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Insurance - Municipal Media - 2025-07-14ACORH CERTIFICATE OF LIABILITY INSURANCE `,� DATE(MMIDD/YYYY) 07/14/2025 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 Jack Campo NAME: Lighthouse, an Alera Group Company PHONE (800) 344-3531 FAX (616) 455-9489 AIC Na Ext): A/C, No): 56 Cesar E Chavez Ave SW EMAIL ) Po cam li com ADDRESS: G 9hthouse rou 9 P Ste 300 INSURER(S) AFFORDING COVERAGE NAIC # Grand Rapids MI 49503 INSURER A: Hartford Property & Casualty 34690 INSURED INSURER B: Hartford Property & Casualty (Multiple Companies) 525190 Municipal Media Corp. INSURER C: 1321 Upland Dr INSURER D: INSURER E: Houston TX 77043-4718 INSURER F: COVERAGES CERTIFICATE NUMBER: MS 25-26 REVISION NIIMRER- 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 CONTRACTOR 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 AU01-SUBM INSD WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE T OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO KEN I hU PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 A Y 81 SBMBT7NOK 06/18/2025 06/18/2026 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: X POLICY El[7[72,000,000 JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS 81 SBMBT7NOK 06/18/2025 06/18/2026 BODILY INJURY (Per accident) $ X HIRED IXNON-OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ Per accident UMBRELLA UABOCCUR HCLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? El (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 39WECBC7Y2L 04/15/2025 04/15/2026 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 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 when in written contract, written agreement or permit per endorsement SL 30 32 06 21. Said policy shall not terminate, nor shall it be canceled nor the coverage reduced, until thirty (30) days after written notice is given to the District. Any other insurance maintained by the Costa Mesa Sanitary District shall be excess and non-contributing with the insurance provided by this policy. CERTIFICATE HOLDER CANCELLATION ©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 1� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ADDITIONAL COVERAGES Ref # Description Surcharges Coverage Code SURC Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $1.00 Ref # Description Increased employer's liability Coverage Code INEL Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $1.00 Ref # Description Uninsured Employee Benefits Trust Fund Coverage Code UEBTF Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $0.00 Ref # Description Second Injury Fund Coverage Code 2NDIN Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $9.00 Ref # Description Increased employer's liability Coverage Code INEL Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $1.00 ef # r Description Additional Prem to Equal Inc Limits Coverage Code AILMP Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $148.00 Ref # Description Expense constant Coverage Code EXCNT Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $180.00 Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium OFADTLCV Copyright 2001, AMS Services, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. nE��� This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM Except aootherwise stated hnthis endorsement, the terms and conditions of the Policy apply A. The following haadded toSection C. WHO IS AN INSURED: Additional Insureds When Required By Written Contract, Written Agreement Or Permit The person(s) ororganizadon(e) identified in Paragraphs a. through f. below are additional insureds when you have agreed, in a written contract or written agreement, or when required by a written permit issued by a state or governmental agency or subdivision or political subdivision that such person or organization be added as an additional insured on your Coverage Pad' provided the injury or damage occurs subsequent to the execution of the contract oragreement, orthe issuance ofthe permit. Apemon or organization is an additional insured under this provision only for that period of time required by the contract, agreement orpermit. However, no such person or organization is an additional insured under this provision if such person o/ organization is included as an additional insured by any other endorsement issued by us and made a part of this Coverage Part. The insurance afforded to such additional insured will not be broader than that which you are required by the contract, agreement, orpermit 10provide for such additional insured. The insurance afforded to such additional insured only applies to the extent permitted by law. The limits ofinsurance that apply 10 additional insureds are described in Section D. LIABILITY AND MEDICAL EXPENSES LIMITS OF INSURANCE. How this insurance applies when other insurance is available to an additional insured is described in the Other Insurance Condition in 8ao1|on E. LIABILITY AND MEDICAL EXPENSES GENERAL CONDITIONS. m. Vendors Any person(s) or organization(s)(referred to below as vendor), but only with respect to "bodily injury" or �mpertydamme" arising out of "your products" which are distributed orsold inthe regular course of the vendor's business and only ifthis Coverage Part providescoverage for "bodily injury" or"property damage" included within the "prod ucto'comp|otadoperations hazard" (1) The insurance afforded to the vendor is subject to the following additional exclusions: This insurance does not apply to: (m) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by naoaon of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have |nthe absence ofthe contract oragreement; (b) Any express warranty unauthorized by you; (c) Any physical orchemical change inthe product made intentionally bythe vendor; (d) Repaokoging, except when unpacked solely for the purpose of inspection, demonstration, teeting, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (*) Any failure to mnho such inspections, adjuetmanto, tests or servicing aathe vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) OemonaYration, installation, servicing or repair operations, except such operations performed at the vendor's premises inconnection with the sale ofthe product; Policy 81 S BM BT7NO K Form SL3Q02 082M Page 1 o 3 02O21.The Hartford THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THEwJ (g) Products which, after distribution or sale by you, have been labeled or relabeled or used ase container, part or ingredient of any other thing or substance by or for the vendor; or (h) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own actsor omissions orthose of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (U) The exceptions contained inParagraphs (d)orUU;or (ii) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. b' Lessors Of Equipment (1) Any person ororganization from whom you lease equipment; but only with respect to their liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation oruoeofequipmant|easedbzyoubyauohpersmnoroqJanization. (2) With respect tothe insurance afforded hothese additional insureds, this insurance does not apply boany "occunenoe^which takes place after you cease 10lease that equipment. c. Lessors OfLand OrPremises (1) Any person or organization from whom you lease land or premises, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land or premises leased to you. (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to: (a) Any "occurrence" which takes place after you cease to lease that land or be a tenant in that premises; or (b) Structural a|tarediona, new construction or demolition operations performed by or on behalf of such person ororganization. d. Architects, Engineers Or Surveyors (1) Any architect, engineer, nraumeyor,but only with respect 10liability for "bodily irjury'',"pnopa�ydamage'' or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions ofthose acting onyour behalf: (e) |nconnection with your premises; (b) In the performance of your ongoing operations performed by you or on your behalf; or (c) In connection with "your work" and included within the "prod uda'nomp|eted operations haznnd'', but only if: (8 The written contract, written agreement or permit requires you to provide such coverage to such additional insured; and (ii) This Coverage Part provides coverage for "bodily injury" or "property damage" included within the "prod ucta-comp|etedoperations hazanj" (2) With respect to the insurance afforded tothese additional inauroda, the following additional exclusion applies: This insurance does not apply to "bodily injury"` "property damage" or "personal and advertising injury" arising out cfthe rendering of or the failure to render any professional services, including: (0 The preparing, approvng, or failure to prepare or approve' mepo, shop drewingo, opinions, reports, surveys, field orders, change orders, designs or drawings and specifications; or (ii) Supervisory, surveying, inspection, architectural or engineering activities. This exclusion applies even if the o|oima allege negligence orother wrongdoing in the oupomioion, hiring, emp|oymert, training or monitoring of others by an insured, if the "bodily injury", "property Policy 81SBMBT7NOK Form 0130 32 0821 Page 2mf3 0�2021.The Hartford THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE HARTFORD damage", or "personal and advertising injury" arises out of the rendering oforthe failure torender any professional service. e. State Or Governmental Agency OrSubdivision Or Political Subdivision Issuing Permit (1) Any state or governmental agency or subdivision or political subdivision, but only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision orpolitical subdivision has issued apermit. (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to: (m) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state ormunicipality; or (t) "Bodily injury" or"property damage" included inc|uded w|1h|nihe "prod uota'oomp|etedoperations hazard". Y. Any Other Party (1)Any other person or organization who ienot inone of the categories orclasses listed above in Paragraphs a.through e.above, but only with respect buliability for "bodily injuryr."property damage" or "personal and advertising injury" caused, in whole or in port, byyour acts or omissions or the acts or omissions ofthose acting onyour behalf: (a) In the performance of your ongoing operations performed by you or on your behalf; (b) |nconnection with your premises owned byorrented hoyou; or (c) In connection with "your work" and included within the "producto'comp|cted operations hazard'', but only if: 0) The written contract, written agreement orpermit requires you to provide such coverage to such additional insured; and (N) This Coverage Part provides coverage for "bodily injury" or"property damage" included within the "prod uota-oomp|ntedoperations horard^ (2) With respect to the insurance offnnjed to these additional ineureds, the following additional exclusion applies: This insurance does not apply to "bodily injury". "property damage" or "personal and advertising injury" arising out ofthe rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (a) The preparing, i orfailure to prepare or approve, maps, shop druwinQm, opiniona, reports, surveys, field orders, change orders, designs or drawings and specifications; or (b) Supervisory, surveying, inspection, architectural or engineering activities. This exclusion applies even if the claims allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by an insured, if the "bodily injury", ^pnzpody damage", or "personal and advertising injury" arises out of the rendering oforthe failure to render any professional service described in Paragraphs f.(2)(a) orf.(2)(b) above. Policy 81SBMBT7NOK Form SL 30 32 06 21 @2O21.The Hartford Page 3 of 3 Tanisha Tingling From: Sent: To: Cc: Subject: Attachments: Hi Candace, Ryan, and Tanisha, Jack Campo <Jack.Campo@aleragroup.com> Tuesday, July 15, 2025 7:14 AM cmciver@ recyclecoach.com; rbuhay@recyclecoach.com; Tanisha Tingling Jeff Naber; Jack Campo RE: CMSD Insurance Requirements Certificate.pdf, GL Al.pdf Jeff is tied up in meetings, but we wanted to get this to you ASAP. Attached is the updated certificate for Costa Mesa Sanitary District. The only change needed was to schedule CMSD for the 30 day cancellation notice (at no additional cost), the policy has all the other necessary coverages to comply with the requirements. Regarding the workers compensation, this is also written through The Hartford who is an admitted carrier in the state of California. I've updated the NAICS code. Please let me know if anything further is needed for this! Thank you, Jack Jack Campo, CISR Commercial Account Manager Q (616) 656-1892 Jack.Campo@aler -grow .com 56 Cesar E. Chavez Ave SW ( Suite 300 ( Grand Rapids, MI 49503 AALERAGROUP CA License #6003856