Loading...
Insurance - Harper & Burns 2020-10-270 t 27 20, 10:18a 9496617869 p.1 4CK 1Ir14tR I C u%jcoo, 14ll 1 ►aivicrgv, cr I c%vv vr% M... i L.r% . r..... v. v �i� r 1 . ...— � BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIPICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(los) must have ADDITIONAL INSURED provisions or be endorsed. It S EnGATICIN IS WAIVFI).,qtjh!Prt to tho, forms and conditions of the policX. certain policies mU reguire an endorsement. A statement on this certificate does not confer rights to the certificate holder in Lieu of such endorsement(s). PRODUCER SIrtateFarm Charles W Bott Insurance Agency Inc ' 647 Camino de los Mares Suite 226 CONTA F1AME: CT Charlie Bott AICNf o E t : 949 661 6272 FAX, A c Nei; 9496617869 E-MAIL ,harile.boft.b8rd@statefarm.com ADDRE : { San Clemente, CA 92673 INSURERS AFFORDING COVERAGE NAIL # INSURER A: State Farm General Insurance Company 25151 92 -EJ -Y122-3 INSURED INSURER B : INSURER C : Harper & Burns LLP, John R Harper a Professional Corporation INSURER 0: and Alan R Bums and Colin Robert Burns INSURER E: 453 S Glassed St INSURER F: Orange, CA 92$66-1905 COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE ADSL JUS1 SUER POLICY NUMBER POLICY EFF, MMIDD..ILICYYYYY LIMITS AUTHORIZED REPRESENTATIVE ` f � ' COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ®OCCUR X -MD- 92 -EJ -Y122-3 E 04101/2020 04/0112021 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence)$ MED EXP (Any one person) S PERSONAL & ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC JECT I OTHER'. GENERAL AGGREGATE 5 2,000,000 PRODUCTS • COMP(OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO tU_ S SCHEDULED Al Toc1tiLY AUTOS HIRED NON•0'AINED AUTOS ONLY AUTOS ONLY 92 -EJ -Y122-3 04/01/2020 0410112021 COMBINED SINGLE LIMIT $ 1_a accident BODILY INJLRY (Per person) $ 1,000,000 BODILYINJURY (Per accident) $ 1,000,000 PROPERTY DAMAGE $ 1,000,000 Per accident UMBRELLA LIAR EXCESS LIAR _ OCCUR CLAIMS -MADE I EACH OCCURRENCE $ AGGREGATE $ I RETENTION $ $ X _2:=D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y j N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? V I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N t A 92-EK-WO56-3 0412412020 04/24/2021 'PER OTH- STATUTE ER 1.{ E.L. EACH ACCIDENT S }00,000 E.L. DISEASE -EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT S 1,000,000 f DESCRIPTION OF OPERATIONS t LOCATIONS t VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) COSTA MESA SANITARY DISTRICT THEIR ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS AND EMPLOYEES LISTED AS ADDITIONAL INSURED --PURSUANT TO ATTACHED ENDORSEMENTS. P..FRTIFICATE HOLDER CANCELLATION Q 1888-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marcs of ACORD 1001486 132849.12 03-16-2016 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE —OP THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COSTA MESA SANITARY DISTRICT ACCORDANCE WITH THE•Pa1rICY PROMIONS. 290 PAULARINO AVENUE AUTHORIZED REPRESENTATIVE ` f � ' COSTA MESA, CA 92626 �� 3 ��% i3 Q 1888-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marcs of ACORD 1001486 132849.12 03-16-2016 Oct 27 20, 10:18a #496617869 P -a SJ S)j Policy No. 92 EJY122 3 CMP -4786.1 Page I 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 Policy Number; 92 EJY122 3 Named Insured: HARPER & BURNS LLP JOHN R HARPER A PROFESSIONAL CORPORATION AND ALAN R BURNS AND COLIN ROBERT BURNS 453 5 GLASSELL ST ORANGE CA 922866-1905 Name And Address Of Additional Insured Person Or Organization: COSTA MESA SANITARY DISTRICT ITS ELECTED AND APPOINTED OFFICIALS AGENTS OFFICERS VOLUNTEERS AND 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 ment, the insurance provided to the organization shown in the Schedule, but only additional insured will not be broader than with respect to liability for "bodily injury", "property damage", or "personal and adverbs -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 c. If the contract or agreement between you (1) Your acts or omissions; or 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 tions for that additional insured; or which: b. Products — Completed Operations "Your work" performed for that additional insured and included in the "procluGt*- completed operations hazard". However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2762 or 27$2.05 rQr your *61c liability, 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 "suit" is tendered to us. Q. Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED Oct 272O.1O18a 2. Any insurance sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. I With respect to the insurance afforded to the additional /nsured, the following is added to SECTISECTION || -- LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: m. Required by the contract oragreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement ahm|| not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the fo||ovv/nQ in added to Paragraph 3. Duties In The Event Of Occur- rence, coupmence' Offense, C8aUrn Or Suit of SECTION || --GENERAL CONDITIONS: The additional insured must: a` See to it that we are notified as moon as practicable of an "occurrence" or an of- fense which may result in a claim. f-fenoevvh|ohmnaynoau|tinocleim. To the extent possible, notice should include, (1) How, when and where the "occur- rence" or offense took place; onnur-renmy^oroffenme0mohp|ece; (2) The names and addresses of any in- jured persons and witnesses; and oPAp-*ruo1 4496617869 p.3 Page 2 of 2 (3) The nature and location of any injury' or damage arising out of the `h��u� rence" or offense; b. Tender the defense and indemnity of any c|@irn or "suit" to us �nd to all other insur- ers who m h may have insurance potentially available tothe 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 provide coverage under SECTION || -- 5. With ditional insured, the following replaces SEC- TION 11 —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION If — 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 phmary, exmaom, contingent or on any other basis for which the additional in- sured has been added mmanadditional in- sured onother policies, There will be no refund of premium in the event this endorsement |scancelled, All other policy provisions apply. D, Copyright, State Farm Mutual Automobile Insurance Company, 2013 10070 u �^oo 1 08-21-2014�� — '