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Insurance - Michale Balliet Consulting, LLC - 2021-09-09CERTIFICATE OF LIABILITY INSURANCE YY)ACDOR" 09/09/2021161. 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 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 Professional Ins. Associates/Ability Insurance Agency Inc. 74133 EI Paseo, Suite 8 CONTANAME: Michael Kosmerl PHONE . N Ext : 714/968-9600 FAX No): AD RIESS: mike abilit ins.com INSURERS AFFORDING COVERAGE NAIC # Palm Desert, CA 92260 INSURER A: Hartford Casualty Insurance Company 29424 INSURED INSURER B: Hartford Casualty Insurance Company 29424 INSURER C : Michael Balliet Consulting, LLC INSURER D: 30181 Outpost Road INSURER E: San Juan Capistrano, CA 92675 INSURER F: Hiscox Insurance Comi2any 110200 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. INSR LTR OF INSURANCE ADDLTYPE INSR SUER POLICY NUMBER EFF MM/DDIIYYYY MLICY Y EXP M DD //YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 A X CLAIMS MADE OCCUR Y Y 57SBABF8296 10/26/2020 10/26/2021 MED EXP {Any one person} $ 10 (1101.0 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ PRO LOC X POLICY JECT AUTOMOBILE LIABILITY COEa aB deD SINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ ANY AUTO B ALL OWNED SCHEDULED AUTOS AUTOS y Y 57SBABF8296 10/26/2020 10/26/2021 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X HIRED AUTOS X NON -OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- TORY LIMITS ER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ F Professional Liability N N UDC -4214172 -EO -20 07/19/2021 07/19/2022 Liability Limit $1,000,000 Policy Deductible $1,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 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 endorsement. CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 290 Paularino Avenue T")12�� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa, CA 92626 ��/� l ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /1 I%c6e' I`C3�'Yl�ed Verified by PDFFiller 07/06/2020 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 57 SBA BF8296 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE/POLITICAL SUBDIVISION CITY OF NEWPORT BEACH 3300 NEWPORT BLVD NEWPORT BEACH, CA 92663 THE COSTA MESA SANITARY DISTRICT, IT'S ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS AND EMPLOYEES 290 PAULARINO AVE COSTA MESA, CA 92626 THE CITY OF IRVINE AND ITS EMPLOYEES, REPRESENTATIVES OFFICERS AND AGENTS(CITY AND CITY PERSONNEL) C/O CERTSONLY-PORTLAND@EBIX.COM 1 CIVIC CENTER PLZ IRVINE CA 92606 CITY OF IRVINE AND ITS EMPLOYEES, REPRESENTATIVES, OFFICERS AND AGENTS PO BOX 257 PORTLAND MI 48875-0257 REF ##113-373270 THE CITY OF LOS ALAMITOS, ITS OFFICERS, EMPLOYEES, AGENTS AND VOLUNTEERS 3191 KATELLA AVE. LOS ALAMITOS, CA 90720 Form IH 12 00 11 85 T SEQ. NO. 002 Printed in U.S.A. Page 001 Process Date: 08/08/19 Expiration Date: 10/26/20 F .v (6) When You Are Added As An Additional Insured To Other Insurance That is other insurance available to you covering liability for damages arising out of the premises or operations, or products and completed operations, for which you have been added as an additional insured by that insurance; or (7) When You Add Others As An Additional Insured To This Insurance That is other insurance available to an additional insured. However, the following provisions apply to other insurance available to any person or organization who is an additional insured under this Coverage Part: (a) Primary Insurance When Required By Contract This insurance is primary if you have agreed in a written contract, written agreement or permit that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in c. below. (b) Primary And Non -Contributory To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement or permit that this insurance is primary and non-contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured. When this insurance is excess, we will have no duty under this Coverage Part to defend the insured against any "suit' if any other insurer has a duty to defend the insured against that "suit'. If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. BUSINESS LIABILITY COVERAGE FORM When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self- insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part c. Method Of Sharing If all the other insurance permits contribution by equal shares, we will follow this method also. Under this approach, each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 8. Transfer Of Rights Of Recovery Against Others To Us a. Transfer Of Rights Of Recovery If the insured has rights to recover all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit' or transfer those rights to us and help us enforce them. This condition does not apply to Medical Expenses Coverage. b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. Form SS 00 08 04 06 Page 17 of 24 POLICY NUMBER: 57 SBA BF8296 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE/POLITICAL SUBDIVISION CITY OF NEWPORT BEACH 3300 NEWPORT BLVD NEWPORT BEACH, CA 92663 THE COSTA MESA SANITARY DISTRICT, IT'S ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS AND EMPLOYEES 290 PAULARINO AVE COSTA MESA, CA 92626 THE CITY OF IRVINE AND ITS EMPLOYEES, REPRESENTATIVES OFFICERS AND AGENTS(CITY AND CITY PERSONNEL) C/O CERTSONLY-PORTLAND@EBIX.COM 1 CIVIC CENTER PLZ IRVINE CA 92606 CITY OF IRVINE AND ITS EMPLOYEES, REPRESENTATIVES, OFFICERS AND AGENTS PO BOX 257 PORTLAND MI 48875-0257 REF ##113-373270 THE CITY OF LOS ALAMITOS, ITS OFFICERS, EMPLOYEES, AGENTS AND VOLUNTEERS 3191 KATELLA AVE. LOS ALAMITOS, CA 90720 Form IH 12 00 1185 T SEQ. NO. 002 Printed in U.S.A. Page 001 Process Date: 0 8 / 0 8 / 19 Expiration Date: 10/26/20