Insurance - Theresa Kasprzyk 2020-05-15•' + t�► CERTIFICATE OF LIABILITY INSURANCE
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERIMCATE HOLDER, THIS
CEttTiFlCATE DONS NOT AI`FIiiMAMFELY OR NEGATIVELY AMEND* EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, TM CERTIFICATE Of INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED,
REPRESENTATIVE ,OR PRODUCER, AND TW CERTIFICATE HO<MA
IMPORTANfi If fhl► catftot holdw Is an ADDITIONAL INSURED, Ow pollq(" must have ADMONAL INSURED provhbm or be enclatsed.
If SUBROGATION IS WAIVED, sut to flw Wm and condidons at the policy, to main pallcles may nquke an endorsement, A statement On
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State)Wlrtft STATE FARM INSURANCE
MARK R REESE, AGENT
8130 MCFADDEN AVE SUITE 205
WESTMINSTER. CA'9=
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THERESA KASPRZYK
DBA TERRASTAR MEDIA
13861 JASPERSON WAY
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COVERAGES CERTIFICATE NUMBE L- REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE. BEEN MWED TO THE INUMD NOD ABM MR THE POLICY PER*0
INDICATED. NOI'VMSTANDING ANY RE REVENT fiEfilN OR 0014DIIIGN OF ANY CONTWT OR OTHER DOCUMENT WITH R96PECT TO WHICH THIS
C8MCATE 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 JPOLX3ES: LIMITS 140M MAY HAVE BEEN REMOM BY PAID CLANS.
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COSTA MESA SANITARY DISTRICT
290 PAULARINO AVENUE `
COSTA MESA, CA 926
SHOULD ANY OF 7NE ABOW DESCOMM POUCIES BE C04ILLSO 9000
THS EXPMtATION DATE THEREOF„ NOTICE WILL BE DEEUVERED IN
AC CORDANCE 1N!'tH THE POLICY PROVISIONS.
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ACORD 25 (WI M3) The ACORD name and logo or* registered marks of ACORD
100140 132W 13 0412-2=
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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
CMP-4706.1 ADDITIONAL INSURED --- OWNERS, LESSEES, OR CONTRACTORS
(Scheduled)
This endorsement modifies insurance provided under the following:
SUSINESSOWNERS COVERAGE FORM
SCHEDULE
Policy Number: 92 C:FN64B 5 G
Named Insured:
KASPRLYK, THERESA
uSA TERRASTAR MEDIA
13861 JASPERSON WAY
WEST.MINSTER CA 92683 4012
Name And Address Of Additional Insured Person Or Organization:
THE COSTA MESA SANITARY DISTRICT ITS ELECTED & AP?OINTED
CFPI'CTALS AGENTS OFFICERS VOLUNTEERS & EMPLOYEES
290 FAULARTNO , VEE
COSTA MESA CA 92626 3 s3 14
1. SECTION If -- WHO IS AN INSURED of
SECTION It -- LIABILITY Is amended to in-
clude, as an additional Insured, any person or
organization shown in the Schedule, but only
vWth respect to liability for "bodily injurer ,
"property damage", or "personal and adverbs-
Ing Injury' caused., In whole or in part, by:
a. Ongoing Operations
(1) Your acts or omissions: or
(2) The acts or omissions of those acting
on your behalf;
In the performance of your ongoing opera-
tions for that additional Insured; or
b. Products — Completed Operations
"Your work" performers fbr than additional
insured and included in the "products -
completed operatlons hazard,
However, Paragraph 1, above is subject to the
following:
aE The Insurance afforded to the additional
Insured only applies to the extent permit -
led by law;
b. If coverage provided to the additional In-
sured is required by a contract or agree-
ment, the Insurance provided to the
addnal insured will not be broader, than
that which you are required by the contract
or agreement to provide for such addition-
al insured, and
c. If the contract or a eernent between u
and the additional �sured Is governed by
California Civil Code Section 2782 or
2782.05, the Insurance provided to the
additional insured is the lesser" of that
which:
(1) Is allowed for the satisfaction of a de-
fense or indemnity obligation by Cali-
fornia Civil Code Section 2782 or
2782.05 fbr your sale Ilabildr, or
(2) You are required by contract or
agreement to provide for such addi-
tional insured.
We have no duty to defend or Indemnify the
additional insured under this endorsement un-
til a claim or "sub°" is tendered to us,
0. Ca ht, stato rearm Mutual A moai ,°me Ina nee Comps y. 2013
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2. Any insurance provided to the additional in-
sured shall only apply with respect to a claim
rude or a "suit" brought for damages for
which you are provided coverage.
3. V'Vith respect to the insurance aftded to the
additional insured, the following is added to
SECTION It -- LIMITS OF INSURANCE:
If coverage provided to the additional insured
is red ,ired by contract or agreement, the most
we wxli pa on behalf of the additional insured
will be gasser of the amount of insurance:
a. Required by the contract or agreement; or
b. Available under the applicable Limits Of
Insurance shown In the Declarations.
This endorsement shell not increase the ap-
plicable Limits Of Insurance shown in the
Declarations.
4. With respect to the insurance afforded to the
additional insured, the following Is added to
Paragraph 3. Duties In The Event Of Occur-
rence, Offense, Claim Or Suit of SECTION
11-- GENERAL CONDITIONS:
The additional Insured must:
a. See to it that we are notified as soon as
practicable of an "occurrence" or an of-
fense which may result in a claim. To the
extent possible, notice should include:
(1 ) How. when and where the "occur-
rence" or offense took place;
CW-4786A
Page 2 of 2
(3) The nature: and location of any injury
or damage arising out of the * occur-
rence" or offense;
b. Tender the defense and indemnity of any
claim or "suit" to us and to all ether insur-
ers who may have insurance potentially
available to the additional insured; and
c. Agree to make available any other insur-
ance the additional insured has for de-
fense or damages for which we would
pprrovide coverage under SECTION it ---
LIABILiTY.
S. With respect to the Insurance afforded the ad-
ditional insured, the following replaces SEC-
TION 11 --LIABILITY of Paragraph 7. Other
Insurance of SECTION i AND SECTION 11--
COMMON POLICY CONDITIONS:
a. This insurance is primary to and will not
seek (contribution from any other insurance
available to the additional insured, provided
that the additional Insured is a named in-
sured under such other insurance.
b. Regardless of any agreement between
you and the additional insured, this insur-
ance Is excess over any other insurance
whether primary, excess, contingent or on
any other basis for which the additional in-
sured has been added as an additional In-
sured on other policies..
There will be no refund of premium in the event
this endorsement is +canceiied.
(2) The names and addresses of any in-
jured persons and witnesses; and All other poky provisions apply.
CMP-47".1 1007033 148011 0&23.2014
n, state Farm Mutual Automobile Insurance Cwnpa y, 2013
Inc Ludes copyrip *0 Material of trawrance serwim C ce. irtts,. with 6 pemftslon