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Insurance - Hamers - 1992-09-25 ACOI:D. CERTIFICATE OF INSURANCE ISSUE DATE 9(M/M�DD f92 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE ASSOCIATION ADMINISTRATORS POLICIES BELOW. & CONSULTANTS INC COMPANIES AFFORDING COVERAGE P 0 BOX 19570 IRVINE CA 92713 COMPANY A LETTER COMPANY B LETTER DDRIRED COMPANY C ft ROBIN B HAMERS & �R ASSOCIATES COMPANY D 234 E 17TH ST #205 LETTER LEGION INSURANCE CO COSTA MESA CA 92627gCOMPANY E COVERAGES 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. T TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE EFFECTIVE DATE(MMTD/YY) GENERAL IJABILITY BODILY INJURY OCC. $ COMPREHENSIVE FORM BODILY INJURY AGG. $ IPREMIIS�EpS/OPERATIONS PROPERTY DAMAGE OCC. $ EXPLOSION 8 COLLAPSE HAZARD PROPERTY DAMAGE AGG. $ PRODUCTSCOMPLETED OPER. BI 8 PD COMBINED OCC. $ CONTRACTUAL BI&PD COMBINED AGG. $ INDEPENDENT CONTRACTORS PERSONAL INJURY AGG. $ BROAD FORM PROPERTY DAMAGE PERSONAL INJURY - AUTOMOBILE LIABOJTY BODILY INJURY $ ANY AUTO (Per pew) ALL OWNED AUTOS(IYIv pass.) BODILY INJURY $ ALL OWNED AUTOS (p p ) (Per attidsM) HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY BODILY INJURY& PROPERTY DAMAGE $ COMBINED EXCESS LABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM D WORKER'S COMPENSATION WC1002899 9/01/92 9/01/93 X STATUTORY LIMITS EACH ACCIDENT $1, 000, 000 Alm DISEASE—POLICY UMIT $1, 000, 000 EMPLOYERS'IJABILITY DISEASE—EACH EMPLOYEE $1, 000, 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS ALL ARCHITECTURAL/ENGINEERING OPERATIONS OF THE NAMED INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE FLO REICHLE EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL ENDEAVOR TO COSTA MESA SANITARY DISTRICT MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 234 E 17TH STREET #205 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR COSTA MESA CA 92627 LIABILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES. AUTIORTZED REPRESENTA CHRIS E KROTI O FOR AA&C K ACORD 25 (7/90) OACORD-CORPORATION 1990 ACOI:u® CERTIFICATE OF INSURANCE IBSUE DATE 9 25 92 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE ASSOCIATION ADMINISTRATORS POLICIES BELOW- & CONSULTANTS INC COMPANIES AFFORDING COVERAGE P 0 BOX 19570 IRVINE CA 92713 `n`_ D Y �V''�' NNSURED COMPANY C ROBIN B HAMERS & LETTER ASSOCIATES COMPANY D 234 E 17TH ST #205 LETTER LEGION INSURANCE CO COSTA MESA CA 92627 COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTED 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. POLICY EFFECTIVE POLICY EXPIRATION LT TYPE OF IIBIIRANCE POLICY NUMBER E R DATE( FFEO/Y) DATE(MNDOM/) LIMITS GENERAL LIABIITY BODILY INJURY OCC. I .COMPREHENSIVE FORM BODILY INJURY AGG. I -PR�EMISES/OPERATIONS PROPERTY DAMAGE OCC. S IM EXPLOSION 8 COLLAPSE HAZARD PROPERTY DAMAGE AGG. I -PRODUCTS/COMPLETED OPER. BI&PD COMBINED OCC. $ -CONTRACTUAL BI&PD COMBINED AGG. $ -INDEPENDENT CONTRACTORS PERSONAL INJURY AGG S -BROAD FORM PROPERTY DAMAGE PERSONAL INJURY AUTOMOBILE LJABIITY BODILY INJURY I LYAWO (Par Person) L OWNED AUTOS(PAv pass.) BODILY INJURY I OWNED AUTOS ( � y (Pr aaadenl) RED AUTOS N.OWNED AUTOS RAGE LIABILITY BODILY INJURY& PROPERTY DAMAGE S COMBINED �� ERTER AFORM AGGREGATE $ OTHER T HAN UM BRELLA FORM C WORKER'SCOMPENSATIDN WC1002899 9/01/92 9/01/93 STATUTORY UNITS I EACH ACCIDENT $1 000 000 AND DISEASE—POLICY UNIT f1 000 000 EMPLOYERS'LYBRITY DISEASE—EACH EMPLOYEE f1 000 000 OTHER DESCRIPTION OF OPERATKMB/LOCATIONSNEHICLESISPECIAL ITEMS ALL ARCHITECTURAL/ENGINEERING OPERATIONS OF THE NAMED INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE FLO REICHLE EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL ENDEAVOR TO COSTA MESA SANITARY DISTRICT MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 234 E 17TH STREET #205 LEFT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR COSTA MESA CA 92627 LIABILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES E . AUTHORD REPRESENTATW gr.'TI�e CHRIS E KROT NII FI - AA&C K ACORD 25 (7/90) CACORD CORPORATION 1990 Attach to your policy with the same number shown on this endorsement. E41 03 RECEIVED 1st Edition NJV16 Named Insured 1992 Agent' Policy Number Address ROBIN B HAMERS ✓; ASSOC INC Costa t 97 07 307 1481 02 29 234 EAST 17TH STREET SUITE 11205 of COSTA MESA CA 92627 designated Company designated in the Insured Declarations Location (Same as above unless otherwise stated here) Effective Date 09-22-92 Limit of Liability $ 1 ,000,000 each occurrence ADDITIONAL INSURED ENDORSEMENT (SPECIAL SENTINEL) In consideration of the premium we agree with you to the following 1 The insurance provided by this policy for bodily injury liability and property damage liability under Coverage D—Business Liability insurance shall also apply to the additional insured named below but only with respect to an occurrence arising out of the ownership, maintenance or use of that part of the insured location occupied by you. 2 This insurance does not apply to: (a) Any occurrence which takes place after you cease to occupy the insured location. (b) Any structural alterations, new construction or demolition operations performed by or for any additional insured named below 3. The additional insured shall not be construed or deemed to be a subscriber to the Company issuing this policy 4 The additional insured shall not be or become liable for any premium payments due upon this policy 5. If this policy is terminated for any reason we shall give 30 days notice in writing to the additional insured named below APPROVED AS TO FORM: ATIORf4EY FOR ' STRICT This endorsement is part of your policy It supersedes and controls anything to the contrary It is otherwise subject to all other terms of the policy JIM SCHABARUM INSURANCE 170 East 17th Streetprguite 213 P.O. Box 11119 5 1 t Costa Mesa, California 9262 Bus: (714)642-4223 Fax: (714) 642-2163 Additional COSTA MESA SANITARY DISTRICT Insured P.0 BOX 1200 COSTA MESA CA 92628-1200 /,, Countersigned .V/Li . horized representative FARMERS ,INSYRIN(E . •' GROUP�� 91-4103 1ST EDITION 11 88 1-92 1451 =y-