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Insurance - Michale Balliet Consulting, LLC - 2022-12-14ACOR" C E RT I F I CAT E O F LIABILITY INSURANCE DATE /YYYY) 1...-� 12/ 14/20 4/2022 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 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 CONTANAME: Michael Kosmerl Professional Ins. Associates/Ability Insurance Agency Inc. HO CC , No]_ �A1No. Ext): _714/968-9600 a/( C 74133 EI Paseo, Suite 8 E-MAIL ADDRESS: mike a�abilityins_com Palm Desert, CA 92260 INSURER(S) AFFORDING COVERAGE NAIC # A INSURER A : Hartford Casualty Insurance Company _29424 INSURED INSURER B : Hartford Casualty _Insurance _Compan 29424 Michael Balliet Consulting, LLC INSURERC_ 30181 Outpost Road INSURERD: San Juan Capistrano, CA 92675 INSURER E INSURER F: Hiscox Insurance Com n 1020 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 ADDL SUBRj LTR TYPE OF INSURANCE IN R' WVD i POLICY NUMBER POLICY EFF POLICY EXP _ MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ QQQ t000,000 j COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence _ $ _1 QQ�QQO X CLAIMS -MADE OCCURY Y 57SBABF8296 `MED EXP (Any one person) $ 10/26/2022 10/26/2023 -- ---- 1Q _QQQ - A PERSONAL & ADV INJURY $ 1 000 ,000 GENERAL AGGREGATE $ 2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-- COMP/OP AGG" $ 2000QQQ — _... , X POLICY PE OT- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT �accidentZ------1;Q00}000 ANY AUTO BODILY INJURY (Per person) S ALL OWNED SCHEDULED Y Y 57SBABF8296 B 10/26/2022 10/26/2023, BODILYINJURY(Peraccident) S - ;AUTOS AUTOS NON-OWNED X X PROPERTY DAMAGE HIRED AUTOS _ AUTOS _fir accidents_ UMBRELLA LIAB OCCUREACH OCCURRENCE S EXCESS LIAB CLAIMS -MADE AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION WC STATU- OTH-: AND EMPLOYERS' LIABILITYY / N ____TORY LIMITS .___ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT S OFFICER/MEMBER EXCLUDED?__ - (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under _ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S Professional Liability F N N UDC -4214172 -EO -20 07/19/2022 07/19/20231 Liability Limit $1,000,000 Policy Deductible $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS f 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 DistrictSHOULD 290 Paularino Avenue I ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa, CA 92626 VP ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE l �I) r icn e I�Js lel verified by PDFFiller ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: A IQ If this policy is cancelled by the Company, other than for non-payment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. If this policy is cancelled by the company for non- payment of premium, or by the insured, notice of such cancellation will be provided within ten (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Form SS 12 24 06 11 Page 1 of 1 © 2011, The Hartford BUSINESS LIABILITY COVERAGE FORM This Paragraph f. applies separately to you and any additional insured. 3. Financial Responsibility Laws a. When this policy is certified as proof of financial responsibility for the future under the provisions of any motor vehicle financial responsibility law, the insurance provided by the policy for "bodily injury" liability and "property damage" liability will comply with the provisions of the law to the extent of the coverage and limits of insurance required by that law. b. With respect to "mobile equipment" to which this insurance applies, we will provide any liability, uninsured motorists, underinsured motorists, no-fault or other coverage required by any motor vehicle law. We will provide the required limits for those coverages. 4. Legal Action Against Us No person or organization has a right under this Coverage Form: a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Form unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this insurance or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative. 5. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this policy to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom a claim is made or "suit" is brought. 6. Representations a. When You Accept This Policy By accepting this policy, you agree: (1) The statements in the Declarations are accurate and complete; (2) Those statements are based upon representations you made to us; and (3) We have issued this policy in reliance upon your representations. b. Unintentional Failure To Disclose Hazards If unintentionally you should fail to disclose all hazards relating to the conduct of your business at the inception date of this Coverage Part, we shall not deny any coverage under this Coverage Part because of such failure. 7. Other Insurance If other valid and collectible insurance is available for a loss we cover under this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when b. below applies. If other insurance is also primary, we will share with all that other insurance by the method described in c. below. b. Excess Insurance This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis: 1T That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (2) Premises Rented To You That is fire, lightning or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (3) Tenant Liability That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner; (4) Aircraft, Auto Or Watercraft If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section A. — Coverages. (5) Property Damage To Borrowed Equipment Or Use Of Elevators If the loss arises out of "property damage" to borrowed equipment or the use of elevators to the extent not subject to Exclusion k. of Section A. — Coverages. Page 16 of 24 Form SS 00 08 04 05 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 THE CITY OF NEWPORT BEACH, ITS ELECTED OR APPOINTED OFFICERS, AGENTS OFFICIALS, EMPLOYEES AND VOLUNTEERS PO BOX 100085 - FV DULUTH, GA 30096 Form IH 12 00 11 85 T SEQ. NO. 002 Printed in U.S.A. Page 001 Process Date: 0 8 110 12 2 Expiration Date: 10 / 2 6 12 3