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Insurance - Coastal Traffic Systems Inc. - 2013-02-19 t ACORD® DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 2/19/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ilivCERTIFICATE DOES NOT AFFIRMATIVELY, OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED EPRESENTATIVE 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 CONTACT Debbie Kilby y James G Parker Insurance Associap�iblels^ A/ E IAIC NO Ext), (559)222-7722 I aC.No): 1559)222-1724 �`C�� V' �Q�'E-MAIL License #0554959 ADDRESS:DebbieKilby@jgparker.com 1753 E Fir Ave ^ L^ �� INSURER(S)AFFORDINGCOVERAGE NAIC# Fresno CA 93720 FEB�F°^ 6 INSURERA:Western World Insurance Company 13196 INSURED I,u�IH lritJN JFINlIARY Mar 1INSURER B:James River Insurance Company 12203 Coastal Traffic Systems Inc "INSURER C: 2602 S Halladay INSURERD: INSURER E: Santa Ana CA 92705 INSURERF:•_ _ _ COVERAGES _ . -CERTIFICATE NUMBER:13-14 GL UMB __ - 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 L TYPE OF INSURANCE ADDL WSUBR POLICY EFF POLICY EXP LIMITS LTR INSR VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ A CLAIMS-MADE X OCCUR PGP0733961 2/17/2013 2/17/2014 MED EXP(Any one person) _ $ 5,000 X X C 13 Included PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY IT'I JF n LOC r $ AUTOMOBILE LIABILITY • COMBINED SINGLE LIMIT — (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I RETENTION$ 000566280 2/17/2013 2/17/2014 $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder is named as Additional Insured as per form WW180 0310 attached CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 628 W 19th Street \ Costa Mesa, CA 92627 \vyv, AUTHORIZED REPRESENTATIVE J Parker III/DKILBY —itis•■ 11:0•••---14--- — ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD • This Endorsement Modifies Your Policy (Effective At Inception Unless Another Date Shown Below) ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The insurance afforded by this policy for"bodily injury,""property damage"and/or"personal and advertising injury" shall also apply to the "additional insured" listed below for claims, suits, and/or damages made against the "additional Insured," but only to the extent the "additional insured" is being held responsible for the acts,omissions and/or negligence of the"named insured," This insurance afforded shall not apply to claims, suits and/or damages arising out of the acts, omissions and/or negligence of the"additional insured(s)," The inclusion of the"additional Insured(s)"shall not operate to increase the Limits of Insurance. To the extent, if any, that this policy affords coverage to an "additional insured," the "additional insured" is subject to all of the terms of the policy, Our obligation to provide coverage to an "additional insured" is further limited by the interest of the "additional Insured"as defined below. interest of the Additional Insured(s)Defined: TRAFFIC CONTROL OPERATIONS • THE INSURANCE AFFORDED BY THIS POLICY FOR THE BENEFIT OF THE ADDITIONAL INSURED SHALL BE PRIMARY AND NON-CONTRIBUTORY BUT ONLY WITH THE RESPECT TO CLAIMS,"SUITS" AND/OR DAMAGES ARISING OUT OF THE SOLE NEGLIGENCE OF THE NAMED INSURED. For the purpose of this endorsement, the "named insured" Is the person(s)and/or party(les)designated on the Declarations Page of the policy or on any endorsement. The"additional insured"is the person(s)and/or party(les)identified below. Identity of Additional Insured(s): BLANKET AS REQUIRED BY WRITTEN CONTRACT (Complete this section if endorsement Is added after policy Is Issued.) PG P0733961 Policy Number Endorsement Number Endorsement Effective Date Signature of Authorized Representative Producer Number I • WW180(03/10) INSURED