Insurance - Management Partners - 2013-07-09C$CiRfi" CERTIFICATE OF LIABILITY INSURANCE
DATE
TYPE OF INSURANCE
7/7 19/ 2 00YYY1
713 13
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT., If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsements .
PRODUCER
Hauser Insurance Group
8260 Northcreek Drive, Suite 200
N
PHONE F
No
AoDREaS: I,p
Cincinnati OH 45236
INSURERS AFFORDING COVERAGE NAICN
NBUMERAI
INSURED MANAG.2
INBURERB: rds of I ondon
Eaoc rrenea
INSURERG:
Management Partners, Inc.
1730 Madison Road
Cincinnati OH 45206
INBURERE
INSURER E:
IN6URERF:
CLAIMS-MADE OCCUR
COVERAUES CERTIFICATE NUMBER: RAnAAD'iAA REVIRInN NIIMRFR-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IL R
TYPE OF INSURANCE
I
POLICY NUMBER
LIMIT$
A
GENERAL LIABILITY
38BAUG1832
CCURRENCE
$1,000,000
Eaoc rrenea
$300,000
X COMMERCIAL GENERALUAINUTY
$10,000
CLAIMS-MADE OCCUR
7M$
P(An one peraaN
NAL &ADVINJURY
$1000000
AL AGGREGATE
$2000 000
GEN'L AGGREGATE
LIMITAPPLIES PER:
CTS- COMP/OPAGG
$2000000
POLICY
P LOC
$
AUTOMOBILE
UABILITY
33UECVG5096
/1/2013
/1/2014
2 sa Iwl
$1,000.000
X
ANYAUTO
BODILY INJURY (Per penal)
$
ALLOWNEp SCHEDULED
AUTOS X AUTOS
BODILY INJURY(peracownll
E
X
NON."ED
HIREDAUTCG X AUTOS
PROPEflTY E
Per aidBlll
$
E
A
X
UMBRELLA LIAB
X
OCCUR
338SAUG1832
31112013
11112014
EAGHOCCURRENCE
$3,ODD,000
EXCESS LIge
CLAIMS-MACE
AGGREGATE
$3,000,000
[)ED IX
I RETENTION $10000
E
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTNE YIN
OFRCERIMEMBER EXCLUDED?
MIA
93WECRX9356
31112013
71/2014
X STAT I %T
E.L. EACH ACCIDENT
$1,000,000
E.L. DIBEABE •EAEMPLCYE
$1,000,000
(MalMetory In NH)
R Yyee, deeclbe under
Or RIPTION OF OPERATIONS below
E.L. DI6EASE - POLICY LIMIT
81000000
B
Professional Llal,
312012013
2012014
Ea. Claim $1,000,000
A00 $1,000,000
DeduCOble $10,000
DESCRIPTION OF OPERATIONBI LOCA710MB /VEHICLES (ARaah ACORD 101, Ade ltlonel Remalke Schedule, If mom apace to mqulnd)
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).
�I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Costa Mesa Sanitary District ACCORDANCE WITH THE POLICY PROVISIONS.
626 W 19th St. e/Y
Costa Mesa CA 82627 -2716 ^ AUTHORIZED REPRESENTATIVE
ACORD 25 (2010105)
lox
The ACORD name and logo are registered marks of ACORD
Mnh }e roeervetl
POLICY Nu689ER; 33SBAUG1832
v.: I
THOS (ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
TlIls endorsement modifies Insurance provided under the following:
ADDITIONAL INSURED - PARSON OR ORGANIZATION
Costa Mesa Sanitary District its directors, officials, officers, employees
agents and volunteers
628 W 19th St.
Costa Mesa, CA 92627 -2716
Form IH 12 01 1186 Primed In U.S.A.