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Insurance - Robert Thornton Architects Inc. A °RO® CERTIFICATE OF LIABILITY INSURANCE D TE(MM/ Y DDN ) 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 JEFF BAKER NAMEACT JEFF BAKER STATE FARM INSURANCE IA/CC.NNo.ExtI:714.846.5548 (A/c No):714.840.4987 E-MAIL StateFarm 4952 WARNER AVENUE SUITE 250 ADDRESS: C>0. HUNTINGTON BEACH, CA 926 9- 521E VED INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:State Farm General Insurance Company 25151 INSURED ROBERT A THORNTON OCT 0 3 2093 INSURER B: LAURA THORNTON INSURERC: 28611 RANCHO GRANDE Go(NIVILJA saw DISIIIICI INSURER D: LAGUNA NIGUEL, CA 92677-7418 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W /Y LIMITS LTR INSR VD POLICY NUMBER (MM/ODYYY) (MM/DD/YYYY) GENERAL LIABILITY 92-CF-Y599-3 08/13/2013 08/13/2014 EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY _$ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 7 POLICY 'Er LOC Business Liability $ • 1,000,000 AUTOMOBILE LIABILITY 377 4895-A01-75 07/01/2013 01/01/2014 COMBINED SINGLE LIMIT (Ea accident) $ X ANY AUTO 377 4896-A01-75 07/01/2013 01/01/2014 BODILY INJURY(Per person) $ 500,000 ALL OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS AUTOS $ 500,000 HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ 500,000 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICE/MEMBER EXCLUDED? N/A (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 CANCELLATION Costa Mesa Sanitary DIStrIC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ry THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 628 W. 19th Street ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa, CA 92627 AUTHORIZED REPRESENTATIVE I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.8 01-23-2013 Policy No.: 92 CFY599 3 FE-6609 t3AT(ftM` SECTION II ADDITIONAL INSURED ENDORSEMENT c r? ,MtYtaMC! Policy No.: 92 CFY599 3 Named Insured: ROBERT THORNTON ARCHITECTS, INC Additional Insured (include address): COSTA MESA SANITARY DISTRICT 628 W. 19TH STREET COSTA MESA, CA 92627 WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there is an "X" in the box. ❑ Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the'Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. FE-6609 Printed in U.S.A.