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Insurance-Bartel Associates-2014-09-01AC6RhF CERTIFICATE OF LIABILITY INSURANCE Dg0E1mM/007 09/01/2014 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 NAONT. ROBERT B RICE, JR. 0181288 PHON o En: (818) 547 -1975 AX N . (818) 438 -5988 SARGEANT INSURANCE AGENCY, LLC. mbeR@sargeantinsurance.com INSURERS AFFORDING COVERAGE NAICR 300 WEST GLENOAKS BLVD. SUITE 104 INSVRERA: AMERICAN STATES INSURANCE COMPANY 19704 GLENDALE CA 91202 -2985 INSURED INSURERS: INDIAN HARBOR INSURANCE COMPANY 36940 BARTEL - ASSOCIATES, LLC INSURERC: TECHNOLOGY INSURANCE COMPANY INSURER D: DAMAGE TO RENTffD-- PREMISES Eaamunenm JOHN BARTEL INSURERE: CMMS�MAOE FRI OCCUR 411 SOREL AVE STE 101 INSURER F: SAN MATEO CA 94402 -3525 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 LTR TYPE OF INSURANCE ADOL 9UBft POLICY NUMBER MMIDIDYA`YYYY MMLID EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTffD-- PREMISES Eaamunenm $ 1,000,000 CMMS�MAOE FRI OCCUR MED EXP(Any one emon) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 A X 25CC12442990 09101/2014 09/01/2015 GENERALAGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGO $ 2,000,000 Z'L POLICY PRO- LOC $ AUTOMOBILE LIABIMTY CEOMaetlNdEDtSINGLE LIMIT $ 1,000,000 BODILY INJURY (P., Person) S ANY AUTO A ALLOWNEO SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTO$ X AUTOS X 25CC12442990 09/01/2014 09/01/2015 DOILY INJURY (P., accldw) S PROPERTY DAMAGE Permcldent S UMBRELLA LIAR OCCUR EACH OCCURRENCE 8 AGGREGATE 8 EXCESS LIAR CLAIMS-MADE DED RETENTION E WORKERS COMPENSATION X WC STATLL OTH- G AND EMPLOYERS' LIABILITY YIN OFFICER/MEMBER EXCLUDED ?�UTIVE (Mandatory In NH) X TWC3431682 09/01/2014 09/0112015 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYE $ 1,000,000 DEB..IPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I S 1,000,000 B MISC. PROFESSIONAL LIABILITY MPPOO1715210 09/01/2014 09101/2015 - $2,000,000 PER CLAIM $4,000,000 ANNUAL AGGREGATE DESCRIPTION OF OPERATIONS / LOOATION$f VEHICLES (AtlaeN ACOR01gt, gtltlltlpnel Remerka Scgetlula, It more epacp 4 requlretl) D TNON-CONTRIBUTORY O AND ABOVE EOFF A�D II SE�HE CERTIFICATE LATE HOLDECS) MAY CARRY. DAYNO CANCELLATION. SEP 15 2014 A <AN CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010105) ©1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE COSTA MESA SANITATION DISTRICT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: ANNA SANCHEZ, ADMINISTRATIVE SERVICES MANAGER ACCORDANCE WITH THE POLICY PROVISIONS. 628 WEST 19TH STREET AUTHORIZED REPRESENTATIVE �'\1 COSTA MESA \,{A1 GA 92627 ROBERT B. RICE, JR.e,�„�. g � &� jr„ ACORD 25 (2010105) ©1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BARTEL- ASSOCIATES, LLC CG 86 72 10 02 POLICY NUMBER: 25CC12442990 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS— COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: COSTA MESA SANITATION DISTRICT Location and Description of Completed Operations: All operations of the Named Insured: Additional Premium: Included (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) SECTION II — WHO IS AN INSURED is amended to include as an insured the person or organization shown in the Schedule, but only to the extent you are held liable due to "your work" at the location designated and described in the schedule of this endorsement for that insured and included in the "product- completed operations hazard ".