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Insurance - Harper & Burns 2022-02-11ACOREf CERTIFICATE OF LIABILITY INSURANCE `--�'� DATE (MM/DD/YYYY) 02/11/2022 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 Charlie Bott StateFarm Charles W Bott Insurance Agency Inc PHONE NE 949 661 6272 949 6617869 AC 647 Camino de los Mares Suite 226 Ext: — NoL - E-MAIL San Clemente, CA 92673 ADDRESS: -charlie.bott.b8rd@statefarm.com - — INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : State Farm General Insurance Company 25151 INSURED INSURER B : Harper & Burns LLP, John R Harper a Professional Corporation INSURER C : and Alan R Burns and Colin Robert Burns _ - INSURER D: 453 S Glassell St INSURER E : Orange, CA 92866-1905 INSURER F: COVERAGES CERTIFICATE NUMBER: QFviclnnl ml le111011=0 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 — SUBR - -- LTR TYPE OF INSURANCE POLICY EFF POLICY EXP INSDWVDPOLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE - $ 1,000,000X M - CLAIMS -MADE OCCUR AO D - -- _PREM ISESLEa occurrence) }$ MED EXP (Any one person) $ X 92 -EJ -Y122-3 04/01/2021 04/01/2023 ---PERsoNAL & ADV - INJURY s ------------------------ GEEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 PRO POLICYLOC ---------- JECT -LOC ---- - --- --- PRODUCTS - COMP/OP AGG S OTHER: ------ -- -- $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea accident) xy ANY AUTO BODILY INJURY (Per person) S 1,000,000 OWNED SCHEDULED ---------- - — --- AUTOS ONLY _ AUTOS BODILY INJURY (Per accident) S 1,000,000 HIRED NON -OWNED 92 -EJ -Y122-3 04/01/2021 04/01/2023 ;PROPERTY DAMAGE --- AUTOS ONLY _ AUTOS ONLY �er_accident S 1,000,000 S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE S DED ! RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE _ _ ER y__ ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,000,000 X OFFICER/MEMBER EXCLUDED? X❑ N / A' 92-EK-WO56-3 04/24/2021: 04/24/2023 -==-- H AC - (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 DESCRIPTION OF OPERATIONS / LOCATIONS / 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. —� %oAN%,r_LLH 1 IUN COSTA MESA SANITARY DISTRICT 290 PAULARINO AVENUE COSTA MESA, CA 92626 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.12 03-16-2016 Policy No. 92 EJY122 3 3601-FA64 CMP -4786.1 Page 1 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 SCHEDULE Policy Number: 92 EJY122 3 Named Insured: HARPER & BURNS LLP JOHN R HARPER A PROFESSIONAL CORPORATION AND ALAN R BURNS AND COLIN ROBERT BURNS AND 453 S GLASSELL ST ORANGE CA 92866-1905 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 II — WHO IS AN INSURED of b. If coverage provided to the additional in - SECTION II — 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", " "personal that which you are required by the contract property damage", or and advertis- ing injury" caused, in whole or in part, by: or agreement to provide for such addition - al insured; and a. Ongoing Operations 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 thatwhich: tions for that additional insured; or b. Products – Completed Operations (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali - "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability; or completed operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the agreement to provide for such addi- following: tional insured. a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement un - ted by law; til a claim or "suit" is tendered to us. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED CMP -4786.1 Page zofo 2. Any insurance provided to the additional in- (3) The nature and location of any injury shalloured shall only apply with respect to e claim or damage arising out of the "occur- o ur-mode madeor a "suit" brought for damages for renoe'oroffense; which you are provided coverage. b. Tender the defense and indemnity of any O. With respect tothe insurance afforded to the c|einn or "suit" to us and to all other inyur- addiUone| insured' the fo||ovvxlg is added to erm who may have insurance potentially SECTION 11 --LIMITS OF INSURANCE: available tothe additional insured; and If coverage provided to the additional insured c. Agree to make available any other inmup iarequinadbycontnectoragreernent.thernomt once the additional insured has for de - we will pay on behalf of the additional insured fenee or damages for which we would will bethe lesser ofthe amount ofinsurance: provide coverage under SECTION || -- a. Required bythe contract oragreement; or LIABILITY. b' Available under the applicable Limits Of 5^ With respect to the insurance afforded the ad - Insurance shown inthe Declarations. diUona| insured, the following replaces SEC- TION |Y —LIABILITY of Paragraph 7. Other This endorsement shall not increase the ap- Insurance ofSECTION | AND SECTION 11 p|icub|e Limits Of Insurance shown in the COMMON POLICY CONDITIONS: Declarations. - a. This insurance is primary to and will not 4. With respect to the insurance afforded to the seek contribution from any other insurance additional inaured, the following is added to available iothe additional insured, provided Paragraph 3. Duties In The Event Of Occur- that the additional insured is a nernad in- renoe' Offense, Claim Or Suit of SECTION aured under such other insurance. ||-- GENERAL CONDITIONS: b. Regardless of any agreement between The additional insured must: you and the additional insured, this insur- nauponce e. See to itthat vve are notified as soon as anceis excess over any other insurance whether pr|rnory, exceam, contingent or on -additional practicable of an "occurrence" or an of - any other basis for which the in- fensovvhioh may result in o claim. To the aured has been added as an additional in - extent possible, notice should include: mured on other policies. /1>Hovv when and where the "occur-` ' ', There will be no refund of premium in the event rence oroffense took place; this endorsement iecancelled. (2) The narn*a and addresses of any in- jured persons and witnesses; and All other policy provisions apply. oMP-478s/ 1007033 14e011 08-21'2014 m.Copyright, StetoFarmmuma/Automom/e/n,umncmoompanv.0010