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Insurance - Robin B. Hamers & Associates, Inc. 2021-08-02� � AcoRo CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YWY) 11-­ 8/2/2021 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 endorsement(s). PRODUCER CONTACT NAME: Chelsea Rosato (MP) Heffernan Insurance Brokers 1460B O'Brien Drive PHONE FAX A/C No_Ext): 650-842-5200 _ i (A/C, No): 650-842-5201 - ADMDRESS: chelsear@heffins.com Menlo Park CA 94025 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Travelers Property Casualty Compa.0y of America 25674 License#: 0564249 INSURED ROBIBHA-01 INSURER B: Hanover Insurance Company 22292 Robin B. Hamers & Associates, Inc. - --_— -- — - - --- 234 E. 17th Street, Suite 205 INSURER C : Costa Mesa CA 92627 INSURER D : INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 1153665816 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 ADDLSUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR ! IN D ; WVD i POLICY NUMBER MM/DWYYYYMM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 6801S14879A2147 6/1/2021 6/1/2022 EACH OCCURRENCE 51,0_00,000_ - -', CLAIMS -MADE X ;OCCUR _ -- DAMAGE TO RENTED _ MI PRESES�Ea occurrence S 1,000,000 -- - MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 X :, PRO POLICY JECT LOC PRODUCTS - COMP/OP AGG S 2,000,000 OTHER: A AUTOMOBILE LIABILITY Y 6801S14879A2147 6/1/2021 6/1/2022 COMBINED SINGLE LIMIT $Included in GL LEa acciden t — �------ __-------- ---------------- --- _ ---- -.-. ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident): $ AUTOS ONLY AUTOS X HIRED X i NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY ;___- AUTOS ONLY jPer_accident)- : $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ----- � -- -- EXCESS LIAB y CLAIMS -MADE AGGREGATE $ DED RETENTIONS $ B WORKERS COMPENSATION WZF901252910 3/23/2021 3/2312022 X : PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY Y / N _.__. _.... ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED?:N/A - --- (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE' S 1,000,000 If yes, describe under ----------- -- DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 B Professional Liability LHFD32755804 7/27/2021 7/27/2022 Per Claim 1,000,000 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 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 included as an additional insured and primary with respects to the General Liability and Automobile Liability policies per the attached endorsements, if required. CERTIFICATE HOLDER CANCELLATION Ql q l / ` , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 11 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN i("�� ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District \i11(({{ 290 Paularino Ave., AUTHORIZED REPRESENTATIVE Costa Mesa, CA 92626 _r-- @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, done under a "written contract requiring insurance" with that person or organization. We waive this right only where you have agreed to do so as part of the "written contract requiring insurance" with such person or organization signed by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. 4. The following definition is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After you have signed that written contract; b. While that part of the written contract is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2015 The Travelers Indemnity Company. All rights reserved. CG D3 81 09 15 Includes the copyrighted material of Insurance Services Office, Inc., with its permission AdW- TRAVELE9S Report Claims Immediately by Calling* 1-800-238-6225 Speak directly with a claim professional 24 hours a day, 365 days a year *Unless Your Policy Requires Written Notice or Reporting ENGINEERS A Custom Insurance Policy Prepared for: ROBIN B. HAMERS & ASSOCIATES, INC. 234 E 17TH ST STE 205 COSTA MESA CA 92627 Presented by: HEFFERNAN INS BROKERS TRAVELERS One Tower Square, Hartford, Connecticut 06183 BUSINESSOWNERS COVERAGE PART DECLARATIONS OFFICE PAC POLICY NO.: 680-1S14879A-21-47 ISSUE DATE: 03/18/2021 INSURING COMPANY: THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT POLICY PERIOD: From 06-01-21 to 06-01-22 12:01 A.M. Standard Time at your mailing address FORM OF BUSINESS: CORPORATION COVERAGES AND LIMITS OF INSURANCE: Insurance applies only to an item for which a "limit" or the word "included" is shown. COMMERCIAL GENERAL LIABILITY COVERAGE OCCURRENCE FORM LIMITS OF INSURANCE General Aggregate (except Products -Completed Operations Limit) $ 2,000,000 Products -completed Operations Aggregate Limit $ 2,000,000 Personal and Advertising Injury Limit $ 1,000,000 Each Occurrence Limit $ 1,000,000 Damage to Premises Rented to You $ 11000,000 Medical Payments Limit (any one person) $ 51000 BUSINESSOWNERS PROPERTY COVERAGE DEDUCTIBLE AMOUNT: Businessowners Property Coverage: $ 500 per occurrence. Building Glass: $ 500 per occurrence. BUSINESS INCOME/EXTRA EXPENSE LIMIT: Actual loss for 12 consecutive months Period of Restoration -Time Period: Immediately ADDITIONAL COVERAGE: Fine Arts: $ 25,000 Other additional coverages apply and may be changed by an endorsement. read the policy. SPECIAL PROVISIONS: COMMERCIAL GENERAL LIABILITY COVERAGE IS SUBJECT TO A GENERAL AGGREGATE LIMIT MP TO 01 02 05 (Pagel of 2 ) Please POLICY NUMBER: 680-1S14879A-21-47 EFFECTIVE DATE: 06/01/2021 ISSUE DATE: 03/18/2021 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS IL TO 19 02 05 COMMON POLICY DECLARATIONS MP TO 01 02 05 BUSINESSOWNERS COVERAGE PART DECLARATIONS IL T8 01 01 01 FORMS ENDORSEMENTS AND SCHEDULE NUMBERS IL T3 15 09 07 COMMON POLICY CONDITIONS BUSINESSOWNERS MP Tl 30 02 05 TABLE OF CONTENTS - BUSINESSOWNERS COVERAGE PART - DELUXE PLAN MP PO 06 09 15 ARCHITECTS, ENGINEERS AND SURVEYORS PROPERTY ENHANCEMENT MP PO 07 09 15 ARCHITECTS, ENGINEERS AND SURVEYORS FLOOD ENDORSEMENT MP PO 08 09 15 ARCHITECTS, ENGINEERS AND SURVEYORS EARTHQUAKE ENDORSEMENT MP Tl 02 02 05 BUSINESSOWNERS PROPERTY COVERAGE SPECIAL FORM MP Tl 05 02 05 AMENDATORY PROVISIONS - OFFICES MP T3 06 02 07 SEWER OR DRAIN BACK UP EXTENSION MP T3 25 01 21 FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE MP T3 29 09 18 ERISA COVERAGE MP T3 50 11 06 EQUIPMENT BREAKDOWN - SERVICE INTERRUPTION LIMITATION MP T3 56 02 08 AMENDATORY PROVISIONS - GREEN BUILDING AND BUSINESS PERSONAL PROP COV ENHANCEMENTS MP T4 90 05 10 LIMIT OF INS/OCCURRENCE ENDT - CALIFORNIA MP T5 08 02 20 CALIFORNIA CHANGES MP T5 02 02 05 CALIFORNIA CHANGES - ESCROW AGENT COMMERCIAL GENERAL LIABILITY CG D4 69 02 19 TOT AGG LIMIT OTHER THAN PROJECTS CG TO 34 02 19 TABLE OF CONTENTS - COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG Tl 00 02 19 CG T1 00 02 19 COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG D3 09 02 19 AMENDATORY ENDORSEMENT - PRODUCTS -COMPLETED OPERATIONS HAZARD CG D3 81 09 15 BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) CG D6 75 02 19 AMEND -WHO IS INS-ARCHIT/ENG/SURVEY ACTIV CG D2 03 12 97 AMEND - NON CUMULATION OF EACH OCC CG D3 79 02 19 XTEND ENDORSEMENT FOR ARCHITECTS, ENGINEERS AND SURVEYORS MP Tl 25 11 03 HIRED AUTO AND NON -OWNED AUTO LIABILITY CG D3 80 10 11 EXCLUSION - ENGINEERS, ARCHITECTS OR SURVEYORS PROFESSIONAL LIABILITY CG D4 21 07 08 AMEND CONTRAL LIAB EXCL - EXC TO NAMED INS IL T8 01 01 01 PAGE: 1 OF 2 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKETADDITIONAL (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION 11 — WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c. With respect to the independent acts or omissions of such person or organization; or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. f. This insurance does not apply to the rendering of or failure to render any "professional services". g. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement does not increase the limits of insurance described in Section III — Limits Of Insurance. h. This insurance does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products - completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 2. The following is added to Paragraph 4.a. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the additional insured which covers that person or organizations as a named insured for such loss, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have signed that "written contract requiring insurance". But this insurance provided to the additional insured still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. CG D3 81 09 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission