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Insurance - Workers' Comp - Municipal Maintenance Equipment 2017-12-14MME -001 nP In- RR `�`oszo CERTIFICATE OF LIABILITY INSURANCE DATUM/2017 Y) 12/14/2017 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- - 530-345-9849 CONTACT Don Dahlmeier North Valley Ins. Agency, Inc.PHONE 2485 Notre Dame Blvd Ste 370-D 530-345-9849 FAX 530-345-9857 INC, No, Ext): _ , No=- Chico, CA 95928 Don Dahlmeier- _ EADDRESS----.,____MIL --- EACH OCCURRENCE DAMAGE TO RENTED INSURELA) FFORDING COVERAGE INSURERA: Insurance COmpd ny of the West % INSURED MME 4634 Mayhew Road INSURER B: -- Sacramento, CA 95827 INSURER c: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER- 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. II TRNSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBERPOLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE DAMAGE TO RENTED MED EXP (A.Y one erson $ PERSONAL& ADV INJURY GFNT AGGREGATE LIMIT APPLIES PER: POLICY EI jECT DLOC GENERAL AGGREGATE $ PRODUCTS - COMPIOPAGG $ OTHER'. - LIABILITY COMBINED SINGLE LIMIT AUTOMOBILE BODILY INJURY Perperson) ANY AUTO OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY Per accident $ PROPERTY DAMAGE Per acrid t $ HIRES N0N-OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITYSTATUTE ANY PROPRIETORIPARTNERIEXECUTIVE [—]YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONSbelow__J NIA Y WSA 5032079 02 12/15/2017 12/15/2018 x PER OTH- F—R _ E.L. EACH ACCIDENT $ 1,DUD,BBO E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may bo attached It more space is required) Waiver of subrogation applies. DBojarski@cmsdca.gov COSTAME COSTA MESA SANITARY DISTRICT 290 PAULARINO AVENUE `/1.'/`q COSTA MESA, CA 92626 r SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE ACCIRD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD