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Insurance - Mighty Oak Technology, DBA: Acorn Technology Services 2021-06-217 ACC>Rt�► CERTIFICATE OF LIABILITY INSURANCE DATE (AI�WOtitYYY`!j CERTIFICATE: MAY BE ISSUED OR MAY PERTAIN; THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 6/21/2021 THIS CERTIFICATE IS ISSUE© 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) mint 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 canter rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: 1lie Rybak Kellogg & Moreland Agency, Inc. DBAPHONE '192 8950 A7C. No ; t'9051 _20:1 Arroyo insurance Services E-MAIL ' ulier,@arra tains . com ADDRESS: Y 1654 Plum Lane INSURER(S) AFFORDING COVERAGE MAIC # INSURER A: Federal Ins Co 20281 Redlands CA 92374-4532 INSURED INSURERS . Alltnerica Financial Benefit Insurance C 41840 Mighty Oak Technology, DBA: Acorn Technology Services INSURER C: 1960 Chicago Ave #E9 INSURER 0, INSURER E : X INSURERF: .�rsre+fir�ai tit taan�n. Riverside CA 92507 nn�tcnA^r!e f1t:0TIGIt1AT9: kill RFP* RGv110I%J14 INVrvrvc.M. v%JVL_ %P%v+_v ........, ,_... ,._.._.__. _. 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 CONTRACTOR OTHER DOCUMENT VATH 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 ANIS CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADD—L SUBR POLICY EFF POLICY EXP iL R TYKE OF INSURANCE POLICY NUMBER MMIOW(-) IMM100=Y LIMITS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE X COMMERCIAL GENERAL LIABILITY EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Costa Mesar CA 92626 1�, � I �I� TACH OCCURRENCE $ 1,000,000 AIMAGF Tis R N Excluded PREMISES enoe Ea OS Uss5 �� r-, 4a00 1Jf%4A At ADn rr1QD!'3QATInh1 All rtrlh#e rPserved. A CLAWS -IMAGE r'`. r OCCUR MED EXP (Any one person) 10,000 X 3583-35-68 WCE 3/20/2021 3/20/2022 PERSONA-_ & A0V N ;UI Y S 1,000,000 ',ENFERAt. AGGREGATE 5 2,000,000 GEN °LAGGREGA'rE LIMIT APPLILS PER ='RC- POLICY � LC -C PRODUCTS - C,GMPiC3P AGG $ 2,000,000 GT OTHER COMBINF13 SINGLE LIRM,' $ 1,000,000 AUTOMOBILE LIABILITY ''EA acodcntl BODIIY ?N„ URY (Per person; S A ANYAUI'O ALL OWN ED SCHEDULED 7352-68-66 3/20/2021 3/20/2022 BODILY INJURY ;ger arc4donn S AUTOS AUTOS PROPERTY DAMAGE S NON -OWNED X HIRED AUTOS X AUTOS tPer a=dent% $ X UMBRELLA LIAB XC C>C�.JR I»A�,',ri i1.;'v`.3ReiENDE $ 2 12.001-000 EXCESS LIAR _ CLAWS -MADE —AGGREGATE 5 2,000,000 IP, 7363-27-01 3/20/2021 3/20/2022 $ CEG RE7CFstIi7N S R rJTH- X WORKERS COMPENSATION $`i+Tl3TE ER S Iu L FACH ACCIGEN" 5 1,000,000 AND EMPLOYERS' LIABILITY Y i ANY PROPRIET OWPARTN ER,1EXEC U T IVE, � S E L IitS_ASI EA EMPLOYEE 1,000,000 t FFIvEFI MEMB R EXCLUDED? tI 1 A W23 -D361238 02 7/1./2421 7/1/2022 B (Mandatory in NH) it yes describe :ander E I DISEASE - �-t�� I.Y L1sT S 1,000,000__ I�o��..R;PTI�I�I GE C4PE?2ATi�u'N below Cyber Liability 3583--35-68 WCC I 3J20/2021 3/2012022 52.�0J.30�A99(er3areLimt A DESCRIPTION OF OPERATIONS J LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached if more space Is required) "The Costa Mesa Sanitary District, its elected and appointed officials, agents, officers, volunteers, and employees are additional insureds including primary wording per attached form #800223671' titK I (F-KoAI I_ MULucrc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary DistrictTHE 290 Paularino Avenue EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Costa Mesar CA 92626 1�, � I �I� AUTHORIZED REPRESENTATIVE tu r-, 4a00 1Jf%4A At ADn rr1QD!'3QATInh1 All rtrlh#e rPserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 t20140i, r 70rmwixl�� J=finv= rfflr#jm�� Policy Period MARCH 1), 2021 TO MARC H 20, 2022 Effective Date MARCH 20, 2021 Policy Number 3583-35-68 WCE Insured MIGHTY OAK TI CHNOLMY D13A ACORN 'l'1-CHNOI,O(iY SERVICES Name of Company FEDERAL INSURANCE CONVANY Date Issued DfCEMRER 21.2020 This Endorse.awnt applies to the following forms: GENERAL LIABILITY 'Under Who Is An insured, the following provision is added. Who Is An Insured Additional Insured - Persons or organizations shown in the schedulc are: insureds; but they are insureds only if You are Scheduled Person obligated pursuant to a contract of agrecrivut tA) provider them with such insurance as is afforded by Or Organization this policy. However. the person or organization is an insured only: 0 if and then only to the extent the pvisou of organization is dcscribcd in thiz Schedule; # to the extent such contract or agreenicntt requires the person or organization to he afforded status as an knsurtd, # for acdvitics that did not occur, in whoic or is Marc, before: the: CUCU601) of the Contruvt or ,agreement, and 4 with r-,sj-wct to damages, losli, cost or expense for injury of dw-nage to which this insuraticc Applies, No persion or orgallizAtit") is an Insured under this liToWd011: • that is more sI)CCifically identified undL, any other provtsion of tile Who Is An Insured iection (mgardlcss of any lialitation applicabic thcreto). with respect to any assumption of liability (of another person or organizatiou) by them W a contract or agreernent.ThLs limitation docs no, apply to the liability for damagv% loss, cost or expense for injury or damage, to which this insurance applies, that the person or orgauization. would have in the absence of such contract or agreement. Liability Insuranco Addiborwl Insure d - Scheduled Poison Or OtYunt"000 contnued Page I Form 80-02-2367 Endorsement Liability Endorsement (continued) Under Conditions, the following proNision is added to the condition titled Other Insurance. Other Insurance — if you arc obligated, pursuant to a contract or agreement, to pr vi the person or organization priMary, Non tributory shown in the ,Schedule with primay inmirdrce such as is -afforded by this policy, then in such case Insurance - Scheduled this insurance is primary and we will not seek contribution from iniurAnCc available to such person Person Or Organization or organization. THE COSTA MESA SANITARY DISTRICT, ITS ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS AND EMPLOYEES All other terrws and conditions remain unchanged. Authorized Representative Uabifiry Insurance AftbofW Insuf0d - Scbaoulod Person Of Ofganlzabwlast page Form 80-W-2367 fRev. 6-07) Endorsement Page 2