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Insurance - Thornton - 2011-07-08 (2)
A� CERTIFICATE OF LIABILITY INSURANCE DATE 07/08I/2011) 07/08/2011 PRODUCER THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION STATE FARM INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4952 WARNER AVE STE 250 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR HUNTINGTON BEACH CA 92649 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED y INSURER A'State Farm General Insurance Company 25151 Thornton. Robert INSURER B 28611 Rancho Grande INSURER C Laguna Niguel CA 92677 INSURER D 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 !NERD TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence)_$ CLAIMS MADE H OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGA�TE IUMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 7POLICY II IJECOT Flux X AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 75-8103 L-70 07/01/2011 07/01/2012 (Ea anen)) $ ANY AUTO MINI COOPER 07/01/2011 07/01/2012 X ALL OWNED AUTOS 75-8103 L-71 BODILY INJURY $ 250 000 SCHEDULED AUTOS CHEV SUB (Pe person) HIRED AUTOS BODILY INJURY $ 500 ODD NON-OWNED AUTOS (Pe accident) PROPERTY DAMAGE $ 100 000 (Pe accident) GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000 (OCCUR CLAIMS MADE AGGREGATE $ 1,000,000 $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETORPARTNEREXECUTIVE E L EACH ACCIDENT I$ OFFICER/MEMBER EXCLUDED? E L DISEASE EA EMPLOYEE $ If yes,He cnbe under SPECIAL PROVISIONS below E L DISEASE POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS All operations Costa Mesa Sanitary District its elected and appointed officials agents volunteers and employees are listed as Additional Insured-Pursuant to attached endorsement CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 628 W 19th Street DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ DAYS WRITTEN Costa Mesa CA 92627 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ALORD 25(2001/08) he registration notices indicate ownership of tie marks by their respective owners ©ACORD CORPORA ON 1988,200/ 132849 03-13-2007 All rights reserved