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Insurance - Discovery Science Center - Workers Comp 2018-03-23271069 ,A� o® CERTIFICATE OF LIABILITY INSURANCE DAT3123/2D/YYYY) 3/23/2018 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 have ADDITIONAL INSURED provisions or 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 Commercial Lines - 213-253-6700 USI Insurance Services National, Inc. - CA Lic#; OD08408 777 South Figueora St, Ste 2100 CONTACT Norah.Jacobo NAME: PHONE FAX NC No E C No : A1 nooRsss:xt Norah.JacoboQusi.com INSURERS AFFORDING COVERAGE NAICN Los Angeles, CA 90017 INSURERA: Philadelphia Indemnity Insurance Company 18058 INSURED Discovery Science Center of Orange County INSURER B: Travelers Property Casualty Cc of America 25674 INSURERC: dbe Discovery Cube Orange County INSURER D: 2500 N. Main Street INSURER E: Santa Ana, CA 92705 INSURER F: COVERAGES CERTIFICATE NUMBER: 12851603 REVISION NUMBER: See below 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. INSRTYPE LTR OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDNYYY LIMITS A X COMMERCIALGENERAL LIABILITY CLAIMS -MADE I OCCUR X PHPK1590101 12/15/2016 7/1/2018 EACH OCCURRENCE S 1,000,000 PREMISES Ea occurrence) $ 1,000,000 PREMISES MED EXP (Any one person) S 51000 PERSONAL &ADV INJURY 5 1,000,000 AGGREGATE OMIT APPLIES PER: GENERA -AGGREGATE $ 2,000,000 GEN'L X POLICY E] PRO- LOC JECT PRODUCTS-COMPIOP AGG $ 2.000,000 Sexual AbuseNclestetion 5 Induced OTHER: A AUTOMOBILE LIABILITY PHPK1590101 12/15/2016 7/1/2018 COMBINED SINGLE LIMIT 5 1,000,000 Ea accident BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accitlenl) $ X HIRED NON -OWNED A1UTOS ONLY X AUTOS ONLY PROPERTY DAMAGE Per ccidenl $ $ UMSRELIALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ 5 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERMXECUTNEE. OFFICEWMEMBEREXCLUDED? C NIA UB -003K355354-18 04/01/16 04/01/19 X STATUTE OTRH- L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 (Mandatory In NH) ((yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 5 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Costa Mesa Sanitary District, its elected and appointed officials, agents, officers, volunteers and employees are included as an Additional Insured for General Liability, but only as respects to claims arising out of the negligence of the Named Insured per attached form. Costa Mesa Sanitary District SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Co a Mesa, Ave /�. / �/ ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa, CA 92626 -�j � Y'ryV1 Y�' AUTHORIZED REPRESENTATIVE The ACORD name and loqo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All riahts reserved. ACORD 25 (2016103) II II I I I I II I II I I III II II III III I I II I I II PI -GL -005 (07/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization (Additional Insured): costa Mesa Sanitary District Effective Date: 12/15/2016 SECTION 11 — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the endorsement Schedule, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of or relating to your negligence in the performance of "your work" for such person(s) or organization(s) that occurs on or after the effective date shown in the endorsement Schedule. This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or "occurrence" we cover for this Additional Insured. The Additional Insured's limits of insurance do not increase our limits of insurance, as described in SECTION III — LIMITS OF INSURANCE. All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER: PHPKI590101 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons) Or Organization(s): Costa Mesa Sanitary District 290 Paularino Ave Costa Mesa, CA 92626 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — 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', "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 •cYeoWemo Wee /W)1000-