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Insurance - ADS LLC - 2023-12-26A►Cf�R 7 0 CC> CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/26/2023 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 MARSH USA LLC. 540 W. MADISON CHICAGO, IL 60661 NAME CT Marsh I U.S. Operations PHONED t : 866-966-4664 FAX No : 212-948-0770 E-MAIL ADDRESS: Chicag q o CertRe ueS marsh.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Liberty Mutual Fire Insurance Company 23035 TB2-681-004088-754 INSURED ADS LLC INSURER B: N/A N/A INSURER C : Liberty Insurance Corporation 42404 340 The Bridge Street, Suite 204 Huntsville, AL 35806 INSURER D : INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: CHI -009336582-25 REVISION NUMBER: 8 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. NR ILLICY TR TYPE OF INSURANCE ADDL J= SUER WVD POLICY NUMBER EFF MM/ D/YYYY POLICY EXP MMI D/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY TB2-681-004088-754 01/01/2024 01/01/2025 EACH OCCURRENCE $ 2,000,00 CLAIMS -MADE a OCCUR DAMAGES ( RENTED 1,000,00 PREMISES Ea occurrence $ MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,00 X POLICY � PRO LOC JECT PRODUCTS - COMP/OP AGG $ 4,000,04 $ OTHER: A AUTOMOBILE LIABILITY AS2-681-004088-034 01/01/2024 01/01/2025 COMBINED SINGLE LIMIT $ 2,000,00' Ea accident BODILY INJURY (Per person) $ X ANY AUTO X OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? �N (Mandatory in NH) N / A WA7-68D-004088-514(AOS) WC7-681-004088-014 () WI 01/01/2024 01/01/2025 01101/2025 X PER I OTH- STATUTE ER E.L. EACH ACCIDENT 2,000,00' $ E. L. DISEASE - EA EMPLOYEE $ 2,000,00' If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 2,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Costa Mesa Sanitary District is included as Additional Insured with respect to General and Automobile Liability coverages as required by written contract, subject to policy terms and conditions. This insurance is Primary and Non -Contributory over any existing insurance and limited to liability arising out of the operations of the Named Insured and where required by written contract. Waiver of subrogation is applicable where required by written contract and subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District 250 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 of Marsh USA LLC ©1988-2016 ACORD CORPORATION. All rights reserved ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 0002496 SP 0505 -C01 -P02497-1 Costa Mesa Sanitary District 250 Paularino Avenue Costa Mesa, CA 92626 0505-01-00-0002496-0001-0005228