Insurance - UBD Inc. 2024-10-09ACOR" CERTIFICATE OF LIABILITY INSURANCE
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DATE (MM/DD/YYYY)
1 10/09/2024
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 Alma Munoz
NAME:
KYC Insurance Services, LLC
PHONE 562-473-4080 FAX (562) 473-4074
AIC No Ext): AIC No
17777 Center Court Dr
E-MAIL certs@kycinsurance.com
INSURER(S)AFFORDIN OVERAGE NAIC#
EACH OCCURRENCE $
INSURER A: United Financial Cas Co 11770
Cerritos CA 90703
INSURED
INSURER B
UBD INC
INSURER C :
6707 Camellia Ave Apt 205
INSURER D:
INSURER E:
AUTOMOBILE
X
North Hollywood CA 91606
INSURER F
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
TYPE OF INSURANCE
N DL
SUER
POLICY NUMBER
LICY EFF
MM/DD/YYYY
POLICY EXP
MM DD/YYYY
LIMITS
AUTHORIZED REPRESENTATIVE
COMMERCIAL GENERAL LIABILITY
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CLAIMS -MADE OCCUR
(
(
EACH OCCURRENCE $
DAMAGE TO RENTED
PREMISES Ea occurrence $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY FI PRO-
JECT ❑LOC
OTHER:
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
OWNED X SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
Y
975370838
06/01/2024
12/01/2024
COMBINED SINGLE LIMIT $ j 000,000
Ea accident
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
Per accident
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
(
I
EACH OCCURRENCE $
AGGREGATE $
DED I RETENTION $
$
WORKERS COMPENSATIONPER
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRI ETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
OTH-
STATUTE ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
I
I
I
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I
I
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DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Costa Mesa Sanitary District is also additional insured as per FORM 1198 (01/04) with respect to Commercial Auto when required by written contract.
CERTIFICATE HOLDER CANCELLATION
Costa Mesa Sanitary District
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
290 Paularino Avenue
ACCORDANCE WITH THE POLICY PROVISIONS.
Costa Mesa, CA 92626.x".
AUTHORIZED REPRESENTATIVE
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD