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Insurance - Thornton - 2011-07-08 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDYYYY) 07/08/2011 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. It the certificate holder en ADDITIONAL INSURED,the po:icy(ies)must be endorsed If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may requ re an endorsement. A statement this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) PRODUCER CONTACT NAME: Stan Burns Insurance Services PRONE E.tn 310 328 7655 I,P ,Na);310 618 6983 210615 Western Ave Ste 110 E-MJL P 0. Box '3309 monad-En 00012552 -Cy.STOMER IOC Torrance CA 90510-3309 INSURER(S)AFFORDING COVERAGE NAIC INSURED INSURERA Hartford Casualty Insurance Co Robert Thornton Architects Inc INSURER B. PO Box 1512 NsuRERC _ Newport Beach CA 92659 INSURER D. INSURER E. INSURER F. COVERAGES CERTIFICATE NUMBER: bop2011/12 REVISION NUMBER: 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE IN SR SUER POLICY NUMBER POLICY MMJDDJEXP UNITS IMWICY EFF (POLICY EXP GENERAL LIABILITY 725E1AA312200710712011 0710712012 EACH OCCURRENCE S 1,0001000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S /,000,000 DAIAAGESOREM rental ICLAIMS-MADE II j OCCUR MED EXP(Any one person) S 10:000 A PERSONAL IT ADV INJURY $ 11000,000 GENERAL AGGREGATE _ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S 2,000,000 POLICY PRO- F JECT LOC AUTOMOBILE UABILRY COMBINED SINGLE LIMIT (F.a=doe) ANY AUTO BODILY INJURY(Pe person) $ ALL OWNED AUTOS BODILY INJURY(Pe le00dent( S SCHEDULED AUTOS PROPERTY DAMAGE S HIRED AUTOS (Pe accident( NON-OWNED AUTOS L UMBRELLA LMB — OCCUR EACH______________________________________ EXCESS LIAR CLAIMS'MADE AGGREGATE DEDUCTIBLE ,RETENTION 3 WORKERS COMPENSATION - WC A U- 0Th- AND EMPLOYERS'LIABIU'rY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE' EL EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E L DISEASE EA EMPLOYEE $ 0 s,describe Oder DESCRIPTION OF OPERATIONS below E L.DISEASE POLICY LIMIT $ A Business Personal Property 72SBAA312200710712011 07/0712012 Special Form $10 000 Deductible $1,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarb Schedule IT more spa a is required) 'Archit'ects & Architecture Services' Zosta Mesa Sanitary District its elected and appointed officials agents volunteers and employees are listed as Additional Insured per attached form #5500080405 page #18 of 24 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE'CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District AUTHORIZED REPRESENTATW_ , 628 W 19th Street J/�J/ Costa Mesa, CA 92627 Tom Burns/vh .0/ry�^� ©1988-2009 ACORD CORPORATIONUI(lxights reserved. ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD "J IMPORTANT If the certificate holder is an ADDITIONAL INSURED the policy(ies) must be endorsed. A statement on this certificate 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, 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). 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)