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Insurance - Workers' Comp - Rogers, Anderson, Malody & Scott 2018-01-03ROGEAND-01 LWEST ,�aco/ZO' CERTIFICATE OF LIABILITY INSURANCE `./ O01/031201ATE YY) 01/03/2018 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 COT COAME:CT NAM a° No, E:r: 951 281-5353 FAX 951 737-5083 1 ( ) (AIC, Nola( ) ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: Insurance Company of the West/ 27847 INSURED INSURER B: Travelers Cas&Surety Co of Am/ 31194 INSURER C: Rogers, Anderson, Melody & Scott LLP 735 E. Carnegie Drive Suite 100 INSURER D : INSURER E: San Bernardino, CA 92408 INSURER F: DAMAGE TO RENTED CnVFRArFS, CFRTIFICATF NIIMRFR- 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 ADDLSUBR IVSD MD POLICY NUMBER IMNPOLICY EFF MMIDPOLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS -MADE ❑ OCCUR PREMISES (Ea o rrence $ MED EXP (My oneperson) $ PERSONAL &ADV INJURY $ COIL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ FJQDUCTS-COMPIOPAGr: T RO- POLICY1-1jEC n'nr OTHER: - _ _ AUTOMOBILE LIABILITY _ _. $ COMBINED SINGLE LIMIT Ea accident $ _ BODILY INJURY Per arson ANY AUTO BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTYOAMAGE Per acc,denl $ AUTOS ONLY AUTOS ONL� $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ii A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY X WSD 5035483 01 0110112018 01/01/2019 X PER OTH- TA TE 1,000,000 EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED?ECUTIVE ❑ (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYEE $ 1'000'000 1,000,000 E.L. DISEASE -POLICY LIMIT $ K yes, describe under DESCRIPTION OF OPERATIONS below B Errors & Omissions 106850737 01/01/2018 01/01/2019 See Description DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, mebe aUacbed Kmore 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 Can holder Costa Mesa Sanitary District, its directors, officials, officers, employees, agents and volunteers. Costa Mesa Sanitary District 290PaMAve 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 %A lyk- U.det— ACORD 25 (2D16/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 01 Endorsement Effective: 01/01/18 Issue Date: 01/01/2018 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: POLICY NUMBER: 72 SBA AR7903 F1 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 Process Date: 10/20/].7 Printed in U.S.A. Page 001 Expiration Date: 01/01/19