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Insurance - Eco Partners, Inc. - 2012-07-05A16-. ® CERTIFICATE OF LIABILITY INSURANCE x/13/2012 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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER Shepherd Insurance, IS.C. 111 Congressional Boulevard Suite 100 Carmel IN 46032 CONTACT NAME: Paula Crandall PHONE (317)846 -5554 aC No: (317)846 -5444 ADDRESS :Pcrandall @shepherdins.com INSURERS AFFORDING COVERAGE NAIC # INSURERAEr1e Insurance Exchange 26271 INSURED ECO PARTNERS INC P O BOX 496 CARNET, IN 46082 -0496 INSURER B : INSURER C : INSURERD: INSURER E: $ 1,000,000 INSURER F: X COMMERCIAL GENERAL LIABILITY COVERAGES CERTIFICATE NUMBER- CL1271316412 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 LTR TYPE OF INSURANCE DL U POLICY NUMBER POLICY DI EFF MMIDDY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEI5__ PREMISES Ea occurrence $ 1,000,000 A CLAIMS -MADE a OCCUR 44- 1790097 /17/2011 /17/2012 MED EXP (Any one person) ' $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE ML AGGREGATE LIMIT APPLIES PER_ PRODUCTS - COMP /OP AGG $ 2,000,000 $ X POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS AGE $ NON-OWNED HIRED AUTOS AUTOS UMBRELLA L.IAB OCCUR NCE $ VAGGREGATE $ EXCESS LU16 CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION OTH- ER AND EMPLOYERS' LIABILITY YIN ANY PROPR IETORIPARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F-] NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Costa Mesa Sanitary District is listed as additional insured for general liability. n JC/ V Uv'� `o Costa Mesa Sanitary District 628 W 19th St. C Costa Mesa, CA 92627 ACORD 25 (2010/05) INS025 r7mnnai ni .h a, W_1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Crandall /PCRAND Q • Crot)dl wQ ©1988 -2010 ACORD CORPORATION. All rights reserved. Tha Ar`f%Pn noma nnri Innn nra ranictarori mnrlrc of A&rnpn �9 (Policy'Provisions: WC 00 00 00 B) 66 DI INFORMATION PAGE i WEG WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER: HARTFORD ACCIDENT AND INDEMNITY COMPANY HARTFORD PLAZA, HARTFORD, CONNECTICUT 06115 NCCI Company Number: 10448 Company Code: 5 THE HARTFORD N d� c1+ O Suffix LARS RENEWAL POLICY NUMBER: 176 WEG DI6609 01 Previous Policy Number: 176 WEG DI6609 HOUSING CODE: 76 tO 1. Named Insured and Mailing Address: ECO PARTNERS INC. H A (No., Street, Town, State, Zip Code) N PO BOX 496 Ln FEIN Number: 351801868 CARMEL, IN 46082 State Identification Number(s): UIN: The Named Insured is: CORPORATION Business of Named Insured: PUBLISHER - NEWSPAPER - LOCAL Other workplaces not shown above: NO SPECIFIC LOCATION IN STATE OF IN 2. Policy Period: From 08/15/12 To 08/15/13 12:01 a.m., Standard time at the insured's mailing address. Producer's Name: AUTOMATIC DATA PROCESSING INS AGCY PO BOX 33015 SAN ANTONIO, TX 78265 Producer's Code: 250717 Issuing Office: THE HARTFORD 55 FARMINGTON AVE., SUITE 301 . HARTFORD CT 06115 (877) 287 -1316 Total Estimated Annual Premium: $57.7 Deposit Premium: Policy Minimum Premium: $291 IN Audit Period: ANNUAL Installment Tenn: The policy is not binding unless countersigned by our authorized re resentative. Countersigned by 06/23/12 Authorized Representative Date Form WC 00 00 01 A (1) Printed in U.S.A. Page 1 (Continued on next page) Process Date: 06/23/12 Policy Expiration Date: 08/15/13 ORIGINAL INFORMATION PAGE (Continued) Policy Number: 76 WEO D16609 i" 1 ter.. 3. A. Workers Compensation Insurance: Part one of the policy applies to the Workers Compensation Law of the states listed here: IN B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily injury by Accident $100,000 each accident Bodily injury by Disease $500,000 policy limit Bodily injury by Disease $100,000 each employee '31 C. Other States Insurance: Part Three of the policy applies to the states, if any , listed here: N d d o ALL STATES EXCEPT ND, OH, WA, WY, AND STATES DESIGNATED IN ITEM 3.A. OF THE INFORMATION PAGE. ° D. This policy includes these endorsements and schedule: rn WC 00 04 21C WC 00 04 22A WC 99 03 00B WC 99 03 59B WC 00 04 14 to WC 00 04 19 A 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating VD Plans. All information required below is subject to verification and change by audit. o Premium Basis °n Classifications Total Estimated Rates Per Estimated * Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 8810 202,300 .14 283 CLERICAL OFFICE EMPLOYEES NOC TOTAL ESTIMATED ANNUAL STANDARD PREMIUM EXPENSE CONSTANT (0900) INDIANA .2ND INJURY FUND 0.66 PERCENT .(0935) TERRORISM (9740) 202,300 CATASTROPHE (9741) 202,300 TOTAL ESTIMATED ANNUAL PREMIUM Total Estimated Annual Premium: $577 Deposit Premium: Policy Minimum Premium: $291 IN Interstate /intrastate Identification Number.: Labor Contractors Policy Number: Form WC 00 00 01 A (1) Printed in U.S.A. Process Date: 06/23/12 283 250 4 .010 20 .010 20 577 NAICS: SIC: 2711 UIN: NO. OF EMP: 000001 Page 2 Policy Expiration Date: 08/15/13 July 17, 2012 Javier Ochiqui Management Analyst Costa Mesa Sanitary District 628 W. 19th Street Costa Mesa CA 92627 Re: Professional Services Agreement Dear Javier: Inc. partner in public outreach RECF'VED JUL 2 0 2012 COS1A MbA althIlAb OM Please find enclosed the signed Professional Services Agreement between the Costa Mesa Sanitary District and Eco Partners, Inc. I have attached the pertinent insurance certificates. If you have questions, please let me know. I look forward to working with you. Sincerely, lizabeth Roe President Enclosure Eco Partners, Inc. x 496 1 Carmel, IN 46082 7- 450 -3346 1 Fax: 317- 575 -8567 shtalk:com J` Web: www.trashtalk.com