Insurance - dTank, Inc. - 2016-09-01O -
ACORD„ CERTIFICATE OF LIABILITY INSURANCE 09/0MI/2016
> C 09/01/2016
STEVEN J WETTERHAHN
22400 N SUMMIT RIDGE CIRCLE
CHATSWORTH, CA 91311
818-772-9646
INSURED_-_-- --__- -
DTANK INC
3500 W. BURBANK BLVD. SUITE 101
BURBANK, CA 91505
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CA 91311 INSURERS AFFORDING COVERAGE :NAIC#
INSURERA. AMCO INSURANCE CO. - ALLIED
iNauRFR a EMPLOYERS COMPENSATION INS CO.
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. AGGREGATE LIMITS SHOWN MAY HAVE
BEEN REDUCED BY PAID CLAIMS.
IMPOSE NO OBLIGATION OR LIABILITY OF ANY WND UPON THE INSURER, ITS AGENTS OR
---- ----
INS -1k DD'I�
—' POLIOY EFFECT ". POMOY EXPIRATION
AUTH MDR RESENTATNE
TYPE OF INSURANCE
POLICY NUMBER p TE O LIMITS
�GENERALUABILITY ACP
BPR 7573795063 101/10/2016101/10/2017'' EACHOCCURRENCE s _-
1,000,000
(� COMMERCIAL GENERALLIABILITY"'.�REMISES1Ea
�6AMAGE"TO RENTED 7
occuwro cej
300,000
ICLAIMSMADE y"lIOCCUR
yE___
�.. I MED EXP Any aneperwn) E
5,0,GO
A
I PERSONAL B ADV INJURY S
1, OQO, 000,
_
I GENERAL AGGREGATE � 5
2,000,000
GEN AGGREGATE LIMIT APPLIES PER.
I„ PRODUCTS COMPIOP AGE,
.2,000,000
__.
,/J'L
POLICY PRO- LOG
AUTOMOBILE LIABILITY ACP
""—
BA 7864583445 08/01/2016/ 08/01/2017, COMBINED SINGLE LIMIT S
1,000,000
ANY AUTO
(Ea a c tlanp
ALL OWNED AUTOS
j BODILY INJURY S
AI SCHEDULED AUTOS
(Pe person)
��) HIRED AUTOS
BODILY INJURY
✓'NON -OWNED AUTOS
(Pe mUenp S
_..
_.._
PROPERTYDAMAGE S
(Per ao,dem)
GARAGE LIABILITY
AUTO ONLY; EA ACCIDENT S
ANY AUTO
OTHER THAN EAACG S
•
._.._.
AUTO ONLY. AGO S
EXCESSIUMBRELLALIABIL ACP
CCA 7873795063 01/10/2016',.01/10/2017-_EACHOCCURRENCE s.
5,000,000
✓', OCCUR I ClA1MS MADE ',.
'., AGGREGATE _ _.. 5 _
_5, 000, 000.
_ DEDUCTIBLE
RETENTION S
S
WORKERS COMPENSATION AND
IEIG
WCSTATU- OTH
ER __..-
1112178 X10/27/2015 10/27/2016--LTCRYLIMITS._ LER---.-
EMPLOYERS' LIABILITY
EMPLOYERS'
I E.L.EACH ACCIDENT 5
1,1000 000_
B ANY PROPRIETORIPARTNERIEXECUTIVE
OFTOERIMEMSEREXCLUDED?
E.L.DISEASE- EA EMPLOYEEIS
QQQ,,QQQ..
Il yyes,tlesPROVeEer
PROVISIONS Eelmv
1 i E.L. DISEASE -POLICY LIMIT S
11000,000
OTHER
OTHER
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1
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
COSTA MESA SANITARY DISTRICT,
ITS ELECTED AND APPOINTED OFFICIALS, AGENTS,
OFFICERS, VOLUNTEERS, AND
EMPLOYEES IS ADDITIONAL INSURED UNDER GENERAL
LIABILITY PER POLICY.
ACORD 25 (2001/08)
COSTA MESA SANITARY DISTRICT
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
290 PAIILARINO
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
COSTA MESA, CA 92626
IMPOSE NO OBLIGATION OR LIABILITY OF ANY WND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTH MDR RESENTATNE
ACORD 25 (2001/08)
BUSINESSOWNERS
PB 60 04 04 11
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - SERVICES PERFORMED ON
PREMISES OF ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
PREMIER BUSINESSOWNERS LIABILITY COVERAGE FORM
A. The following is added to Section II. WHO IS AN
INSURED:
The person or organization designated in the
Schedule of this endorsement is also an
insured, but only with respect to their liability for
"bodily injury" or "property damage" caused, in
whole or in part, by your acts or omissions or the
ads or omissions of those acting on your behalf
in connection with ads or services normal and
usual to your business described in the
Declarations, performed by you or on your
behalf for the person or organization designated
in the Schedule of this endorsement on
premises owned, leased, maintained or used by
such person or organization.
B. ADDITIONAL EXCLUSION
This insurance, including our duty to defend
"suits", does not apply to "bodily injury",
'property damage" or "personal and advertising
injury" arising out of any active negligence of the
person or organization designated in the
Schedule of this endorsement.
All terms and conditions of this policy apply unless modified by this endorsement.
SCHEDULE
Name of Person or Organization: _ _
The Costa Mesa Sanitary District, its elected and appointeyi
officials, agents, officers, volunteers and employees are
additional insured.
PB 60 04 0411
ACP BPR 7853795063
AGENT COPY
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