Insurance - Hamers - 1997-10-01 A O41IIL " CERTIFICATE OF LIABILITY INSURANCE DATE(M D )
_ _. 10/01/97 /
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Dealey, Renton & Associates HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
I License #0020739 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
3S Hutton Centre Suite 450 COMPANIES AFFORDING COVERAGE
Santa Ana CA 92707
COMPANY
A St. Paul Fire & Marine X 1V I V E D
INSURED COMPANY
B OCT - 2 1997
Robin B. Homers & Assoc. Inc. COMPANY
234 E. 17th Street #205
Costa Mesa CA 92627 COSTA MESA SANITARY RIP- I C COMP C'
COVERAGES
D��� ..I LO 3 `�7
THIS IS TO CERTIFY THAT NE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR NE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIN 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
CO POLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE POLICY NUMBER DATE (MMODNY) DATE (MM/DD/YY) , MRS
A GENERAL LIABILITY RP06645006 07/27/97 07/27/98 GENERAL AGGREGATE 5 2,000,000
X COMMERCIAL GENERAL LIABILITY PRODUCTS COMP/OP AGG S 2,000,000
CLAIMS MADE X OCCUR PERSONAL 8 ADV INJURY 5 1,000,000
OWNER'S P.CONTRACTOR'S PROT EACH OCCURRENCE 5 *1 000,000 •
FIRE DAMAGE(My one fire) S *i n,C I U,ded
// MED EXP(My o e person) $ 5,000
A AUTOMOBILE LIABILITY RP06645006 07/27/97 07/27/98 J COMBINED SINGLE LIMIT $ 1 000,000
ANY AUTO
ALL OWNED AUTOS BODILY INJURY 5
SCHEDULED AUTOS (Pe parson)
X HIRED AUTOS BODILY INJURY
• X NON-OWNED AUTOS (Pe oldenq $
PROPERTY DAMAGE S
GARAGE LIABILITY AUTO ONLY EA ACCIDENT 5
ANY AUTO OTHER THAN AUTO ONLY
S
S
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE 5
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND WC STAN- OTR
T(IEL M TC FR -
EMPLOYERS'LIABILITY
EL EACH ACCIDENT 5
THE PROPRIETOR/ INCL EL DISEASE POLICY LIMIT 5
PARTNERS/EXECUTIVE —
OFFICERS ARE EXCL EL DISEASE EA EMPLOYEE S
OTHER I
DESCRIPTION OF OPERATIONSAACATIONSNEHICLES5PECIAL ITEMS
RE ALL OPERATIONS OF NAMED INSURED
CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED
FOR GENERAL LIABILITY PER THE ATTACHED ENDORSEMENT
(AI) *EXCEPT 10-DAY NOTICE FOR NON PAYMENT OF PREMIUM.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
COSTA MESA SANITARY DISTRICT EXPRATION DATE THEREOF THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
0 ATTN: JOAN REVAK -130 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
P O. BOX 1200 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
COSTA MESA ✓ CA 92628
P ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES
AUTHORIZED REPRESENTATIVE L .�\7�/`
,�f?—,x-11 Of! ttr✓✓
ACORD 25-S (1195) 1) ACORD CORPORATION 1988
C52
/ GENERAL ENDORSEMENT
In consideration of an additional premium of N/A , it is hereby understood and agreed that
•he following applies
[ X ] ADDITIONAL INSURED
COSTA MESA SANITARY DISTRICT
is/are Additional Insured/s as respects to work done by Named Insured
[ I PRIMARY COVERAGE
With respect to claims arising out of the operation of the Named Insured, such insurance as
afforded by this policy is primary and is not additional to or contributing with any other insurance
carried by or for the benefit of the above Additional Insured/s
[ I WAIVER OF SUBROGATION
It is understood and agreed that the Company waives the right of subrogation against the above
Additional Insured/s for project described in certificate attached hereto
[ ] CROSS LIABILITY CLAUSE
•
The naming of more than one person, firm or corporation as insureds under this policy shall not,
for that reason alone, extinguish any rights of one insured against another but this endorsement,
and the naming of multiple insureds, shall not increase the total liability of the Company under this
policy
[ X ] NOTICE OF CANCELLATION
It is understood and agreed that in the event of cancellation of the Policy for any reason other than
non-payment of premium, 30 days written notice will be sent to the following by mail
COSTA MESA SANITARY DISTRICT
P 0 BOX 1200
COSTA MESA, CA 92628
In the event the policy is canceled for non-payment of premium, 10 days written notice will be
sent to the above
Policy No RP06645006 Effective Date: 10/1 /97
Insurance Company• ST PAUL FIRE & MARINE
Issued �ROBIN B HAMERS & ASSOCIATES INC
Issue Date 10/1 /97
*Authorized Representative
Elizabeth Franks