Loading...
Insurance - GEO-ETKA 2018-10-26GEO-INC-01 LBOSSHART ,4coR[a CERTIFICATE OF LIABILITY INSURANCE E01012612018 ATE(MM/DD/YYYY) `..•� 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 License # OM1 0410 CONTACT NAME: Armstrong/Robitaille/Riegle Business and Insurance Solutions PHONE 949 381-7700 FAX 949 487-6151 830 Roosevelt, Suite 200 (A/C, No, Ext): ( ) (A/C, No):(949) Irvine, CA 92620 E-MAIL SS: info@ar-ins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Massachusetts Bay Insurance 22306 INSURED INSURER B : Allmerica Financial Benefit 41840 GEO-ETKA, Inc INSURER C: State Compensation Insurance Fund N/A 1801 EAST HEIM AVENUE 00, SUITE 202 INSURER _D:Admiral Insurance Co. 24856 Orange, CA 92865 INSURER E: INSURER F: C_CIVFRAnPA rI=RTIFIrATF NI IMRFR- RFVISInN NI IMRFR- 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 SUBR POLICY NUMBER LTR INSD WVD POLICY EFF POLICY EXP LIMITS MM/DD/YYYY ! MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUROD3D42005401 X 11/06/2018 11/06/2019 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 10,000 MED EXP (Any one person) $ 1,000,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JERef LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO AW3D42006601 11/06/2018 11/06/2019 BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIR D NON rNED X AUOS ONLY X AUTOS ONLY PROPERTY DAMAGE (Per accident) $ _ A UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS -MADE OD3D42005401 11/06/2018 11/06/2019 AGGREGATE $ 2,000,000 DED X RETENTION $ 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY X STATUTE EORH Y/N 68209718 11/01/201$' 11/01/2019 1'000'000 ANY PROPRIETORIPARTNER/EXECUTIVE N / A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NH) 1'000'000 (Mandatory in E.L. DISEASE - EA EMPLOYEE $ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ D Prof. Errors & Omiss E000003727602 03/31/2018 03/31/2019 General Aggregate 2,000,000 D Prof. Errors & Omiss E000003727602 03/31/2018 03/31/2019 Per Occurrence 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees are named additional insured per the attached forms as required by written contract. GANGCLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ry ,^ � Al ACCORDANCE WITH THE POLICY PROVISIONS. 290 Paularino Ave. _V501 _( Costa Mesa, CA 92626 AUTHORIZED REPRESENTATIVE -DM, AJ� ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy #OD3D42005401 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Name of Person or Organization: COSTA MESA SANITARY DISTRICT, THEIR ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS, AND EMPLOYEES. (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) For the purpose of coverage provided by this endorsement, the following changes are made to SECTION II - LIABILITY: A. The following is added to SECTION 11 - LIABILITY, C. Who is an Insured: Any person or organization shown in the Schedule above is also an additional insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations or in connection with your premises owned by or rented to you. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. The following is added to SECTION 11 - LIABILITY, D. Liability and Medical Expenses Limits of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED. 391-194108 16 Includes copyrighted material of Insurance Services Offices, Inc., with its permission. Page 1 of 1