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Insurance - Rogers Anderson Malody & Scott 2017-06-20ROGEAND-01 LWEST ACO/ZO" CERTIFICATE OF LIABILITY INSURANCE DATE(MMa OVYYYJ 06/20/2017 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 Orion Business Insurance and Risk Management Services, Inc. 1250 Corona Pointe Court, Suite 302 Corona, CA 92879 CONTA E:CT (,V NN , E#: (951) 281-5353 FAXNo :(951) 737-5083 nD� INSURERS AFFORDING COVERAGE NAIC If INSURER A: Insurance Company of the West/ 27847 INSURED INSURER B:NaVI ators 42307 Rogers, Anderson, Melody & Scoff LLP 735 E. Carnegie Drive INSURER C DAMAGE TO RENTED Suite 100 INSURER D E PREMISESEa cc.n San Bernardino, CA 92408INSURER NSURER 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. INSR TYPE OF INSURANCE ADDL INSD SUBR MO POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE ❑ OCCUR DAMAGE TO RENTED PREMISESEa cc.n MED EXP (Any one arson PERSONAL&ADV INJURY GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY jreT 17 LOC PRODUCTS - COMPlOP AGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY Per Person) OWNED SCHEDULED AUTOS ONLY AUTOSHp BODILY INJURY (Per accident [UTOSRED AOTOSONLB 0P Eant AMAGE ONLY m. UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION$ A WORKERS COMPENSATION X PTR ERH AND EMPLOVERS'LIABILIDYTNER YIN PROPRIETOR/ WSD 503548300 01/0112017 011011201$ 1,000,000 E.L. EACH ACCIDENT EXCLUDRIEXECUTIVE ❑ QAQN�Y W.F.ICamryln NH)E%CLUDED? NIA 1,000,000 E.L. DISEASE - EA EMPLOYE H yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT B Errors & Omissions LA17APLOBCA38NV 0110112017 01/0112018 See Description DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101, Additlonal Remarks Schedule, ma be coached if more space Is required) Professional Liability $4,000,000 Per Claim; $4,0 0,000 Aggregate; $35,000 Per claim deductible Workers Compensation and professional liability Waiver of subrogation applies to Cert holder Costa Mesa Sanitary District, Its directors, officials, officers, employees, agents and volunteers. ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE sa Sanity District Sanitary 9th Street -V CC28CA 92627 1,1/7 �sa, Ir� I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE tAfil - O'✓ / ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AG _ PAS CERTIFICATE OF LIABILITY INSURANCE R002 DATE(MMIDDNYYY) 1/30/2017 THIS CERTIFICATEIS ISSUED ASA 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, subject to the terns and conditions of the policy, certain pollcies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). M� Y£FF CONTACT ORION BUS INS & RISK MGMT SVC INC NAAE PHONE PAX (MC. No, Esc (951) 281-5353 glc.enl: (951) 737-5083 255363 P: (951) 281-5353 F: (951) 737-5083E'=EEBS 1250 CORONA POINTE CT STE 302 INNffnNNSIAFFOROWGCOV AAOE NNCR CORONA CA 92879 MORENA: Sentinel Ins Co LTD 11000 WS' INSURERe: INSURERC: ROGERS, ANDERSON, MALODY & SCOTT, LLP WSURERD. 735 CARNEGIE DR STE 100 INSURER E: SAN BERNARDINO CA 92408 INSURERF: 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. LVSB LET "PEO£INSUAANCE ADOL SUBA MUCYNUMBEB M� Y£FF PoLICY EXP LIHIM 628 W 19TH COMMERCIAL GENERAL UAIILfTY COSTA MESA, CA 92627 EACH OCCURRENCE $1.,000,000 CIAIMS-MADE OCCUR ,000,000 PREMISSES aENT a $1,000,000 X MED EXP(My ane Person) $10, 000 A X General Liab 72 SBA AR7403 01/01/2017 01/01/2018 PERSONAL a ADV INJURY $1, 000, 000 GENL AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE s2,000,000 POLICY [�]JECT❑X LOG PRODUCTS -COMProP AGO 21000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S1 000 000 (Ea a JEanl) / / BODILY INJURY (Per pereon) ANY AUTO AOWNED SCHEDULED AUTOS ONLY AUTOS 72 SRA AR3403 01/01/2017 01/01/2018 BODILYINJURY(Persa9tlent) e PROPERTY DAMAGE $ (Peravident) X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X UMSRELLAUAB OCCUR EACH OCCURRENCE s3,000,000 A EXCESS UAB H CLAIMS -MADE 72 SBA AR7403 01/01/2017 01/01/2018 AGGREGATE s3,000,000 m: X RETENmN5 10.000 WORIERSLOM's"a"r"' ANDEMPLOYEAf LMNLITY PER OM 9TAME et E.L EACH ACCIDENT ANYPROPRIETOR,PARTNERIEXECUTNE YM OFFICERIMEMBEREXCLUDEDT (Mandofery lD WE ❑ WA E.L. 019PASE-EI EMPLOYEE 5 11 yes, deeadbe Under DESCRIPTION OF OPERATIONS below E.1DISEASE-POLICYLIMIT S DESCRIPTION OFOPERAnONS/LOCATIONS/VEHICLES(ACORD IBI, Addleonal Ramarka Bahedul,may Dealtxa lf,nDrs apace la re"INNI) Those usual to the Insured's Operations. Please see Additional Remarks Schedule Acord Form 101 attached. CERTIFICATE HOLDER CANCELLATION \� ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District AUINORIIEDREPRESENTAnVE - 628 W 19TH STS COSTA MESA, CA 92627 \� ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY ORION BUS INS ROUCYNUMBER SEE ACORD 25 CARRIER SEE ACORD 25 AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE NAMED INSURED & RISK MGMT SVC INC Page _ of ROGERS, ANDERSON, MALODY & SCOTT, LLP 735 CARNEGIE DR STE 100 NAICCDUE SAN BERNARDINO CA 92408 EFFECTIVE DATE: SEE ACORD 25 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM FORMNUMBER: ACORD 25 FORMTITLE: CERTIFICATE OF LIABILITY INSURANCE The Costa Mesa Sanitary District, It's elected and appointed officials, agents, officers, volunteers and employees are additional insureds per the Business Liability Coverage form ss0008 attached to this policy. Any other insurance maintained by the Costa Mesa Sanitary District shall be excess and non-contributing with the insurance provided by this policy per the Business Liability Coverage form ss0008 attached to this policy. Said policy shall not terminate, nor shall it be canceled nor the coverage reduced, until thirty (30) day after written notice is given to the District per the Notice of Cancellation to Certificate Holder(s) form ss1223 attached to this policy. The AGORD name and logo are registered marks of ACORD 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 AR7403 SC Named Insured and Mailing Address; ROGERS, ANDERSON, MALODY & SCOTT, LLP 735 CARNEGIE DR STE 100 SAN BERNARDINO CA 92408 Policy Change Effective Date: 01/26/17 Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: Dol Agent Name: ORION BUS INS & RISK MGMT SVC INC Code: 255363 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. NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED ADDITIONAL INSURED(S) 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: 0.932 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: 01/30/17 Policy Effective Date: 01/01/17 Policy Expiration Date: 01/01/18 POLICY CHANGE (Continued) Policy Number: 72 SBA AR7403 Policy Change Number: 001 FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: SS 12 23 06 11 IH12001185 ADDITIONAL INSURED - STATE/POLITICAL SUBDIVISION Form SS 12 11 04 05 T Page 002 Process Date: 01/30/17 Policy Effective Date: 01/01/17 Policy Expiration Date: 01/01/18 POLICYNUMBER:72 SBA AR7403 Fl THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE/POLITICAL SUBDIVISION COSTA MESA SANITARY DISTRICT 628 W. 19TH STREET COSTA MESA, CA 92627 RE: LOC 001/BLDG 001 Form IH 12 00 11 85 T SEQ. NO. 003 Printed in U.S.A. Page 001 Process Date: 01/30/17 Expiration Date: 01/01/18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other If notice is mailed, proof of mailing to the last known than for non-payment of premium, notice of such mailing address of the certificate holder(s) on file with cancellation will be provided at least thirty (30) days the agent of record or the Company will be sufficient in advance of the cancellation effective date to the proof of notice. certificate holder(s) with mailing addresses on file Any notification rights provided by this endorsement with the agent of record or the Company. apply only to active certificate holder(s) who were issued B. If this policy is cancelled by the company for non- a certificate of insurance applicable to this policy's term. payment of premium, or by the insured, notice of Failure to provide such notice to the certificate holder(s) such cancellation will be provided within ten (10) will not amend or extend the date the cancellation days of the cancellation effective date to the becomes effective, nor will it negate cancellation of the certificate holder(s) with mailing addresses on file policy. Failure to send notice shall impose no liability of with the agent of record or the Company. any kind upon the Company or its agents or representatives. Form SS 12 23 06 11 Page 1 of 1 0 2011, The Hartford WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -BLANKET PfL�'>rII�L! (Ed. 8-00) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). The additional premium for this endorsement shall be 3% of the total California Workers' Compensation premium otherwise due. Person or Organization ANY PERSON OR ORGANIZATION FOR WHOM THIS WAIVER IS REQUIRED. Policy Number: WSD 5035483 00 Endorsement Effective: 01/01/17 Issue Date: 01/12/17 WC 99 06 34 (Ed. 8-00) Schedule Job Description ALL CALIFORNIA OPERATIONS. Insured: Rogers Anderson Malody & Scott LLP Coverage Provided by: Insurance Company of the West Countersigned by: