Insurance - ARC - 2006-12-19 ACORD TM CERTIFICATE OF LIABILITY INSURANCE DATiti199//20O06
PRODUCER Ph: (rep 300-9000 Fa 526-57o-o9Ca THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
NEW CENTURY INS SERVICES,INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
16 N.2ND ST HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALHAMBRA CA 91801 AI T R THE COVERAGE AFFORDED BY THE POL CIES BE OW
INSURERS AFFORDING COVERAGE NAIC#
Agency Uce OB07085
INSURED INSURER A: Colemont Insurance Brokers
ARC INTERNATIONAL CORP INSURER B: NATIONAL LIABILITY&FIRE INS.CO.
DBA COASTAL GROUP CORP INSURER C-
680 S.LEMON AVE.
CITY OF INDUSTRY CA 91789 INSURER D:
INSURER E.
COVERAGES
THE POUCIES Cif INSURANCE USTED 6ELON HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PCLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIRE!ENT.TERM CR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED CR
MAY PERTAIN. THE NSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POUCIES AGGREGATE LINTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
'AFC N"6L TYPE OF INSURANCE POLICY NUMBER OIICVFFi cTIVE CLICVEXPHATD UMITS
LiH IrIAL DATE IA6•AlOIYn DATE P.VA'DDM3
GENERAL LIABILITY 06PKG01617 11/09/06 11/09/07 EACH OCCURRENCE S 5,000,000
X CU ERCALt,ENERALLIAEWT DAMAGE TOROBED
PNEM3SS,En[mulct.) S 50,000
CLAIMSHNDEn OCCUR MED EXP(Any o eperson) S 5,000
A PERSONAL&ADV INJURY 5 5,000,000
GENERAL AGGREGATE S 5,000,000
GE NI_AGGREGATE UMTAPPUES PER PRODUCTS-COMP/OP AGO $ 5,000,000
1 POUCY n JECOT n LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) 5
HIRED AUTOS BODILY INJURY
NONOW NED AUTOS (Pe acudenl) S
PROPERTY DAMAGE S
(Per accident)
GARAGE LIABILITY
AUTO ONLY EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY
AGO S
EXCESS/UI.IBRELLAUABIUTY EACH OCCURRENCE S
—1 OCCUR CLAIMS F ADE AGGREGATE $
S
DEDUCTIBLE $
RETENTION S
S
WCSTATLL
WORKER UNSATION AND 0100017633061 01/01/06 01/01/07 TDRYLIMBS IOIIfe
EMPLOYERS'RS'UABIUTY
A pgepllETOx,pARn,Ea/IXECUTAE E L EACH ACCIDENT S 1,000,000
B OFK:ERAIEMBER Exc DEm E L DISEASE-- A EMPLOYEE $ 1,000,000
aye,a.c,
SPECIAL PROVISO, E L DISEASE-POUCY UNIT $ 1,000,000
OTHER.ENVIRONMENTAL LIMIT
A IMPAIRMENT LIABILITY $5,000,000
CONTRACTOR'S POLLUTION LIABILITY $5,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS
SEE SUPPLEMENTAL CERTIFICATE INFORMATION
CERTIFICATE HOLDER CANCELLATION
CITY OF COSTA MESA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
77 FAIR DRIVE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS
W RNTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO
COSTA MESA 92628 DO 50 SHALL IMPOSE NO OBUGAT1ON OR LIABILITY OF ANY KIND UPON THE INSURER,f'S
MS.DONNA THERIAULT I MANAGEMENT ANALYST PUBLIC AGENTS OR REPRESENTATIVES
AUTHORIZED REPRESENTATIVE
Attention:
ACORD 25(2001/08) Certificate# 57572 ®ACORD CORPORATION 1988
SUPPLEMENT TO CERTIFICATE OF LIABILITY INS #57572 DECT 906
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
THE CERTIFICATE HOLDER,CITY OF COSTA MESA&COSTA MESA SANITARY DISTRICT ARE NAMED AS AN ADDITIONAL INSURED PER
ENDORSEMENT ADDITIONAL INSURED OWNERS,LESSEES OR CONTRACTORS,(FORM B).
CITY OF COSTA MESA:77 FAIR DRIVE,COSTA MESA 92628;MS.DONNA THERIAULT!MANAGEMENT ANALYST PUBLIC
COSTA MESA SANITARY DISTRICT 628 W.19TH STREET COSTA MESA,CA 92627'MR.THOMAS FAUTH/ASSISTANT MANAGER
Cerhfi ate# 57572