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Insurance - JIMNI - 2008-06-09 JIMNSYS-01 HIJE ACORD CERTIFICATE OF LIABILITY INSURANCE DATE( Y) M2008Y PRODUCER (888) 825-4322 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bowermaster&Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 6026 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 10805 Holder Street Suite 350 RECEIVED' Cypress, CA 90630 INSURERS AFFORDING COVERAGE NAIC# INSURED Jlmnl Systems, Inc. INSURER A Navigators Insurance Company _ 25295 Cinnamon Road JUN 0 9 2008 I INSURER B Safeco Insurance Company of America Lake Forest, CA 92630 COSTA MESA SANITARY OISTRICTINSURERC RSUI Indemnity Company _ 1 I INSURER0 Zurich American Insurance Company , INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REOUIREMENT 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 SUBJEC I TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSU LTR'AD i• M POLICY NUMBER I DATE IMIDDIYYI I POLICY AE IMMIDDIYYI LIMITS R r GENERAL LIABILITY EnCH OCCURRENCE 1,000,000 A X X DAMAGE TO REPITTD —h COMMERCIAL GENERAL LIABILITY SFO7CGL00778401 4/1/2008 4/1/2009 PREMISES(Er crurence) I- 10,000 CLAIMS MADE I OCCUR MED Er,P(Any c e pe s r) I ., 5,000 PERSONAL 8 AD\ INJURY I. 1,000,000 I GENERAL AGGREGATE I $ 2,000,000 GENII AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG I $ 2,000,000 X I POLICY X JECT IP1 LOC AUTOMOBILE LIABILITY COMBINED SING'E I WIT $ 1,000,000 B I „NY AUTO 01CH7560501 4/1/2008 4/1/2009 lee c,denn I I ALL OWNED AUTOS BODILY INJUR' X SCHEDULED Al DOS (P Pe \) X HIRED AUTOa BODILY IIJJUR' $ (F- ade :7 I X I NON-O IJNED Al110 _ I - _ PROPERT DAMAGE I , (Pc III GARAGE LIABILITY I 1 1010 ONLY EA AJCIDENT I. E- ANY AUTO l HA EAACc I OTHER TER AN AUTO ONLY AGG-I EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,000 C X1 OCCUR 7, CLAIMS MADE NHA221164 4/1/2008 4/1/2009 AGGREGATE $ 2,000,000 $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND I I'T I cB X RY LIMITS L EMPLOYERS'LIABILITY D I WCO282134800 4/1/2008 4/1/2009 I EL EACH ACCIDENT I 5 1,000,000 !OFF PROPRIETORiPARTNEEeE EI:tECUTIVE I. 1,000,000 OFFICERIMEMBER EXCLUDEC li I. DISEASE En EMPLOYEE . If,es,de cone under I SPECIAL PROVISIONS belm. I E L DISEASE POI ICY LIMIT 1,000,000 r$ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS *10 Day Notice of Cancellation for Non Payment of Premium City of Costa Mesa Sanitary District is Additional Insured as respects to General Liability per form ANF-ES 160 5/2006 attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Costa Mesa Sanitary District DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Attn: Tom Fauth 628 West 19th Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Costa Mesa, CA 92627 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE - �/ ACORD 25(2001/08) ©ACORD CORPORATION 1988 JIMNSYS-01 HIJE IMPORTANT If the certificate holder is an ADDITIONAL INSURED the pohcytes)must be endorsed. A statement on this -ertificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED subject to the terms and conditions of the policy pertain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer and the certificate holder nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon ACORD 25 (2001/08) Jimn Systems In Policy Ih SF07CGL00778401 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY\ BLANKET ADDITIONAL INSURED ENDORSEMENT (EXCLUDING RESIDENTIAL) This endorsement modifies Insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS (FORM B) CG 20 10 11 85 SCHEDULE Name of Person or Organization: Any person or organization that the named insured is obligated by virtue of a written contract or agreement to provide insurance such as is afforded by this policy WHO IS AN INSURED (Section II)is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your work' for that insured by or for you. 1 The following additional provisions apply to any entity that is an insured by the terms of this endorsement. 1 Primary Wording If required by wntten contract or agreement: Such insurance as is afforded by this policy shall be primary insurance and any insurance or self-insurance maintained by the above additional insured(s) shall be excess of the insurance afforded to the named insured and shall not contribute to it. 2. Waiver of Subrogation If required by written contract or agreement: We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of "your work' done under a contract with that person or organization. 3 Neither the coverages provided by this insurance policy nor the provisions of this endorsement shall apply to any claim arising out of the sole negligence of any additional insured or any of their agents/employees 4 This endorsement does not apply to any work involving or related to properties intended for permanent residential or habitational occupancy (other than apartments). The words you and your refer to the Named Insured shown in the Declarations. Your work means work or operations performed by you or on your behalf; and materials, parts or equipment furnished in connection with such work or operations ANF-ES 160 (5/2006)