Insurance - Janico - 2004-12-13 ACORD CERTIFICATE OF LIABILITY INSURANCE CSR DJ DATE(MM/DDmyY)
JANIC-2 12/07/04
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 RECEIVED ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Long Beach CA 90802
DEC 1 3 2004 INSURERS AFFORDING COVERAGE NAIL#
INSURED /r
INSURER A Ar ape arty - IC.311 I
COSTA MESA SANITARY ELM INSURER B Penn America Insurance Co ANFSC V ti
Janico Building aintenance 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
IN R ADD'L( POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DDIYY) DATE(MM/DDIYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A X COMMERCIAL GENERAL LIABILITY BSPKG20381 12/07/04 12/07/05 PREMISES(Ea occurence) $ 50,000
CLAIMS MADE X OCCUR MED EXP(Any pe n) $ 5,000
PERSONALBADV INJURY $ 1,000,000
GENERAL AGGREGATE 3,000,000
GE 'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG $3,000,000
POLICY JECT X LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
ALL OWNED AUTOF
BODILY INJURY $
SCHEDULED AUTOS (Per pe n)
HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Pe accident)
PROPERTY DAMAGE $
(Pe accident)
GARAGE LIABILITY AUTO ONLY EA ACCIDENT $
ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR ] CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WC WORKERS COMPENSATION AND I OTR-
EMPLOYERS'LIABILITY TORY ftV L LI MITS S ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
E L EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED,
E L DISEASE EA EMPLOYEE $
If yes,He nbe untie
SPECIACrROVISIONS below EL DISEASE °OL'CY JVIT
OTHER
B Property Pol PAC6340294 12/07/04 12/07/05 BPP $120 000
Special Form Schad Equ $45,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I 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 Kallab
628 W 19th Street REPRESENTATIVES.
Costa Mesa CA 92627 AUTHORIZED REPRESENTATIVE 44•A+
ACORD 25(2001/08) 0 ACORD CORPORATION 1988