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Insurance - Management Partners - 2013-03-05 ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) L....----. 3/5/2013 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). CONT PRODUCER NAMEACT Matt Walsh Hauser Insurance Group fn/c°.No.Ext1:513-745-9200 INC,No):513-745-9219 8260 Northcreek Drive, Suite 200 E-MAIL Cincinnati OH 45236 ADDRESS:mwalsh(thehausergroup.com INSURER(S)AFFORDING COVERAGE s NAIC# INSURER A:Hartford Fire Insurance Co 22357 INSURED MANAG-2 INSURER B:Lloyds of London Management Partners, Inc. INSURER C: 1730 Madison Road Cincinnati OH 45206 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1444915839 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER LIMITS (MM/DDIYYYY) (MM/DD/YYYY) A GENERAL LIABILITY 33SBAUG1832 3/1/2013 3/1/2014 EACH OCCURRENCE $1,000,000 DAMA E TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000 PERSONAL 8,ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 —1 POLICY PRO- LOC $ JECT A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT • 33UECVG5096 3/1/2013 3/1/2014 Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED (BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X AUTOS Per accident $ X HIRED AUTOS _ A X UMBRELLA LIAB X OCCUR 33SBAUG1832 3/1/2013 3/1/2014 EACH OCCURRENCE $3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED X RETENTION$10,000 $ A WORKERS COMPENSATION 33WECRX9356 3/1/2013 3/1/2014 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Professional Liab MPL1008388 6/20/2012 3/20/2013 Ea.Claim $1,000,000 Agg $1,000,000 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Costa Mesa Sanitary District its directors, officials, officers, employees, agents, and volunteers are are shown as an additional insured(s) solely with respect to general liability coverage as evidenced herein on a primary/non-contributory basis as required by written contract with respect to work performed by the named insure(s). CERTIFICATE HOLDER CANCELLATION 30 days SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa Sanitary District k,� ACCORDANCE WITH THE POLICY PROVISIONS.,),,,„,,._,2, . 1 II) I 628 W 19th St. (/� -, Costa Mesa CA 92627-2716 n_ ✓ AUTHORIZED REPRESENTATIVE 9.At ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1 I fY r/ POLICY€NUMBER: 3 3 SBAug 1832 THOS ENDORSEMENT CHANGES TUE POLICY. PLEASE READ IT CAREFULLY. -- - This endorsement modifies Insurance provided under the following: ADDITIONAL INSURED -- PERSON OR ORGANIZATION Costa Mesa Sanitart District its directors, officers, employees, ' agents and volunteers • • • • Form 11-1 12 01 11 85 Printed in U.S.A.