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Insurance - Rogers, Anderson, Malody & Scott 2017-06-22ROGEAND-01 LWES CO A " CERTIFICATE OF LIABILITY INSURANCE `--� D Y7 TYPE OF INSURANCE 06/22n/2 snzon 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 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 hRAT Orion Business Insurance and Risk Management Services, Inc. PHONE FAX (A/C, No, Ea): (951) 281-5353 A/c, No :(951) 737-5083 1250 Corona Pointe Court, Suite 302 Corona, CA 92879 EO AIL SS INSURERS AFFORDING COVERAGE NAIC E INSURER A: Insurance Company of the West 1 27847 INSURED INSURERS, Navl ators r 42307 Rogers, Anderson, Melody & Scott LLP INSURER C: GEN'L 735 E. Carnegie Drive Suite 100 INSURER D: AGGREGATE LIMIT APPLIES PER: POLICY ❑ jA?T [] LOC OTHER: GENERAL AGGREGATE $ San Bernardino, CA 92408 INSURER E 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 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. INSR TYPE OF INSURANCE ADDL INSID SUER me POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS COMMERCIAL GENERAL UABILITY CLAIMS -MADE OCCUR —]PREMISES EACH OCCURRENCE DAMAGE TO RENTED $ (Ea occunrencel GEN'L MEDEXP An ons rson $ PERSONAL&ADV INJURY $ AGGREGATE LIMIT APPLIES PER: POLICY ❑ jA?T [] LOC OTHER: GENERAL AGGREGATE $ PRODUCTS -COMP/OPAGG AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUCUTNOSSyyNEo AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT(Ea accadent) $ BODILY INJURY Per arson BODILY INJURY Per accident Pe�acc Cent AMAGE UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED I I RETENTION$ A WORKERS COMPENSATION ANDEMPLOVERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y� QQFandatMin NH EXCLUDED'! (s1 % ffyes, descnbe under DESCRIPTION OF OPERATIONS below NIA X WSD 503548300 0110112017 011011201$ �( PER E OTH- ER E.L. EACH ACCIDENT 11000,000 E.L. DISEASE -EA EMPLOYEE S 1,800,808 E.L. DISEASE - POLICY LIMIT 1,000,000 B Errors & Omissions LA17APLOBCA38NV 0110112017 0110112018 See Description DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, ma be attached if more space Is required) Professional Liability $4,000,000 Per Claim;$4,000,000 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. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) ©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 Costa Mesa Sanity District / Sanitary Yili r^ /' —/ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 290 Paularino Ave i/�/ Wi �1//` 1/ Costa Mesa, CA 92626 AUTHORIZED REPRESENTATIVE Y r ACORD 25 (2016/03) ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD EAR DATE(MM/ MYYY) -� CERTIFICATE OF LIABILITY INSURANCE R059 6/21/2017 THIS CERTIFICATMS 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,ANOTHE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(iss) 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). ER ORION BUS INS & RISK MGMT SVC INC 255363 P: (951) 281-5353 F: (951) 737-5083 1250 CORONA POINTE CT STE 302 CORONA CA 92879 CONTACT (a"c. Na. EN): (951) 281-5353.Nol: (951) 737-5083 ADDDRESS! INsuRER(s)AFFosDING covBucE NAICx WSURERA: Sentinel Ins Co LTD 11000 I~ED ROGERS, ANDERSON, MALODY & SCOTT, LLP 735 CARNEGIE DR STE 100 SAN BERNARDINO CA 92408 WSUR£R e: MSURERC: --- WsuRERD: INSURERE: 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. IN58 TLTRTPEOFINSUILINCE ADDL SUER POLCYNUMPER PUOML�OCDYEFF nTo POUCYEXP LIMITS A COMMERCIAL GENERAL LIABILITY CWMS-MADE 1OCCUR X General Liab 72 SEA AR7403 01/01/2017 01/01/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $1, 000,000 PREMISES(Ee.m .) X MEDEXP(Amymepemon) $10,000 PERSONALaADVINJURY $1, 000, 000 GENIAGGREGATELIMITAPPLIESPER POLICY❑PRO- LOC ECT El OTHER GENERAL AGGREGATE s2,000,000 vftODUCTS-COMP/OPAGG 2r000r000 A AUTOMOSILELIASILRY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIREDX NON -OWNED AUTOS ONLY AUTOS ONLY 72 SBA AR7403 01/01/2017 01/01/2018 CAMNDS CE..WEDSINGLE LIMIT 61,000, 000 BODILY INJURY(Per,amn) 6 - BODILYINJURY(Pare enl) s PROPERTYDP e (PnamJEen1) A X UMBRELLA LIAR X EXCESS LIAR OCCUR CLAIMS -MADE 72 SBA AR7403 01/01/2017 01/01/2018 EACH OCCURRENCEs3,000,000 AGGREGATE 63, 000, 000 of X ETErmons 10,000 NORYEFSCOMPEA'SATlON. AND&MPLOYPATLIABIGTY ANY PROPRIETORIPARTNEWEXECUTNE YM OFFICERIMEMSEREXGLUDEO? ❑ (Manryelony IR Arm If y.%dee.nbuu deO DESCRIPTION OF OPERATIONS below WA PE0.TN- STA. OR &IEAC-1ACCIDENT E.L DIGPASE-EA EMPLOYEE E.L. DISEASE- FOUCY LIMIT 6 DESCRIPTION OFOPERAnONSILOCATIONSIVEHMLES (ACORD 1M, AtlElBanal RemeM1s Smetlule, may be abached R mote space Ia m4ulm%I) Those usual to the Insured's Operations. Please see Additional Remarks Schedule Acord Form 101 attached. CFRTIFICATE HOLDER CANCELLATION ©19BU-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. AUTHOMWO REPRESENTATIVE Costa Mesa Sanitary District 290 PAULARINO AVE_ COSTA MESA, CA 92626 ©19BU-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER Av ADDITIONAL REMARKS SCHEDULE Page Of AGENCY ORION BUS INS & RISK MGMT SVC INC NAMEDINBURED ROGERS, ANDERSON, MALODY & SCOTT, LLP 735 CARNEGIE DR STE 100 SAN BERNARDINO CA 92408 POUCY NUMBER SEE ACORD 25 CARFUER SEE ACORD 25 NAICCODE EPFECTwsDATE: SEE ACORD 25 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM (FORM NUMBER: 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. ���v �v v��v ��a ��IG YIIY IVbV YIC ,OaibltllCV IIICI RD UI H1 Wmu 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: 06/21/17 Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: 002 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 FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE: IH12001185 ADDITIONAL INSURED - STATE/POLITICAL SUBDIVISION PRO RATA FACTOR: 0.932 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 12110405T Page oo1 Process Date: 06/21/17 Policy Effective Date: 01/01/17 Policy Expiration Date: 01/01/18 POLICYNUMBER:72 SBA AR7403 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE/POLITICAL SUBDIVISION COSTA MESA SANITARY DISTRICT 290 PAULARINO AVE COSTA MESA, CA 92626 RE: LOC 001/BLDG 001 Form IH 12 00 11 85 T SEQ. NO. 003 Printed in U.S.A. Page 001 Process Date: 06/21/17 Expiration Date: 01/01/18 n 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. 91 If this policy is cancelled by the Company, other than for non-payment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses an file With the agent of record or the Company. If this policy Is cancelled by the company for non- payment of premium, or by the insured, notice of such cancellation will be provided within ten (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. Form SS 12 23 06 11 Page 1 of 1 © 2011, The Hartford WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -BLANKET WC 99 06 34 (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: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -BLANKET 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: