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Insurance - Charles King Co. Inc. - 2013-05-30 • • _ CHAKIN-001 ALAM �CCP R " YYYY) MM/DD/ . CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/3 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 righlts to the certificate holder in lieu of such endorsement(s). PRODUCER' CONTACT 5 AME: Denise Cerna Bowermaster&Associates PHONE FAX P.O.Box 6026 (ac,No,E:t):714-733-6200 219 (A/C,No): 714-252=8253 10805 Holder Street-Suite 350 E-MAIL DSS:dcerna@bowermaster.com Cypress,CA 90630 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:National Fire Insurance of Hartford INSURED Charles King Company, Inc. INSURER B:Continental Casualty Co. 20443 • 2841 Gardena Avenue INSURER C:Travelers Property&Casualty Co of Amer. - Signal Hill, CA 90755 INSURER D:Chartis Specialty Insurance INSURER E: INSURER F COVERAGES' CERTIFICATE NUMBER: 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. TR TYPE OF INSURANCE N W SR SVD POLICY NUMBER POLICY EFF POLICY EXP L LIMITS POLICY (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X 4034952911 3/30/2013 3/30/2014 DAMAGE TO PREMISES(Ea RENTED occurrence) $ 100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 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 X PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) S X ANY AUTO 5091114974 3/30/2013. 3/30/2014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE 5091114988 3/30/2013 3/30/2014 AGGREGATE $ 3,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X WC STATU- 0TH- AND EMPLOYERS'LIABILITY TORY LIMITS ER YIN C ANY PROPRIETOR/PARTNER/EXECUTIVE DJTUB3452N74313 6/2/2013 6/2/2014 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 D Pollution Liability CPL3850939 3/30/2013 3/30/2014 Ded: $10,000 Limit:$5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Costa Mesa Sanitary District is an Additional Insured with respects to General Liability per attached endorsement form G140331C. CERTIFICATE HOLDER CANCELLATION (4 (/ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 11 THE EXPIRATION DATE THEREOF, NOTICE WILL • BE DELIVERED IN Costa Mesa Sanitary District ACCORDANCE WITH THE POLICY PROVISIONS. 628 W. 19th Street Costa Mesa, CA 92627- AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD