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Insurance - Mike Kilbride, Ltd. - 2017-03-14 DATE p SDIVYYYYI ACORN• CERTIFICATE OF LIABILITY INSURANCE 03!1412017 THIS CERTIFICATE 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). vaooucER Phone: (760)8373826 Fax (760)8373898 CACT M.L.Adams Insurance Services M.L.ADAMS INSURANCE SERVICES N MO 42-280 BEACON HILL,SUITE D-7 ."r ._Exu: (760)837-3626 IFA (no)(760)8373898 -ram. www PALM DESERT CA 92211-5168 EADDRESS: •mladamsins.com INSURERS)AFFORDING COVERAGE NAIC d • Agency Liat:0609232 w£uRER A : Colony Insurance Co / 118o I : m MIKE KILBRIDE,LTD. INSURER a State Compensation Insurance Fund COAST WATER AND POWER INSURER C : Great American E 8,S Insurance Co / P.O.BOX 3341 INSURER 0: NEWPORT BEACH CA 92659 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 22747 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . *MR TYPE OF INSURANCE ADO. SUBR POIJCY NUMBER Pou¢Y err PDuCY EXP UNITS INSD _ IIa0DOIYYYYI . IMMDD YYYY1 A X COMMERCIAL GENERAL LIABILITY X X 103GL0015876-00 10!30116 10130!17 EACH OCCURRENCE S 1,000,000 • CLAIMS-MADE 1—)1( OCCUR DAMAGE TO RENTED $ 100,000 PREMISES(Ea ocarawe) MED.EXP(My one person) 3 5,000 PERSONAL a ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE HS 2,000,000 -J POLICY I- I JPERC LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: S AUTOMOBILE LWE.ITY COMBINED SINGLE MT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) S AU.OWNED SCHEDULED—AUTOS _ AUTOS BODILY INJURY(Pm accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ — — AUTOS (per ) - r C IAISRELLA um X OCCUR XS3306768-02 10/30/16 10/30/17 EACH OCCURRENCE $ 2,000,000 PRESS LIAO CLAIMS-MADE AGGREGATE $ 2,000,000 DED I RETENTION S $ g WORKERS eGIIPEigAlroa X 9087110-16 10/01/18 10/01/17 X UTE ER 1,000,000 AND E�iI.DY[aY LIABILITY Y I N ANY PROPRIETORIPARTNIDUEXECUTIVE E L EACH ACCIDENT $ 1,000,000 OFFICEIVISEMSER CLUOED7 NIA - EL.DISEASE-EA EMPLOYEE $ INCLUDED pumeaMy In NII) nySaab underE.L DISEASE-POLICY LIMIT S INCLUDED DESCRIPTION OF OPERATIONS below _ - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached B mon space Is required) RE:ALL OPERATIONS THE COSTA MESA SANITARY DISTRICT,IT'S ELECTED AND APPOINTED OFFICIALS,AGENTS,OFFICERS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSUREDS PER FORM CG 20 12 0413 ATTACHED. PRIMARY WORDING PER FORM CG 20 01 0413 ATTACHED. 30 DAYS NOTICE OF CANCELLATION PER FORM ATTACHED. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE COSTA MESA SANITARY DISTRICT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 290 PAULARINO AVENUE ,iVACCORDANCE WITH THE POLICY PROVISIONS. COSTA MESA,CA 92626 /jl 1 AUTHORIZED REPRESENTATIVE 3,0140.11-- Attention: /V/ I7 a...44/44/Z. 1: Michael L.(Mike)Adams ACORD 25(2014101) 01988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 103 OL 001587040 POLICY NUMBER:103 GL 0015876-00 COMMERCIAL GENERAL LIABILITY CO20120413 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDNISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABIUTY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: COSTA MESA SANTfARY DISTRICT.ITS ELECTED AND APPOINTED OFFICIALS AND r.aru(%%fl I c 290 PAULARINO AVE.COSTA MESA CA 92626 Intomnation required to complete this Sdnedide.if not shown above.will be shown in the Declarations. A. Section N—Who Is An Insured is amended to 2. This insurance does not apply to: indude as an additional insured any state or a. `Body injury'. "property damage" or governmental agency subdivisionshown in or s Schedule.subject 'Persona and adverti■iing intury�'arising out of operations performed for the federal following Provisions: government,state or municipaity;or 1. This insurance applies only with respect to b. "Sadly injury or "property damage" operations per formed by you or on your behalf Included within the "products-completed for which the state or governmental agency or operations hazard". subdivision or political subdivision hes issued permit or authorization. B. NAM respect b the insurance afforded to these However Section insureds. the fdlowing is added to section ql—Limits Of Insurance: a. The insurance afforded to such additional If coverage provided to the additional insured is insured only applies to the extent permitted required by a contractor agreement,the most we by low:and wil pay on behalf of the additional insured is the b. If coverage provided to the additional amount of insurance: inured is required by a contract or agreement,the Insurance afforded to such 1. Required by the contract or agreement;or additional insured will not be broader than 2. Available under the applicable Limits of that which you we required by the contract Insurance shown in the Declarations; or agreement to provide for such additional whichever is less. insured. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 2012 0413 0 Insurance Services Office,Inc.,2012 Page 1 of 1 103 GL 0015876-00 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 103 GL 0015876-00 4 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION - DESIGNATED PERSON(S) OR ORGANIZATION(S) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person(s) or Organization(s): COSTA MESA SANITARY DISTRICT The Person(s) or Organization(s) listed or described in the SCHEDULE above have requested that they receive written notice of cancellation when this policy is cancelled by us. It is agreed that should this policy be cancelled before the expiration date thereof, the issuing company will endeavor to mail 30 days written notice (10 days for non-payment of premium) to the additional insured. The notification of cancellation of the policy is solely for the purpose of informing the Person(s) or Organization(s) shown in the SCHEDULE the effective date of cancellation and does not grant, alter, or extend any rights or obligations under this policy. Our failure to provide such notification will not extend any policy cancellation date nor impact or negate any cancellation of the policy. Any provision of this endorsement that is in conflict with a statute or rule is hereby amended to conform to that statute or rule. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U900-0513 Includes copyrighted material of ISO Properties, Inc., Page 1 of 1 with its permission. Great American E & S Insurance Company - Company Profile - Best's Credit Rating Center Page 1 of 3 A.M. Best Rating Services Great American E & S Insurance Company u A.M.Best#:003837 NAIC#:37532 FEIN#:310954439 Mailing Address View Additional Address Information ptinelid 301 E.Fourth Street Cincinnati,OH 45202 A+. or United States Assigned to insurance companies that have,in our opinion,a superior ability to Web:www.greatamericaninsurance.com meet their ongoing insurance obligations. Phone:513-369-5000 Fax:513-369-3600 View additional news,reports and products for this company. Based on A.M.Bests analysis,058317-American Financial Group, Inc is the AMB Ultimate Parent and identifies the topmost entity of the corporate structure.View a list of operating insurance entities in this structure. Best's Credit Ratings 1 Financial Strength Rating View Definition Rating: A+(Superior) Affiliation Code: r(Reinsured) Financial Size Category: XV($2 Billion or greater) Outlook: Stable Action: Affirmed Effective Date: May 12,2016 Initial Rating Date: June 30, 1980 Long-Term Issuer Credit Rating View Definition Long-Term: Stable IIS aa- Outlook: Action: Affirmed Effective Date: May 12,2016 Initial Rating Date: June 17,2005 II u Denotes Under Review Best's Rating Bests Credit Rating Analyst Rating Issued by:A.M.Best Rating Services, Inc. Senior Financial Analyst:Gregory Dickerson Director:Jennifer Marshall,CPCU,ARM Disclosure Information FOF View A.M.Best's Rating Disclosure Form �ir A.M.Best Affirms Ratings of American Financial Group, Inc.and Most of Its Insurance Subsidiaries May 12,2016 Rating History A.M.Best has provided ratings&analysis on this company since 1980. http://www3.ambest.com/ratings/entities/CompanyProfile.aspx?ambnum=3 837&URatingl... 3/14/2017 List of Approved Surplus Line Insurers (LASLI) Page 3 of 7 Empire Indemnity Insurance Company (Oklahoma) 12/01/1995 Endurance American Specialty Insurance Company (Delaware) 02/23/1996 (Name changed from Traders & Pacific Insurance Company effective 06/08/2006) Energy Insurance Mutual Limited (Barbados) 12/17/1997 Evanston Insurance Company (Illinois) 08/11/1995 Everest Indemnity Insurance Company (Delaware) 08/14/1998 Executive Risk Specialty Insurance Company (Connecticut) 09/01/1995 Fair American Select Insurance Company (Delaware) 07/28/2014 Fireman's Fund Insurance Company of Ohio (Ohio) 05/19/1999 First Mercury Insurance Company (Delaware) 10/16/1997 (Domicile changed from Illinois to Delaware, effective 10/28/2015) First Specialty Insurance Corporation (Missouri) 09/01/1995 Gemini Insurance Company (Delaware) 02/23/1998 General Security Indemnity Company of Arizona (Arizona) 09/01/1995 (Name changed from Fulcrum Insurance Company effective 05/03/2002) General Star Indemnity Company (Delaware) 08/11/1995 (Domicile changed from Connecticut to Delaware, effective 12/31/2012) Gotham Insurance Company (New York) 08/04/1995 Great American E&S Insurance Company (Delaware) 06/30/1995 (Name changed from Agricultural Excess and Surplus Insurance Company, effective 07/27/2000) Great American Fidelity Insurance Company (Delaware) 09/01/1995 (Name changed from American Dynasty Surplus Lines Insurance Company, effective 06/27/2001) Great Lakes Insurance SE (Germany) 12/01/1995 (Domicile changed from UK to Germany and name changed from Great Lakes Reinsurance (UK) SE effective December 30, 2016 (Name changed from Great Lakes Reinsurance (UK) PLC (U.K.) effective 07/28/2015) GuideOne National Insurance Company (Iowa) 12/07/2015 Gulf Underwriters Insurance Company (Connecticut) 07/07/1995 (Domicile changed from Missouri to Connecticut, effective 10/01/2001) Back to Top H - L Insurer Date Approved Hallmark Specialty Insurance Company (Oklahoma) 07/01/2011 Health Care Indemnity, Inc. (Colorado) 03/21/2001 Homeland Insurance Company of New York (New York) 09/24/2003 Houston Casualty Company (Texas) 09/01/1995 http://www.insurance.ca.gov/01-consumers/120-company/07-lasli/lasli.cfm 3/14/2017 Colony Insurance Company - Company Profile - Best's Credit Rating Center Page 1 of 3 A.M. Best Rating Services Colony Insurance Company u A.M.Best#:003283 NAIC#:39993 FEIN#:541423096 Mailing Address View Additional Address Information prrnoY P.O.Box 469012 San Antonio,TX 78246 A United States Assigned to insurance companies that have,in our opinion,an excellent ability Web:www.colonvspecialtv.com to meet their ongoing insurance Phone:804-560-2000 obligations. Fax:804-560-4820 View additional news,reports and products for this company. Based on A.M.Best's analysis,058448-Argo Group International Holdings,Ltd is the AMB Ultimate Parent and identifies the topmost entity of the corporate structure.View a list of operating insurance entities in this structure. Best's Credit Ratings Financial Strength Rating View Definition Rating: A(Excellent) Affiliation Code: g(Group) Financial Size Category: XII($1 Billion to$1.25 Billion) Outlook: Stable Action: Affirmed Effective Date: November 16,2016 Initial Rating Date: June 28, 1993 Long-Term Issuer Credit Rating View Definition Long-Term: a Outlook: Stable Action: Affirmed Effective Date: November 16,2016 Initial Rating Date: June 29,2005 u Denotes Under Review Best's Rating Best's Credit Rating Analyst Rating Issued by:A.M.Best Rating Services,Inc. Senior Financial Analyst:Susan Molineux Director:Jennifer Marshall,CPCU,ARM Disclosure Information FOF� View A.M.Best's Rating Disclosure Form -.- A.M.Best Affirms Credit Ratings of Argo Group International Holdings,Ltd.and Subsidiaries November 16,2016 Rating History A.M.Best has provided ratings&analysis on this company since 1993. http://www3.ambest.com/ratings/entities/CompanyProfile.aspx?ambnum=3283&URatingl... 3/14/2017 List of Approved Surplus Line Insurers (LASLI) Page 2 of 7 Atain Specialty Insurance Company (Michigan) 09/01/1995 (Name changed from USF Insurance Company effective 08/25/2011) (Domicile changed from Pennsylvania to Michigan effective 12/31/2007) Atlantic Casualty Insurance Company (North Carolina) 07/16/2009 AXA Corporate Solutions Assurance (France) 08/14/2003 AXIS Specialty Europe SE (Ireland) 06/20/2007 (Name changed from AXIS Specialty Europe Public Limited Company effective 09/10/2012. Name changed from AXIS Specialty Europe Limited effective 04/26/2012) AXIS Surplus Insurance Company(Illinois) 12/15/1995 (Name changed from Sheffield Insurance Corporation effective 06/09/2003) Back to Top B - D Date Insurer Approved Berkley Assurance Company (Iowa) 07/20/2011 Berkley Regional Specialty Insurance Company (Delaware) 04/12/2012 Berkshire Hathaway International Insurance Limited (UK) 04/01/2008 The Burlington Insurance Company (Illinois) 11/17/1995 (Domicile changed from North Carolina to Illinois, effective 12/31/2015) Canopius US Insurance, Inc. (Delaware) 07/20/2011 (Name changed from Omega US Insurance, Inc. effective 08/20/2012) Capitol Specialty Insurance Corporation (Wisconsin) 05/15/2008 Catlin Insurance Company (UK) Limited 04/10/2007 Catlin Specialty Insurance Company (Delaware) 06/14/2006 (Name changed from Wellington Specialty Insurance Company effective 03/31/2007) Century Surety Company (Ohio) 09/01/1995 Chubb Custom Insurance Company (New Jersey) 08/04/1995 (Domicile changed from Delaware to New Jersey, effective 04/01/2013) The Cincinnati Specialty Underwriters Insurance Company (Delaware) 01/31/2011 Colony Insurance Company (Virginia) 09/01/1995 Columbia Casualty Company (Illinois) 07/06/1995 Covington Specialty Insurance Company (New Hampshire) 07/20/2011 Crum & Forster Specialty Insurance Company (Delaware) 04/20/1998 (Name changed from Transnational Insurance Company effective 12/26/2000. Domicile changed from Arizona to Delaware effective 11/21/2014.) CUMIS Specialty Insurance Company, Inc. (Iowa) 05/15/2008 Back to Top E - G Date Insurer Approved http://www.insurance.ca.gov/01-consumers/120-company/07-lasli/lasli.cfm 3/14/2017