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Insurance - Rogers, Anderson, Malody & Scott 2017-06-21EAR CERTIFICATE OF LIABILITY INSURANCE 8059 6/21/2017 THIS CERTIFICATEIS 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). PNDDucPR ORION BUS INS & RISK MGMT SVC INC 255363 P:(951) 281-5353 F:(951) 737-5083A`oBB., 1250 CORONA POINTE CT STE 302 CORONA CA 92879 cornAcr iaNc°N.Iro, EXB: (951) -281-5353 "".nal: (951) 737-5083 POL)CyNOMEPR INSIIftEBIS1ArPDNOIN6CWER0.6E NAICk W6uRERA: Sentinel Ins Co LTD / 11000 INsu ROGERS, ANDERSON, MALODY & SCOTT, LLP 735 CARNEGIE DR STE 100 SAN BERNARDINO CA 92408 WSUPEft B: WBDRERC' -- WsuRERD : MBU-E INsury=Rr. 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 SE 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 TYPPOFfNSURANt2 "DL SUBR POL)CyNOMEPR POLITS EFF POGCYEXP Vary. A COMMERCIAL GENERAL LIABILITY CLAIMS tMDEOCCUR X General Liab 72 SBA AR7403 01/01/2017 01/01/2018 EACH OCCURRENCE $1,000,000 PRDAB.M iS S0(Eaoccvn�euce) $1, 000,000 X MEDEXP(Anyonepmson) $10,000 PERsoNpLagov wJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER POLICY D JEOa LOC OTHER GENERAL AGGREGATE s2,000,000 PROOUCTs-GOMP/OPAGG 2,000,000 A AUTOMOBILE LIABRBY ANY AUTO OWNED SCHEOUIJ=O AUTOS ONLY rED }{ HIREDX NON -OWNED AUTOS ONLY AUTOS ONLY El 72 SBA AR7403 01/01/2017 01/01/2018 COMBINED SINGLE UM T (Ea.W00) 1, 000, 000 BODILY INJURY (Pttm man) BODILY INJURY (Puxddent) PROPERTYDAMA3e (PmavideM) A X UMBRELLA LIAB X EXCESSLIAS OCCUR CLAIMS -MADE 72 SBA AR7403 01/01/2017 01/01/2018 EACH OCCURRENCE s3,000,000 AGGREGATE s3,000,000_ 1.4 X kENlm,lo,000 NOftYEASCONP£ uQN. ANOEMPLOM$TVABNlTI' ANY PROPRIETORPARTNER/FJLECUnVE YIN OFFICEWMEMBEREXCLUDED? (Mandatory M Ni% F]N/A If yes,desaibe undef DESCRIPTION OF OPERATIONS bebw PFA OTK SrATUtE ER El -EACH ACCIDENT E.L DISEASE -EA EMPLOYEE E.L DISEASE -PODGY LBAn S DESCRIPTN)N OF OPERATIONS ILOCAT/ONS/VEHICLES(ACORD IBI. AddlEoroi Remams schedule, may be atl c R mom spare Is rotulmd) 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.--,y�J 290 PAULARINO AVE AWHOMMDREPRESENTATIVE COSTA MESA, CA 92626 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 17e7H :11e111111 I WEFT .44cORO' CERTIFICATE OF LIABILITY INSURANCE �� DAM 06/2 212 01 YY) 06/2212017 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 terns 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 CONTACT NAME: Orion Business Insurance and Risk Management Services, Inc. 1250 Corona Pointe Court, Suite 302 Corona, CA 92879 uc°Nt o, Eat): (951) 281-5353 jac, No):(951 737-5083 ) ENTAIL INSURERS AFFORDING COVERAGE NAIC 9 INSURERA: Insurance Company of the West 27847 INSURED INSURER B: Navigators 42307 Rogers, Anderson, Melody & Scott LLP 735 E. Carnegie Drive INSURER C: Suite 100 INSURER D: E San Bernardino, CA 92408INSURER INSURER F: COVERAGES CERTIFICATE NUMBER- RFVICInN MUNI 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 DOCUMENTWITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTOALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. /NSR TYPE OF INSURANCE ADOL SUERLTR POLICY NUMBER PWLICYEFFPOLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS ❑ OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED -MADE EREMISES ISaomun MED EXP LAny one rion) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 11 JELPT 11 LOC GENERAL AGGREGATE $ PRODUCTS-COMP/OPAGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E acciden! $ _ BODILY INJURY PerPerson) $ ANY AUTO OWNED SC OS ONLY AUTOSULED BODILY INJURY Per accident $ PROPERTY DAMAGE Peramidenl $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE YIN �FFI tgR ,MBER EXCLUDED? Mantlatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below NLA X SD 503548300 01/0112017 O1I0112018 j( PER OTH- STATUTE ER _ E.L. EACH ACCIDENT $ 1,000,000 E. L. DISEASEEA EMPLOYEE $ 1'000'000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Errors & Omissions LA17APLOBCA38NV 01101/2017 01/01/2018 See Description DESCRIPnONOFOPERATIONS/LOCAnONSIVEHICLES(ACORD 101, Additional Remarks Schedule, mabeattachedifmarespaceisrequlred) Professional Liability $4,000,000 Per Claim;$4,000,000 Aggregate; $35,000 Per claim beductible Workers Compensation and Professional Liability Waiver of subrogation applies to Cert holder Costa Mesa Sanitary District, its directors, officials, officers, employees, agents and volunteers. Costa Mesa Sanitary District 290 Paularino Ave Costa Mesa, CA 92626 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE to aJgfi Ivt dry" ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER A� ADDITIONAL REMARKS SCHEDULE Page Of AGENCY ORION BUS INS & RISK MGMT SVC INC NAMED INSURED ROGERS, ANDERSON, MALODY & SCOTT, LLP 735 CARNEGIE DR STE 100 SAN BERNARDINO CA 92408 P UCY NUMBER SEE ACORD 25 CARRIER SEE ACORD 25 NAICCODE EEF weDAw: 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 ssl223 attached to this policy. .... ......... ..�... ,.y.. a.�.�y.o.o. �.. wm ne v„a�.vrtv 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. i�(i�J7�l!i4u'�nUafe��i]�f ZOA[N�ii;il�Ce}:,�Nyy�Lg�yii]�7.TiYa FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE: IM12001185 ADDITIONAL INSURED - STATE/POLITICAL SUBDIVISION PRO RATA FACTOR: 0.932 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 12 11 04 05 T Page oo1 Process Date: 06/21/17 Policy Effective Date: 01/01/17 Policy Expiration Date: 01/01/1a POLICY NUMBER: 72 SEA 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 ODI/BLDG 001 Form IH 12 00 11 85 T SEQ. NO. 003 Process Date: 06/21/17 Printed in U.S.A. Page 001 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 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 on file with the agent of record or the Company. B. 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 0611 Page 1 of 1 © 2011. The Hartford 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(01117 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: