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Insurance-Jimni Systems Inc. - 2016-09-26RECETirriiA �1 QED O o 9nfe JIMNSYS-01 VOLIVARES ACORO° J� CII ERTIFICATE OF LIABILITY INSURANCE Da 9126/2TE 016 9/26/2016 THIS CERTIFICATE I>L'/RDjlW,ASy#/t%0T F,�j� OFWNFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELYJISFiSEia''ATIVELY 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(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 endoreement(s). PRODUCER License # OD79613 Bowermaster & Associates Insurance Agency, Inc. 10805 Holder Street, Suite 350 Cypress, CA 90630 YP CONTACT Lizette Orozco NAME: _ PHONE (714 733-6248 FAX No AIC No E#* ) E-MAIL ADDRESS: lorozco@bowermaster.com bowermasteccom INSURER(S) AFFORDING COVERAGE NAICM X INSURERA: Admiral Insurance Company 124656 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 INSURED INSURER B:American Fire & Casualty Company 24066 J Imnl Systems, Inc. INSURER C : Praetorian Insurance Company INSURER D: 11161 Jeffrey Rd Irvine, CA 92602 INSURER E: INSURER F 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ADDL:SUBR INSDIMO POLICY EFF POLICY EXP POLICY NUMBER 1(MMIDDI)OYY) (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 1 EACH OCCURRENCE S 1,000,000 CLAIMS -MADE IA] OCCUR X FEIECC2133401 04/01/2018 04/01/2017 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED ENE (Any one person) $ 5,000 I PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGRErGATE LIMIT APPLIES PER. POLICY X JECOT LOC PRODUCTS-COMPIOP AGO 2,000,000 _S $ OTHER AUTOMOBILE LIABILITY COM BINESINGLE LIMIT $ 1000000 Ea accitlant BODILY INJURY (Per person) 5 B X ANY AUTO BAA56443207 04/01/2016 04101/2017 ALL OWNED SCHEDULED AUTOS �_ AUTOS BODILY INJURY (Par accident) $ PROPERTY DAMAGE $ Per accident) NON -OWNED HIRED AUTOS AUTOS S i UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 2,000,000 _ AGGREGATE S 2,000,000 A X EXCESS LIAB 'LA MADE FEIEXS2133501 04/0112016104/0112017 DEO RETENTIONS $ WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY C AN V PROPRIETORWARTNERIEXECUTIVE YINEQB0102429 04/01/2016 04/01/2017 PER OTH- STATUTE ER ELEACH ACCT DENT 5 1,000,000 OFFICERIMEMBER EXCW DED4 (Mandatory in NH) IA E.L. DISEASE- EA EMPLOYEES 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE- POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: All Operations Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees are listed as Additional Insured - Pursuant to attached endorsement CG2010 0413 and CG2037 0704. Any other insurance maintained by the Costa Mesa Sanitary District shall be excess and non-contributing with the insurance provided by this policy per form ECC548 0712. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014101) ©1988-2014 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 Sanitary District I, //,a 628 W. 19th Street `� CI/ hjl''{ Mesa, esa, CA 92627 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Of. V 151 ACORD 25 (2014101) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KAN Jimni Systems, Inc. Endorsement Number: 20 Additional Insured — Owners, Lessees or Contractors — Completed Operations This endorsement, effective 4/1/2016 attaches to and forms apart of Policy Number FEI-ECC-21334-01. This endorsement changes the Policy. Please read it carefully. In consideration of an additional premium of $Applied, this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed O erations Any person(s) or organization(s) whom the Named Insured Those project locations where this agrees, in a written contract, to name as an additional insured. endorsement is required by contract. However, this status exists only for the project specified in that contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for 'bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Jimni Systems, Inc. Endorsement Number: 13 AeARRAL �.... Automatic Primary and Non-Contributory Insurance Endorsement Designated Work Or Project(s) This endorsement, effective 4/1/2016 attaches to and forms a part of Policy Number FEI-ECC-21334-01. This endorsement changes the Policy. Please read it carefully. SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to provide Primary and/or Non-contributory status of this insurance. However, this status exists only for the project specified in that contract. Inconsideration of an additional premium of SApvlied and notwithstanding anything contained in this policy to the contrary, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third parties in respect to work performed by you under any written contractual agreement with such third party. It is further agreed that any other insurance which the person(s) or organization(s) named in the schedule may have is excess and non- contributory to this insurance. ECC -548-0712