Insurance - SpringML, Inc. - 2020-4-16A C�R 1 0
CCO CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
4/16/2020
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 endomement(s).
PRODUCER ABD Insurance & Financial Services
NAME NTAC Certificate Request
450 Sansome Street, #300
San Francesco, CA 94111
PHONE 415-483-7770 FAX Na ; 415-483-7769
DORIESS: TechCertR uest theabdteam.com
INSURERS AFFORDING COVERAGE NAIC #
INSURERA: Continental Casualty Company 20443
www.theabdteam.com
INSURED
Spprin ML, Inc.
6200-Stoneridge Mall Road, Suite 300
Plesanton CA 94588
INSURER B : CFC Underwriting/Lloyd's
INSURERC:
INSURER D :
INSURER E
T
INSURER F :
COVERAGES CERTIFICATE NUMBER: 55097286 REVISION NUMBER:
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
SUBR
POLICY NUMBER
POLICY EFF POLICY EXP
MM/DD MMIDD
LIMITS
COMMERCIAL GENERAL LIABILITY
✓
6021094546
5/14/2019 5/14/2020 EACH OCCURRENCE 1 $1,000,000
CLAIMS -MADE ✓ OCCUR
DAMA�TO A-EPi 96 j $1,000,000
+ PREMISES Ea occurrence). _1
I
MED EXP (Anyone person)___I $10,000
''
_—
PERSONAL & ADV INJURY ($ 1 000 000
GEN'L AGGREGATE LIMIT APPLIES PER: III
1
{ GENERAL AGGREGATE I $ 2,000,000
PRO- I
✓ POLICY !_ JECT _. —1LOC i
i
I
—�
I�PRODUCTS - COMP/OP AGG Z,000 000 _ --
OTHER:
I
A AUTOMOBILE LIABILITY
6021094546 1 5/14/2019 .
5/14/2020 1 O B tleDiSINGLE LIMIT(Ea $ 1,000,000
ANY AUTO
j
i
BODILY INJURY (Per person) ( $
OWNED SCHEDULED
AUTOS ONLY AUTOS
i
I
I
BODILY INJURY (Per accident) $
I HIRED NON -OWNED
' ✓ AUTOS ONLY ✓ AUTOS ONLY
; PR EPO RTY DAMAGE $
,$
UMBRELLA LIAB OCCUR
f `EACH OCCURRENCE J
__•
j
$
r
EXCESS LIAR -CLAIMS-MADE
`
AGGREGATE �i-
DED RETENTION $
$
WORKERS COMPENSATION
PER OTH-
i_ (_STATUTE ''. i ER
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNERIEXECUTIVE
{
! E.L. EACH ACCIDENT
$
OFFICERIMEMBEREXCLUDED? ❑
NIA A
(Mandatory in NH)
'
i E.L. DISEASE - EAEMPLOYEE1
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
B
Errors & Omissions/Cyber
ESH031160126
5/14/2019
5/14/2020 Limit: $5,000,000
I
Ded: $5,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: All Operations of the Named Insured.
Costa Mesa Sanitary District, their Elected and Appointed Officials, Agents, Officers, Volunteers and Employees are additional insureds as respects
General Liability and Automobile Liability policies but only to the extent required by written contract or written agreement. General Liability is
Primary and Non -Contributory.
GEKTIFICATE MOLOEK CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Costa Mesa Sanitary District THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
290 Paularino Avenue ACCORDANCE WITH THE POLICY PROVISIONS.
Costa Mesa, CA 92626 1;0
AUTHORIZED REPRESENTATIVE
Rod Sockolov
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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POLICY NUMBER INSURED NAME AND ADDRESS
B 6021094546 SpringML, Inc.
6200 STONERIDGE MALL RD STE 300
PLEASANTON, CA 94588
POLICY CHANGES
ENDORSEMENT EFFECTIVE 04/10/2020
This Change Endorsement changes the Policy. Please read it carefully.
This Change Endorsement is a part of your Policy and takes effect on the
effective date of your Policy, unless another effective date is shown.
The following Additional Insured(s) has (have) been added:
Type: State or Political Subdivisions - Permits
Name: The Costa Mesa Sanitary District, its elected and appointed officials,
agents, officers, volunteers and employees are additional insureds
Name 2:
Address: 290 Paularino Avenue
Address 2:
City: COSTA MESA
State: CA
Zip Code: 92626
G-56015-B (ED. 11/91)
Chairman of the Board
Secretary
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CHA
SB300100B
(Ed. 04/14)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED = STATE OR GOVERNMENTAL AGENCY OR
SUBDIVISION OR POLITICAL SUBDIVISION
- PERMITS OR AUTHORIZATIONS
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS LIABILITY COVERAGE FORM
SCHEDULE
State Or Governmental Agency Or Subdivision Or Political Subdivision:
Information required to complete this Schedule, if not shown above, will be shown in the Declarations
A. Section C: WHO IS AN INSURED is amended to include as an insured any state or governmental agency or
subdivision or political subdivision shown in the Schedule that has issued a permit or authorization for operations
performed by you or on your behalf, but only with respect to "bodily injury," "property damage," or "personal and
advertising injury" arising out of the permitted or authorized operations.
However, if coverage for the additional insured is required by written contract or agreement, then subject always to the
terms and conditions of this policy, including the limits of insurance, we will not provide such additional insured with:
1. Coverage broader than required by such contract or agreement; nor
2. A higher limit of insurance than required by such contract or agreement.
B. This insurance provided to the additional insured does not apply to:
1. "Bodily injury," "property damage" or "personal and advertising injury" arising out of operations performed for the
additional insured; nor
0
ti
m 2. 'Bodily injury" or "property damage" included within the "products -completed operations hazard."
Any coverage granted by this endorsement shall apply solely to the extent permissable by law.
s
to
9
All other terms and conditions of the Policy remain unchanged
SB300100B (Ed. 04/14)
Page 1 of 1
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services office, Inc., with its permission.
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