Insurance - Golden Bell Products Inc.- Workers' Comp - 2018-10-01TDATE (MMfDD/YYYY)
ACORD CERTIFICATE OF LIABILITY INSURANCE 10/0
TRODUCER 10/0112018
THIS CERTIFICATE IS IS9UED AS A MATTER OF INFORMATION
CalCoast Insurance Agency ONLY AND CONFERS 'NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P,O. Box 1070 ALTER THE COVERAGE ',AFFORDED BY THE POLICIES BELOW.
Los Alamitos, GA. 90720
INSURERS AFFORDING COVERAGE NAIL
INSURED Golden Bell Products Inc. LINSURFRA, Mercuyqasualt�
any
PO BOX 366 INSURER 13: State Comp"n ati6n Ins. Fund
ATWOOD CA 92811
INSURER C.
INSURER 0:
INSURER E
COVERAGES
E
POLICIES OF 'NSURANCE LISTED BELOW HAVE BEEN ZSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IND'�-_ATED. NOTW�THSTAND,NG
A.NY REQUW
IREMENr, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 70 HICH, 7H:S CERTIF'ICA-E VAY BE ISSUED OP
MA'f PERTAIN THE INSURANCE AFFORDED By THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND COND17ONS OF SUCH
C' ICIES. ACGREGA7_7 _;IWTS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAIMS.
. . . ........ .
INSK A66�C POLICY EXPIRATION
i -rm im—ri ____ I � POLICY EFJFEC
GENERAL LIABILITY
LL-ACH,OCCURRENCE $
MERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
.P SES tEaLu=vrer,�j
—i CLAIMS MADE OCCUR!
EXP iAr,� one personi q
III
PERSONAL& ADV INJURY
L Af:-GREGATF LWIT APPLIES PER
GENERAL AG-UREGATE
j -
PRC -!'0MP!OP AGG
3 Pot, ^Y PRO C
AUTOMOBILE LIABILITY
y
A T ANY AUTO BA040000047332
10-14-2018 110-14-2019
COMB� NFD WiT 1.000A0
A.., OV1NE0AJTCS
S C HEDULED AU TIOS
BODILY INJURY
(Pe, person;
X HQf-`DAJTOS
X NON -OWNED AJTOS
BODILY INUR.
jY
Per arzicert)
PR M
0 PERIY DAAGF 1
GARAGE LIABILITY
APTO ONLY - EA AC"-IDFN7 S
ANY AUTO
OTHER _Et, ACC $
AUTO ONLY AGG
i EXCESSIUMBRELLA LIABILITY
-EACH OCCURRENCE
OCCUR CLAIMS MADE
0 E,
AGGREGAT F
DEDUCTIBLE
RETENTION
-------
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
U
X OTfq_
ER
B
10-04-2018
NP , R 11714034
,C' , PRI F -0 RfPkR'-' SER
10-04-2019
EL EACH ACCfDF_NT 1,000,000
RW
F L D181FASE - FA; kff .OvS 1,000.000
PPOV;SIONS bp
L.'" DISEASE - POL4-Y 4 WT 51,000,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
The Costa Mesa Sanitary District, It's elected and appointed officials, officers, agents, and employees are additional insured's.
we have Requested that the Certificate Holder be listed as Additional Insured.
10 day notice of cancellation for non-payment of premium.
CERTIFICATE HOLDER n N(% -r -I I ATWIM
Costa Mesa Sanitary District
628 West 19th Street
Costa Mesa, CA. 92627
949-516-1534
At ORD 25 (2001/08)
SHOULD ANY OF THE ABOVE DI
DATE, THEREOF, THE ISSUING
NOTICE TO THE CERTIFICATE I
IMPOSE NO OBLIGATION OR L
AUTHORIZED REPRESENTA
POLICIES BE CANCELLED BEFORE THE EXPIRATION
WILL ENDEAVOR TO MAIL 3() DAYS WRITTEN
AIED TO THE LEFT, BUT FAILURE TO 00 SO SHALL
ANY KIND UPON THE INSURER, ITS AGENTS OR
Q'ACORD CORPORATION 1988