arising out of the premises or operations, or products and completed operations, for which you have been added as an additional insured by that insurance; or (7) When You Add Others As An Additional Insured To This Insurance That is other insurance available to an additional insured. However, the following provisions apply to other insurance available to any person or organization who is an additional insured under this Coverage Part: (a) Primary Insurance When Required By Contract This insurance is primary if you have agreed in a written contract, written agreement or permit that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in c. below. (b) Primary And Non -Contributory To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement or permit that this insurance is primary and non-contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured. When this insurance is excess, we will have no duty under this Coverage Part to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. BUSINESS LIABILITY COVERAGE FORM When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self- insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method Of Sharing If all the other insurance permits contribution by equal shares, we will follow this method also. Under this approach, each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 8. Transfer Of Rights Of Recovery Against Others To Us a. Transfer Of Rights Of Recovery If the insured has rights to recover all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. This condition does not apply to Medical Expenses Coverage. b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. Form SS 00 08 04 06 Page 17 of 24 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: Policy Number: 72 SBA UW0690 SC Named Insured and Mailing Address; GEO-ETKA, INC. SEE FORM SS1235 1801 E HEIM AVE STE 202 ORANGE CA 92865 Policy Change Effective Date: 12/21/16 Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: 001 Agent Name: ARMSTRONG/ROBITAILLE/RIEGLE Code: 186301 POLICY CHANGES: SENTINEL INSURANCE COMPANY, LIMITED ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT.IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL. RETURN PREMIUM DUE AT POLICY CHANGE EFFECTIVE DATE: $2.00 RATES AND PREMIUMS ARE CHANGED. BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED ADDITIONAL INSUREDS) ARE ADDED THE FOLLOWING ARE ADDITIONAL INSURED FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY. LOCATION 001 BUILDING 001 ST/POL SUBDIVISION: SEE FORM IH 12 00 PRO RATA FACTOR: 0.877 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN Form SS 12 11 04 05 T Page 001 (CONTINUED ON NEXT PAGE) Process Date: 12/21/16 Policy Effective Date: 11/06/16 Policy Expiration Date: 11/06/17 POLICY CHANGE (Continued) Policy Number: 72 SBA UW0690 Policy Change Number: 001 FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: IH12001185 ADDITIONAL INSURED - STATE/POLITICAL SUBDIVISION Form SS 1211 04 05 T Page 002 Process Date: 12/21/16 Policy Effective Date: 11/06/16 Policy Expiration Date: 11/06/17 POLICY NUMBER: 72 SBA Uw0690 Fl THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE/POLITICAL SUBDIVISION COSTA MESA SANITARY DISTRICT, ITS ELECTED AND APPOINTED OFFICIALSS, AGENTS, OFFICERS, VOLUNTEERS AND EMPLOYEES 290 PAULARINO AVE COSTA MESA CA 92626 Form IH 12 0011 85 T SEQ. NO. 003 Printed in U.S.A. Page 001 Process Date: 12/21/16 Expiration Date: 11/06/17