Insurance - Management Partners - 2014-02-27ACORO® CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
2/27/2014
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
MTEACT Matt Walsh
The Hauser Group
8260 Northcreek Drive, Suite 200
Cincinnati OH 45236
PHONE PAX
PAC. Na
MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC#
33SBAUG1032
INSURERA
/112015
EACH OCCURRENCE
INSURED MANAG -2
B:Llgyds of London
X COMMERCIAL GENERAL LIABILITY
INSURER C:
Management Partners, Inc.
1730 Madison Road
Cincinnati OH 45206
INSURER D:
PREMISES Eaoccu ence
$1,000,000
INSURER E:
CLAIMS -MADE O OCCUR
INSURER F:
COVERAGES
CERTIFICATE NUMBER: AAAA9r01 R
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
LTR
TYPE OF INSURANCE
AWL
IN SR
SUBR
MD
POLICY NUMBER
POLICY EFF
fMWDDrCYYn
POLICY EXP
ImWDDNYYY)
LIMITS
A
GENERAL LIABILITY
33SBAUG1032
/112014
/112015
EACH OCCURRENCE
$1,000,000
X COMMERCIAL GENERAL LIABILITY
PREMISES Eaoccu ence
$1,000,000
CLAIMS -MADE O OCCUR
MEO EXP (Any one parson)
$10,000
PERSONAL &ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMP /OP AGG
$2,000,000
$
POLICY PRO LOC
A
AUTOMOBILE
LIABILITY
33UECVG5096
31112014
/1/2015
Ea accident
1,000,000
BODI LY INJURY (Per person)
$
X
ANY AUTO
ALL OWNED X SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per acddem)
$
X
X NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
Perawdent
$
A
X
UMBRELLA LUIB
�X71
OCCUR
33SBAUG1832
/1/2014
11/2015
EACH OCCURRENCE
$3,000,000
AGGREGATE
$3,000,000
EXCESS LIAR
CLAIMS -MADE
DED IX RETENTION $10,000
$
A
WORKERS COMPENSATION
ANDEMPLOYERS'LIABIUTY YIN
33VVECBU6135
/1/2014
/1/2015
1 WC STATU- OTH-
E.L. EACH ACCIDENT
$1,OD0,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
N/A
E.L. DISEASE -EA EMPLOYEE
$1,000,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$1,000,000
B
Professional Lied
MPLID08388
/20/2013
312012014
Ea. Claim $1,000,000
Agg $1,000,000
Deductible $10,000
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, IT more space is required)
Costa Mesa Sanitary District its directors, officials, officers, employees, agents, and volunteers are are shown as an additional insured($)
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).
RECEIVFr)
Costa Mesa Sanitary District
628 W 19th St. ( v
Costa Mesa CA 92627 -2716 �I1�
k,AIYUCLLX I IUn OU UayS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
8.4 b)v"'CIV
(n IARR -2n9n ArnRn CnRPnRATION All rinhle moo.,.od
ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD
I I b
POLICY Numam 33sBAUG1832
.2w
TH9 S ENDORSEMENT CHANGES THE POLICY. PLEASE {BEAD IT CAREFULLY,
This endorsement modifies insurance provided under the following:
ADDITIONAL INSURED - PERSON OR ORGANIZATION
Costa Mesa Sanitary District its directors, officials, officers, employees
agents and volunteers
628 W 19th St.
Costa Mesa, CA 92627 -2716
Form 07 12 01 1185 Printed In U.S.A.