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Insurance - Mike Kilbride Ltd. 05/02/2013 10: 49 949548161E KILBRIDE PAGE 01 A 10/30/2 01 2 O° CERTIFICATE OF LIABILITY INSURANCE CAW `M2012 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 S REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holler is an ADDITIONAL INSURED, the pollcy(Ies) must Be eneorsel. 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 riot confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER Phan*: (76O)637-35'-b Fax: (76D)037?696 c T s ACT M.L.Adams Insurance Service; M.L.ADAMS INSURANCE SERVICES PHONE 760 837-3626 r (760)837-3898 42-280 BEACON HILL,SUITE D-7 E-MAIL"'4`}" ( �aa.No} E-M Www.mladamslns.COm ■ PALM DESERT CA 92211-5168 moo-°FEZ= —• ___._.._... DRODUCER 3128 CUSTOMER ID: _ ARCncy Lice;0639232 INSURERS) AFFOnrnNQ COVERAGE NalC P INSURED INauRERA : Gemini Insurance Co MIKE KILDRIDE,LTD. P.O. BOX 3341 INEI/RERe, : State Compensation Insurance Fund • NEWPORT BEACH CA 92659 INsuntsc : II46URER Cr, INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 18284 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, • .i •.S• S . -• a .•:1r ua .: A . . : • I a : • LAMS, INSR 1 TYPE.OF INSLIRANCE 'AMYL BURR POLICY NUMBER i POLICY EPP POLICY Om I LIMITS• LT• ..-_.__ ' WSF MO _.- ,IMrNonf YYY) i (.moor rro GENERAL uABIUT( VCGP020241 10/30/12 ' 10/30/13 I EACH OCCURRENCE $ 1,000,000 � InAvACeTORENTED a 50,000 X CDMiJ7ERCl:cL GENERAL LIABILITY l ���tE Cr�.,�t1 ___ _ 1 PR 1!92 .n ronr �� ��CLAIMS-MADE X !OCCUR ' ' MED.EXP(Any ere perm) E 5,000 PERSONAL e AM/INJUCY g 1,000,000 GENERAL ACYGREGATE $ 2,000,000 :GENL AGGREGATE LIMIT APPLIES PER: PROOUCTS-COMP/OP AGG $ 2,000,000 al__• PRO- $ POLICY IEC1T I LOC _ _ ____.. AUTOMOBILE UABIUTY COMBINED SINGLE LIP.IIT (Es accident) ANY AUTO BODILY INJURY(P.rpericn) . 5 - ALL OWNED AUTOS BODILY INJURY(Pcr RDCIOPoi) e SCHEDULED AUTOS — -----'-- PROPERTY"DAMAGE HIRED AUTOS (Pcr arririvnl) $ . NON-OWNED AUTOS $ I(rmeRacF uan--- OCCUR ...,~ EACH OCCURRENCE a .- ., ..., I EXCE°.9 LINK i CLAIMS-MADE i AG'(:REGATE 15 1 DEDUCTIBLE a. — RETENTION $ __ B I r"oec;'s Cou,..,-".rOM 238-0012020-12 10/01/12 : 10/01/13 I )( I c••c eTa'U' I OTN I 1,000,000 •AND EMPLOYERS LIABILITY TQRr;IhII1�S cg '� 1arJY PRDPRIEl PAtTIJ[P,'P'(QCUTIYE v/u 1 E.L.EACH ACCIDENT 1$ 1,000,000 .OFFICERJE i/BER EXCLUDED? N/A .(M1AanBMnry In mil E.L.DISEASE-EA EMPLOYEE I S N/A u yo g.APCrCC4.nMt D6eOFIP,IOM OF Gv'EFhYl4i•U'belw 1 EL DISC-i+SE-PGI.CY LIMIT I5 N/A I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORO 101,Additional Ricmarkc Schedule.If more space la required) TEN DAY NOTICE OF CANCELLATION WILL BE GIVEN FOR NON PAYMENT OF PREMIUM. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED PER FORM CG 20 10 10 01 ATTACHED. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES DE CANCELLED BEFORE THE EJ(PIRAiION DATE THEREOF, NO TICE WILL LIE DELIVERED IN\ 'I' ACCORDANCE WITH THE POLICY PROVISIONS. COSTA MESA SANITATION DISTRICT AND ITS OFFIC S.AGENTS AND EMPLOYEES I\� .AUTHORIZED REPREFENTATIVE 628 W.19TH STREET / COSTA MESA CA 92627-2718 /( Att©nflon: {>f ACORD 25(2009/09) g 1988-2009 ACORD CORPORAYIUN. All rights reserved. The ACORD name and logo are registered marks of ACORD , MPY-02-7013 11:47 9495481616 96% P.01 05/02/2013 10: 49 94954131616 KILBRIDE PAGE 02 • Policy`'umber: VCCP020241 CG-2010 10 01 Insured Name:MIKF MLBRIDL LTD Effective Date: 10-3.1-2111.2 THIS'ENDORSEMENT CHANGES THE POLICY.. PLEASE REAL) ['IF CAREFULLY. ADDITIONAL INSURED —OWNERS, LESSEES OR CONTRACTORS-SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person Or Organization: AS REQUIRED I3Y WRITTEN CONTRACT; COMME,R.CIAL PROJECTS ONLY; INCLUDING APARTMENTS (If no entry appears above, information required to complete this endorsement will be shown in the.Dec'larations as applicable to this endorsement.)._.. A.. Section II Who is An Insured is amended to include as an insured the person or organization st►oW•n in the..Schedule;,but only with respect to liability arising out of your ongoing operations performed for that insured • B. With respect lo the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to"bodily injury" or"property damage" occurring sifter; (1) All work. includingmaterials, parts or equipment furnished in connection with such work; on the project(other than service,maintenance or repairs)to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) That portion of"your work"out of which the injury or damage arises has bren put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a.part.of the same project. • CG 2010 10 01 Pe.1 of 1 MRY-02-2013 11:47 9495481616 96% P.02 05/01/2013 15:66 9497702084 STATEFARMINSURANCE PAGE 01/01 CERTIFICATE OF INSURANCE This certifies that ® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois insures the following policyholder for the coverages Indicated below: Name of policyholder MIKE KILBRIDE LTD DBA COAST WATER L. POWER Address of policyholder -P.O. BOX 3341 -- - NEWPORT BEACH, CA. 92659 - Location of operations • Description of operations The policies listed below have been issued to the policyholder for the policy periods shown. The Insurance de scribed in these policies is subject to all the terms exclusions,and conditions of those policies.The limits of liability shown may h;we heen reduced by any paid claims. POLICY PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date Expiration Date (at begirinin of policy period) Comprehensive BODILY INJURY AND Business Liability PROPERTY DAMAGE This Insurance includes: ❑ Products-Completed Operations 0 Contractual Liability ❑ Underground Hazard Coverage Each Occurrence $ ❑ Personal Injury ❑ Advertising Injury General Aggregate $ ❑ Explosion Hazard Coverage Products'-Completed ❑ Collapse Hazard Coverage Operations Aggregate S ❑General Aggregate Limit applies to each project U ❑ POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE EXCESS LIABILITY Effective Date Expiration Dale (Combined Single Limit) ❑ Umbrella Each Occurrence S U Other _ Aggregate 16 �s Part 1 STATUTORY Part 2 BODILY INJURY Workers' Compensation and Employers Liability Each Accident S Disease Each Employee $ Disease- Policy Limit $ —_ POLICY PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date Expiation Date (at beginning of policy period) P447489A1075 AUTOMOBILE 1/10/13 1/10/ 14 1, 000_ 0000_ If any of the described policies are canceled before its expiration date. State Farm will try to mail a written notice to v {'Oi_!_`' srrr n C1n ^,GENT•Services,CLL.,r''' , ." y; the certificate holder 3 0 days before cancellation. If, r LlCEt\iS !asinine 7nG Financial 5erxices ` UCENSE06�B344. however, we fail to mail such notice, no obligation or liability ,RA,cam ; 300 CHRiSAP"1A BR.SUi i E'15g will be imposed on State Farm or Its agents or ;1" MISSION VIEJO.CA 9255.I representatives.Fi OtCIE 548-i?C-C1Qf? 7.3X.y,?t;-7 7 tl-208-1 trolly ke('I jctrrentlarl.con) ij Name and Address of Certificate Holder 771 r�/f Costa Mesa Sanitation District =�('�6� l,na a of Auth razed Representative 628 W. 19t''' Street L Costa Mesa, CA 92629 ' ✓17"Z. - ftid - 1/f (_. � L 558.984 a 2-50 PrintCd In U,S,A. t�8te MAY-01-2011 17:01 9497702094 96°<: P.01 12/03/2012 16: 59 9497702084 STATEFARMINSURANCE PAGE 01/01 - �E�VED CERTIFICATE OF INSURANCE This certifies that a STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois DEC 0 3 2012 III ❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois;, ;:,... tiffs nsures the following policyholder for the coverages indicated below: aNITARYDISTRICT Name of policyholder MIKE KILBRIDE LTD DBA COAST WATER & POWER . Address of policyholder P.D. BOX 3 341 _-_ -- NEWPORT BEACH, CA. 92659 _ • Location of operations Description of operations The policies listed below have been Issued to the policyholder for the policy periods shown. The insurance described in these policies is st.tject to all the terms exclusions,and conditions of those policies.The limits of liability shown may have hFen reduced by any paid claims POLICY PERIOD LIMIT'S OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date Expiration t?ato (at beginning of palicyyperiod) Comprehensive BODILY INJURY AND . Business liability _ PROPERTY DAMAGE This insurance includes: ❑ Products-Completed Operations ❑ Contractual Liability ❑ Underground'Hazard Coverage Each Occurrence $_—_ ❑ Personal Injury ❑Advertising Injury General Aggregate $ ❑ Explosion Hazard Coverage Products- Completed ❑ Collapse Hazard Coverage Operations Aggregate $ _ ❑ General Aggregate Limit applies to each project ❑ POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE • EXCESS LIABILITY Effective Date Expiration Date (Combined Single Limit) ❑ Umbrella Each Occurrence $ ❑ Other Aggregate $ Part 1 STATUTORY Part 2 BODILY INJURY Workers' Compensation and Employers Liability Each Accident - $ • Disease Each Employee $ Disease- Policy Limit $ _ POLICY PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date Expiration Date. (at,Beginning of polio period) . P447459A1075 AUTOMOBILE 1/10/12 1/1.0/13 I, 000, 000 - _. If any of the described policies are canceled before its expiration date, State Farm will try to Inail a written notice to the certificate holder 30 days before cancellation, If, however, we fail to mail such notice, no obligation or liability will be imposed on State Form or its agents or representatives. 1 Name and Address of Certificate Holder / (/ N L. Costa Mesa Sanitation District 11� � /l"l/tI t.--e � �, Sienntur of Authonz.d—Rapre::errlative G�$ W . 19 ' Street Costa. Mesa, CA 92629 -.1 2'_ _J- _... _ Title • _ /L - l a- ---.-- 555-994 a -96 Pr -d In U.5.A. Oslo I DEC-03-2012 16:56 94977020E4 9S% P.01