Insurance - Southern California Fleet Services , Inc. - Workers Comp. 2019-04-29ACC> ?b' CERTIFICATE OF LIABILITY INSURANCE
164 " Acct#: 2673259
'
DATE(MM/DD/YYYY)
F4/29/2019
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 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
Willis of Greater Kansas City Inc.
5700 W 112th Street, Ste. 100
Overland Park, KS 66211
CONTACT
PHONE FAX
A/C No Ext): 844-290-4908 A/C No):
E-MAIL
ADDRESS: BBSlcerts@locktonaffinity.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A : Ecole Insurance Company 13601
INSURED
SOUTHERN CALIFORNIA FLEET SERVICES, INC.
INSURER B :
INSURER C :
2855 SAMPSON AVE,
CORONA, CA 92879
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: RFVISION NI]MRFR-
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
ADD L
IN D
SUBIR
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
� I
CLAIMS -MADE OCCUR
U
EACH OCCURRENCE $
DAMAGE TO RENTED
PREMISES Ea occurrence $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY ❑ PRO JECT LOC
—J
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT $
Ea accident
BODILY INJURY (Per person) $
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
P
BODILY INJURY (Per accident)
tid
( ) $
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
Per accident $
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE $
AGGREGATE $
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
WORKERS COMPENSATIONX
AND EMPLOYERS' LIABILITY Y / N
PER OTH-
STATUTE I ER
E.L. EACH ACCIDENT $ 2,000,000
A
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
N / A
X
E000489
5/1/2019
5/1/2020
E.L. DISEASE - EA EMPLOYEE $ 2,000,000
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT $ 2.000,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Policy State = AZ
Blanket Waiver of Subrogation in favor of certificate holder when requred by written contract
CERTIFICATE HOLDER CANCELLATION
Costa Mesa Sanitary District
290 Paularino Avenue
Cost 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.
REPRESENTATIVE
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD