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Insurance - Western A/V Inc - 2020-04-17STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS COVERAGE SUMMARY APR 17 2020:' RQ hard8on ATX 75085-3925 Addl Insured -Section II Only M-23-3535-FB8A F Z 002001 3123 COSTA MESA SANITARY DISTRICT THEIR ELECTED & APPOINTED OFFICIALS, OFFCIERS, VOLUNTEERS & EMPLOYEES 290 PAULARINO AVE COSTA MESA CA 92626-3314 1111111, I � [Jill 1 111111111111111111111111 Home Product Sales Policy Policy Number 92 -EX -5166-6 Policy Period Effective Date Ex iration Date 12 Months MAY 16 2020 MAY 16 2021 The policy period begins and ends at 12:01 am standard time atthe premises Tocation. Named Insured WESTERN A/V INC 1592 N BATAVIA ST STE 2 ORANGE CA 92867-3554 Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Entity: Corporation Policy Premium Discounts Applied: Protective Devices Claim Record 00"1^ 10OVD $ 9,575.00 Prepared APR 17 2020 ^ Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 016089 290 Al Continued on Reverse Side of Page N Page 1 of 7 530686 a.2 05 31 2011 (o1f32310 DECLARATIONS (CONTINUED) Home Product Sales Policy for COSTA MESA SANITARY DISTRICT Policy Number 92 -EX -5166-6 SECTION I - PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase - Premises Coverage A - Coverage B - Business Buildings Business Personal Personal Property Property 003 6353 CORTE DEL ABETO STE 106 No Coverage $ 23,800 25% CARLSBAD CA 9201 1-1 437 004 1592 N BATAVIA ST STE 2 No Coverage $ 224,600 25% ORANGE CA 92867-3554 * As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. gECTION I - INFLATION COVERAGE INDEX ES) . Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES Basic Deductible Special Deductibles: Money and Securities Prepared APR 17 2020 CMP -4000 016089 N/A 257.3 $2,500 $250 Data Compromise Oc Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services office, Inc., with its permission. Continued on Next Page $1,000 Page 2 of 7 DECLARATIONS CONTINUED Home Product Sales Policyy for COSTA MESA SANITARY DISTRICT Policy Number 92 -EX -51 fifi-fi Employee Dishonesty $250 Equipment Breakdown 1, Other deductibles may apply refer to policy. $2,500 0 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES �a � The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises Off Premises Arson Reward Back -Up Of Sewer Or Drain Collapse Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Debris Removal Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge Expense Forgery Or Alteration Glass Expenses Increased Cost Of Construction And Demolition Costs (applies only when buildings are insured on a replacement cost basis) Money And Securities (Off Premises) Money And Securities (On Premises) Money Orders And Counterfeit Money Prepared APR 17 2020 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 016090 290 Continued on Reverse Side of Page N See Schedule See Schedule $5,000 See Schedule Included Coverage B Limit 25% of covered loss Included $2,500 $5,000 $10,000 Included 10% See Schedule See Schedule $1,000 Page 3 of 7 DECLARATIONS (CONTINUED) Home Product Sales Policy for COSTA MESA SANITARY DISTRICT Policy Number 92 -EX -5166-6 Newly Acquired Business Personal Property (applies only if this policy provides Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides Coverage A - Buildings) Ordinance Or Law - Equipment Coverage Outdoor Property Personal Effects (applies only to those premises provided Coverage B - Business Personal Property) Personal Property Off Premises Pollutant Clean Up And Removal Preservation Of Property Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Signs Valuable Papers And Records On Premises Off Premises $100,000 $250,000 Included See Schedule $2,500 $25,000 $10,000 30 Days See Schedule See Schedule See Schedule See Schedule SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - SCHEDULE The coverages and corresponding limits shown below apply only to the described premises as shown. LOCATION COVERAGE 0003 Accounts Receivable (On Premises) Accounts Receivable (Off Premises) Back -Up Of Sewer Or Drain Money And Securities (Off Premises) Money And Securities (On Premises) Outdoor Property Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Signs Valuable Papers and Records (On Premises) Valuable Papers and Records (Off Premises) 0004 Accounts Receivable (On Premises) Prepared APR 17 2020 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 016090 Continued on Next Page LIMIT OF INSURANCE $10,000 $5,000 $15,000 $5,000 $10,000 $5,000 $2,500 $5,000 $10,000 $5,000 $10,000 Page 4 of 7 DECLARATIONS (CONTINUED) Home Product Sales Policy for COSTA MESA SANITARY DISTRICT Policy Number 92 -EX -5166-6 Accounts Receivable (Off Premises) Back -Up Of Sewer Or Drain Money And Securities (Off Premises) Money And Securities (On Premises) Outdoor Property Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) �d Signs Valuable Papers and Records (On Premises) Valuable Papers and Records (Off Premises) SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY $5,000 $15,000 $5,000 $10,000 $5,000 $2,500 $5,000 $10,000 $5,000 The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations, COVERAGE Data Compromise Legal And Forensic Information Technology Review Per Occurrence Dependent Property - Loss Of Income Employee Dishonesty Identity Restoration Other Expenses Case Management Services Per Occurrence Lost Wages And Supervision Expenses Utility Interruption - Loss Of Income Loss Of Income And Extra Expense SECTION 11- DEDUCTIBLES Business Liability - Property Damage $1,000 Other deductibles may apply - refer to policy. LIMIT OF INSURANCE $5,000 $50,000 $5,000 $10,000 $1,000 12 months $35,000 $5,000 $10,000 Actual Loss Sustained - 12 Months Prepared APR 17 2020 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 016091 290 Continued on Reverse Side of Page Page 5 of 7 N DECLARATIONS (CONTINUED) Home Product Sales Policy for COSTA MESA SANITARY DISTRICT Policy Number 92 -EX -5166-6 SECTION 11- LIABILITY Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP -4101 LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $2,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $300,000 CMP -4710 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $4,000,000 General Aggregate $4,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP -4101 Businessowners Coverage Form CMP -4705.2 Loss of Income & Extra Expense CMP -4990.1 Identity Restoration Coverage FE -6999.2 Terrorism Insurance Cov Notice CMP -4994 Data Compromise CMP -4710 Employee Dishonesty GMP -4746.1 Hired Auto Liability CMP -4261 Amendatory Endorsement CMP -4260.1 Amendatory Endorsement -CA CMP -4709 Money and Securities CMP -4698 Back -Up of Sewer or Drain CMP -4704.1 Dependent Prop Loss of Income CMP -4703.1 Utility Interruption Loss Incm Prepared APR 17 2020 ©Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 016091 Continued on Next Page Page 6 of 7 aK-;«,,57 DECLARATIONS (CONTINUED) Home Product Sales Policy for COSTA MESA SANITARY DISTRICT Policy Number 92 -EX -5166-6 CMP -4786.1 1 { CMP -4787 CMP -4788.1 CMP -4610 FD -6007 Addl Insd Owners Lessee Sched Waiver of Trans Rgt of Recov Addl Insd Mgrs Lessor of Prem General Agg Limit Per Proj Inland Marine Attach Dec This policy is issued by the State Farm General Insurance Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm General Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President IMPORTANT NOTICE: California law requires us to provide you with information for filing complaints with the State Insurance Department regarding the coverage and service provided under this policy. Your agent's name and contact information are provided on the front of this document. Another option is to reach out by mail or phone directly to: State Farm' Executive Customer Service PO Box 2320 Bloomington IL 61702 Phone # 1-840-STATEFARM (1-800-782-8332) Department of Insurance complaints should be filed only after you and State Farm or your agent or other company representative have failed to reach a satisfactory agreement on a problem. California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles, CA 90013 Phone # 1 -800 -927 -HELP (4357) or visit www.insurance.ca.govl0l-consumers Prepared APR 17 2020 CMP -4000 016092 290 N O Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 7 92 -EX -5166-6 016092 N STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS 85 75085-3925 Policy Number 92 -EX -5166-6 Named Insured Policy Period Effective Date Expiration Date M -23-3535-17138A F Z 12 Months MAY 16 2020 MAY 16 2021 The Aey period begins and ends at 12:01 am standard WESTERN A/V INC time premises locabon. 1592 N BATAVIA ST STE 2 ORANGE CA 92867-3554 ATTACHING INLAND MARINE Automatic Renewal - If the policy period is shown as 12 months , this policy will be renewed automatically subjectto the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE -8745 Inland Marine Computer Prop FE -6271 Amendatory Endorsement FE -8739 Inland Marine Conditions See Reverse for Schedule Page with Limits Prepared APR 17 2020 ^ Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD -6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 016093 530 686 a.2 05 31-2011 WN232c1 92 -EX -5166-6 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE -8745 Inland Marine Computer Prop 2 5, 0 0 0 $ 500 Included Loss of Income and Extra Expense 2 5 , 0 0 0 Included Prepared APR 17 2020 FD -6007 016093 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 530 606a.2 05-31-2011 1013233c) 92 -EX -5166-6 016094 CMP -4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY. CMP -4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 -EX -5166-6 o Named Insured: WESTERN A/V INC 1592 N BATAVIA ST STE 2 ORANGE CA 92867-3554 Name And Address Of Additional Insured Person Or Organization: COSTA MESA SANITARY DISTRICT THEIR ELECTED & APPOINTED OFFICIALS OFFCIERS, VOLUNTEERS & EMPLOYEES 290 PAULARINO AVE COSTA MESA CA 92626-3314 1. SECTION 11 WHO IS AN INSURED of b. If coverage provided to the additional in - SECTION 11 LIABILITY is amended to in- sured is required by a contract or agree- clude, as an additional insured, any person or organization shown in the Schedule, but only ment, the insurance provided to the with respect to liability for "bodily injury", additional insured will not be broader than y damage", or "personal and advertis- "property that which you are required by the contract ing injury" caused, in whole or in part, by: or agreement to provide for such addition - a. Ongoing Operations al insured; and (1) Your acts or omissions; or c. If the contract or agreement between you and the additional insured is governed by (2) The acts or omissions of those acting California Civil Code Section 2782 or on your behalf; 2782.05, the insurance provided to the in the performance of your ongoing opera- additional insured is the lesser of that which: tions for that additional insured; or b. Products – Completed Operations (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali - "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability; or completed operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the agreement to provide for such addi- following: tional insured. a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement un - ted by law; til a claim or "suit" is tendered to us. 0, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED 92 -EX -5166-6 016094 CMP -4786.1' Page 2 of 2 2. Any insurance provided to the additional in- (3) The nature and location of any injury sured shall only apply with respect to a claim or damage arising out of the "occur - made or a "suit" brought for damages for rence" or offense; which you are provided coverage. b. Tender the defense and indemnity of any 3. With respect to the insurance afforded to the claim or "suit" to us and to all other insur- additional insured, the following is added to ers who may have insurance potentially SECTION li — LIMITS OF INSURANCE: available to the additional insured; and If coverage provided to the additional insured c. Agree to make available any other insur- is required by contract or agreement, the most ance the additional insured has for de - we will pay on behalf of the additional insured fense or damages for which we would will be the lesser of the amount of insurance: provide coverage under SECTION Il — a. Required by the contract or agreement; or LIABILITY. b. Available under the applicable Limits Of 5. With respect to the insurance afforded the ad - Insurance shown in the Declarations. ditional insured, the following replaces SEC- TION it --LIABILITY of Paragraph 7. Other This endorsement shall not increase the ap- Insurance of SECTION I AND SECTION II — plicable Limits Of Insurance shown in the COMMON POLICY CONDITIONS: Declarations. a. This insurance is primary to and will not 4. With respect to the insurance afforded to the seek contribution from any other insurance additional insured, the following is added to available to the additional insured, provided Paragraph 3. Duties In The Event Of Occur- that the additional insured is a named in- rence, Offense, Claim Or Suit of SECTION sured under such other insurance. II — GENERAL CONDITIONS: b. Regardless of any agreement between The additional insured must: you and the additional insured, this insur- ance is excess over any other insurance a. See to it that we are notified as soon as whether primary, excess, contingent or on practicable of an "occurrence" or an of any other basis for which the additional in- fense which may result in a claim. To the sured has been added as an additional in - extent possible, notice should include: sured on other policies. (1) How, when and where the "occur- There will be no refund of premium in the event rence" or offense took place; this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP -4786.1 0, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Servioes Office, Inc., with its permission.