Insurance - Eco Partners Inc. - Workers Comp -2022-08-15ACOR& CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
��.
08/15/2022
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
NAMEACT Automatic Data Processing Insurance Agency, Inc.
Automatic Data Processing Insurance Agency, Inc.
PHONE 1-800-524-7024 FAX
MED EXP (Any one person) S
A/C No Ext - -___-___--_ __-�A/ , Nod_
--- _ _ ____
PERSONAL & ADV INJURY S
E-MAIL
GENERAL AGGREGATE S
ADDRESS:
1 Adp Boulevard
OTHER:
S
INSURER(S) AFFORDING COVERAGE NAIC #
Roseland---
NJ 07068
— -�
INSURER A : Rated by Multiple Companies
INSURED Eco Partners Inc.
INSURER B :
BODILY INJURY (Per person) S
INSURER C :
7026 W Lone Cactus Dr
INSURER D:
BODILY INJURY Per accident S
( )
INSURER E :
Glendale AZ 85308
INSURER F
t.UVtKAUtb L;I=K i IFIGATE NUMBER: Z!)b4!JJb RFVISIr1N NI IMRFR•
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.
ACCORDANCE WITH THE POLICY PROVISIONS.
-- ---
INSR ADDL SUBR --____ . __._____ ___._ _ _
r POLICY EFF T POLICY EXP
LTR TYPE OF INSURANCE INSID WV POLICY NUMBER MM/DD/YYYY ! MM/DD/YYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
_ -
EACH OCCURRENCE S
CLAIMS -MADE OCCUR
_ LWAGETO_REIgTED
S
PREMISES (Ea occurrence)
_
MED EXP (Any one person) S
PERSONAL & ADV INJURY S
GEN'L AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE S
POLICY PRO- PRO- LOC
JECTPRODUCTS
- ._.
- COMP/OP AGG S
OTHER:
S
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT S
Ea accident
ANY AUTO
BODILY INJURY (Per person) S
OWNED SCHEDULED
AUTOS ONLY 'AUTOS '
BODILY INJURY Per accident S
( )
HIRED NON -OWNED
PROPERTY DAMAGE S
AUTOS ONLY AUTOS ONLY
Per accident
iS
UMBRELLA LIAB OCCUR
y
EACH OCCURRENCE $
EXCESS LIAB CLAIMS -MADE'
_____-- -- ----
AGGREGATE S
DED RETENTIONS
WORKERS COMPENSATION
;PER OTH-
AND EMPLOYERS' LIABILITY Y / N
STATUTE _ER
---
A ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? N❑ N /A . N 76WEGD16609 08/15/2022 08/15/2023
E.L. EACH ACCIDENT S 100,000
- -- ------ — - - --- -
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE S 100,000
If yes, describe under
•, DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT s 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER rANlrFI I ATIr)N
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
.
Costa Mesa Sanitary District
ACCORDANCE WITH THE POLICY PROVISIONS.
290 Paularino Avenue
AUTHORIZED REPRESENTATIVE
Costa Mesa CA 92626}�-
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD