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Insurance - White Nelson Diehl - 2012-05-19P-E-4; IVED ,acorn CERTIFICATE OF LIABILITY INSURANCE . �i Swn�Tl 2012 E D DATHMMIDD, 01 05 -19 -2012 THIS E TIFIC IS ISSUED AS A MATTER OF INFORMATION ONLY ANDCONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CIO OWPoIXFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE CO I 4.1OTED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TH ISSUIN jj((�V URER(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 SUBROGATIONIS WAIVED, subject to terms and conditions of the policy, certain policies may require an endorsement. A statementon this certificate does not confer rights to the tificate holder in lieu of such endorsementls). PRODUCER WIAA INSURANCE SERVICES /PHS 251467 P:(866)467 -8730 F:(877)905 -0457 NAME: PAONNE E.w (166)467 -8730 I(AC, N.). (877)905 -045 PREMISES (Ea o «nrrence) s 300,000 PO BOX 33015 ADDRESS: PRODUCER SAN ANTONIO TX 78265 CUSTOMER ID #: INSURERS) AFFORDING COVERAGE NAIC # AUTOMOBILE --� A,_J x XHIRED INSURED INSURER A: Hartford Casualtv Ins Co 01/01/2012 INSURER B: Hartford Underwriters Ins Co COMBINED SINGLE LIMIT Ea ae.dant) ' S 1,000,000 WHITE NELSON DIEHL EVANS LLP $ BODILY INJURY (Per accident) $ 2875 MICHELLE STE 300 INSURER C: IS X UMBRELLA LIAB x I OCCUR `EXCESS LIAB CLAIMS MADE IRVINE CA 92606 INSURER D: 01/01 /2013 INSURER E: AGGREGATE 1$4,000,000 A j DEDUCTIBLE ! X' ' X' RETENTION 5 10, 000 ! INSURER F s BSI 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. INSfl LTR TYPE OF INSURANCE 'INSR VIVO, POLICY NUMBER (MMIDDIYYYY) (MM /DDNYYY) 1 LIMITS GENERAL LIABILITY I COMMERCIAL GENERAL LIABILITY A !, CLAIMS -MADE LX OCCUR XI General Liab X DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. j !72 SBA KZi9101 01/01/201) 01/01/2013 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea o «nrrence) s 300,000 MED EXP Any one Person) S 10,000 PERSONAL &ADV INJURY $ 1, 000,000 GENERAL AGGREGATE s 2, 000,000 �ICWL AGGREGATE LIMIT APPLIES PER: POLICY PRO- X I LOC JECT PRO - PRODUCTS - COMPIOPAGG s 2, 000,000 AUTOMOBILE --� A,_J x XHIRED LIABILITY ANY AUTO ALL OWNED AUTOS 1 SCHEDULED AUTOS AUTOS X NON -OWNED AUTOS 1 '', 72 SBA KZ 9101 01/01/2012 01/01/2013 COMBINED SINGLE LIMIT Ea ae.dant) ' S 1,000,000 BODILY INJURY He, person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) s s IS X UMBRELLA LIAB x I OCCUR `EXCESS LIAB CLAIMS MADE 72 SBA KZ 9101 1 01/01/2012 01/01 /2013 EACH OCCURRENCE s 4, 000,000 AGGREGATE 1$4,000,000 A j DEDUCTIBLE ! X' ' X' RETENTION 5 10, 000 ! 5 s BSI j WORKERS COMPENSATION ! AND EMPLOYERS' LIABILITY YIN ANY PROP.RIETORIPARTNERIEXECUTIVEI—I� Mandnory in NHjcXuLUDEDi L�I� "' 1 172 jA7 E'(" IX3258 06 /01/ 2012 06/01/20131 If yes, describe under DESCRIPTION OF OPERATIONS below X WC STATU- ! IOTH- 1 TORY LIMITS ER 1 EL. =Af,H ACCIDENT $ = , O �' � , coo E.L. DISEASE - EA EMPLOYEE! a 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1, 000, 0 0 0 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Abash ACORD 101, Additional Ranieri. Schedule, if more space is required) Those usual to the Insured's Operations. The District, its directors, officers, employees, agents and volunteers are listed as an Additional Insured per the Business Liability Coverage Form SS0008, attached to this policy. Coverage is primary & non - contributory per the Business Liability Coverage Form SS0008, attached to this policy CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Attn: Sherry Kallabe, Administrative BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE Manager DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZE H PRESENTATIVE 9_�_ 8 W 19TH ST �_,STA MESA, CA 92627 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD