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Insurance - Janico - 2004-11-17
ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID BN DATE(MMIDD YYYY) JANIC-2 11/15/04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Cosmos America Insurance Svrs ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CA License# 0768427 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 555 East Ocean Blvd Suite 515 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Long Beach CA 90802 RECEIVED INSURERS AFFORDING COVERAGE NAIC# INSURED NOV 1 7 Z004 l INSURER Arch p ty RB(�T� ce� ��ryry� INSURER 8 Penn America Insurance Co Janico Building MalIlRl@tll '^"��""- DI INSURER C 3001 Red Hill Ave, INSURERD Costa Mesa CA 92626-4529 INSURER E COVERAGES 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADD'L' POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY BSPKG20381 12/07/03 12/07/04 PREMISES(Ea occurence) _ $ 50,000 CLAIMS MADE X OCCUR MED EXP(Any pe n) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG $ 3,000,000 POLICY PRO- JECT X LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Pe pe n) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Pe accident) PROPERTY DAMAGE $ (Pe accident) GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WC WORKERS COMPENSATION AND I 01H- EMPLOYERS'LIABILITY TOORY RY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED'+ E L DISEASE EA EMPLOYEE $ If yes,de cnbe under SPECIAL PROVISIONS below E L DISEASE POLICY LIMIT $ OTHER B Property Pol PAC6340294 12/07/03 12/07/04 BPP $120 000 Special Form Sched Equ $45,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re Job 2024 (*) 10 days for non-payment CERTIFICATE HOLDER CANCELLATION COSTAM4 ) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Costa Mesa Sanitary District IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Attn Sherry Wallah) 628 W 19th Street REPRESENTATIVES ///YYY Costa Mesa CA 92627 AUTHORIZED REPRESENTATIVE ltiatent . ACORD 25(2001108) ©ACORD CORPORATION 1988