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Insurance - FM Thomas Air Conditioning, Inc. - Workers Comp 2018-12-28® ACOR1:7 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) TYPE OF INSURANCE 12/28/2018 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(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 NAME: CONTACT Shane Sneddon BoWermaSter & Associates P.O. Box 6Q26 PHONE FAX IC No • 714-733-6251 AIC No): WC. E-MAIL ADDRESS: ssneddon@bowermaster.com _ 10805 Holder St Suite 350 INSURERS AFFORDING COVERAGE NAIC# Cypress CA 90630 INSURER A: Valley Fore Insurance Company 20508 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY a JE � LOC OTHER: INSURED FMTHOMA-01 INSURER B. Continental Casualty Co. 20443 FM Thomas Air Conditioning, Inc. 231 Gemini Ave. INSURER C: Continental Insurance Company 35289 INSURER D: Cypress Ins Co/' 10855 Brea CA 92821 INSURER E: 6057258063 INSURER F.- 4/1/2019 nnvr0Ar_Pc r_1=0TII:I(`ATR NI IUR1=R- IInAlAOAA1 RFVICInN NIIMRFR- 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 LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [_�_] OCCUR Y 6057223216 4/1/2018 4/1/2019 , EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY a JE � LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY X ANY AUTO OWNEDSCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY Y 6057258063 4/1/2018 4/1/2019 COMBINED SINGLE LIMIT S1,000,000 Ea accident _ BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident S C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 6057258077 4/1/2018 4/1/2019 EACH OCCURRENCE 54,000,000 AGGREGATE S4,000,000 DED X RETENTIONS 1 n nnn$ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECU I IVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A i FMWC010974 1/1/2019 111/2020 X PER OTH- STATUTE ER E.L. EACH ACCIDENT S1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) All Operations of Named Insured Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees are Additional Insured as respects General Liability per and Automobile Liability per attached policy endorsement form; Primary and Non -Contributory wording applies. lrtK 111-JUA I t MULUtK GANGtLL.A I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa Sanitary District ACCORDANCE WITH THE POLICY PROVISIONS. 290 Paularino Avenue t Costa Mesa CA 926261 f a AL1 RIZEDREPRESENTATIVE USA 4 � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD