Loading...
Insurance - Lan Wan Enterprise Inc. 2018-04-10CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDIYYVY) 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 129NTACT YASSA INSURANCE AGENCY INC 26361 Crown Valley Parkway #230 Mission Viejo, CA 92691 INSURED Lan Wan Enterprise, Inc. 17500 Red Hill, Suite # 120 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. NOTWTHSTANDING 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. 'NSR LTR I TYPE OF INSURANCE ADDLSUBR INSD WVD POLICYNUMBER POLICYEFF MMIDDIYYYY POLICY EXP MM/DD/YYYY LIMITS X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE OOO L CLAIMS -MADE IX OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence 5 300000 _ _ 1 MED EXP (Any one person) S 5 000 A X 680-21-1705893-17-42 8/19/2017 8/19/2018 PERSONAL& ADV INJURY 11 2000,000 GEN 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 4 0001000 X POLICY PRO- LOC _ JECT PRODUCTS-COMP/OPAGG S 4,000,000 X OTHER CYBER LIABILITY S 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 15 Ea accident 10, 00,000 ANY AUTO BODILY INJURY(Perperson) S B OED SCHEDULED x A SONLYI�Auros X BA9G337755 4/1/o2018 41112019 BODILY INJURY (Per accident) 1 $ RED 11 X AUOTOS WNED X PTY DAMAGE $ PROER — AUTOS ONLY ONLY S 1 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 110.00_ ,000 D EXCESS LIAB CLAIMSMADE005H364288 1 8/19/2017 1 8/19/2018 AGGREGATE DED RETENTIONS ' $ WORKERS COMPENSATION i PER ` STATUTE ORH AND EMPLOYERS' LIABILITY YIN - -- - - - 1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE NIA EL. EACH ACCIDENT 5 -- C OFFICERIMEMBER EXCLUDED' (Mandatory ryiIn 83 WEC 162988 6/9/2017 i 6/9/2016 EL. DISEASE -EA EMPLOYEE S 1,000,000 beNH) If yes,DESCRIPTION OF OPERATIONS below I 1 El DISEASE - POLICY LIMIT _ S 1,000,000 ERROR & OMISSION 680-2H705893-17-42 8/19/2017 8119/2018 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attacher/ if more space Is re,r tl) Costa Mesa Sanitart District, their elected and appointed officials, agents, officers, volunteers and employees listed as Additional Insured. Cancellation: Said policy shall not terminate, nor shall it be canceled nor the coverage reduced, until thirty (30) days after written notice is given to the District. l�li:\rIa PL'\��:Pl�gaC _\0PJ3�1�_\�L�IC Additional Insured: Costa Mesa Sanitary District 290 Paularino Ave Costa Mesa, CA 92626 ✓ �'/j� I 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 M,CZ4� G, © 1988-2015 ACORD CORPORATION ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD GENERAL PURPOSE ENDORSEMENT TECH OFFICE PAC POLICY NUMBER: 6e0 -2H705893-17-42 ISSUE DATE: 02/22/2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED STATE OR POLITICAL SUBDIVISIONS - PERMITS This endorsement modifies insurance provided under the following: PER IL T8 04 THE COSTA MESA SANITARY DISTRICT, ITS ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS AND EMPLOYEES ARE ADDITIONAL INSUREDS. IL T8 04 08 17 Page 1 Of 1 TRAVELERSJW One Tower Square, Hartford, Connecticut 06183 CHANGE ENDORSEMENT INSURING COMPANY: TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA Named insured: LAN WAN ENTERPRISE INC Policy Number: Policy Effective Date: Policy Expiration Date: Issue Date: Premium S 680-2H705893-17-42 08/19/2017 08/19/2018 02/22/2018 NIL Effective from 02/14/18 at the time of day the policy becomes effective. THIS INSURANCE IS AMENDED AS FOLLOWS: Additional Insureds are added to the policy as provided under the attached endorsement(s): CG 20 13 The following forms and/or endorsements is/are included with this change. These forms are added to the policy or replace forms already existing on the policy: IL TO 07 09 87 CG 20 13 11 85 IL T8 04 08 17 Rates and/or premiums have been changed to reflect a change in the exposure and/or rating procedure NAME AND ADDRESS OF AGENT OR BROKER ERAS MAKRAM YASSA 26361 CROWN VALLEY PKWY STE 230 MISSION VIEJO Countersigned by Aut oq Representative CA 92691 DATE: 02/22/2018 IL TO 07 09 87 (Page 1 Of 1 ) Office: BREA/LA/ORANGE CA GENERAL PURPOSE ENDORSEMENT TECH OFFICE PAC POLICY NUMBER: 680-2H705893-17-42 ISSUE DATE: 02/22/2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE WAIVER OF TRANSFER RIGHTS OF RECOVERY AGAINST OTHERS AMENDMENT - SEPARATION OF INSUREDS This endorsement modifies insurance provided under the following: PER IL T8 03 THE COSTA MESA SANITARY DISTRICT, ITS ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS AND EMPLOYEES ARE ADDITIONAL INSUREDS IL T8 03 08 17 Page 1 of 1 POLICY NUMBER: 680-28705993-17-42 ISSUE DATE: 02/21/2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EARLIER NOTICE OF CANCELLATIONMON RENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: WHEN WE DO NOT RENEW (Nonrenewal): PROVISIONS: A. For any statutorily permitted reason other than nonpayment of premium, the number of days re- quired for notice of cancellation, as provided in the CONDITIONS Section of this insurance, or as amended by any applicable state cancellation endorsement applicable to this insurance, is in- creased to the number of days shown in the SCHEDULE above. Number of Days Notice: 30 Number of days Notice: 30 B. For any statutorily permitted reason other than nonpayment of premium, the number of days re- quired for notice of When We Do Not Renew (Nonrenewal), as provided in the CONDITIONS Section of this insurance, or as amended by any applicable state When We Do Not Renew (Nonrenewal) endorsement applicable to this in- surance, is increased to the number of days shown in the SCHEDULE above. IL T3 20 09 97 Copyright, The Travelers Indemnity Company, 1997 Page 1 of 1 POLICY NUMBER: 680-2H705893-17-42 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 02/22/2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED -STATE OR POLITICAL SUBDIVISIONS -PERMITS RELATING TO PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State or Political Subdivision: PER IL T8 04 628 W. 19TH ST. COSTA MESA CA 92627 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured any state or political sub- division shown in the Schedule, subject to the follow- ing additional provision: This insurance applies only with respect to the follow- ing hazards for which the state or political sub- division has issued a permit in connection with premises you own, rent, or control and to which this insurance applies: 1. The existence, maintenance, repair, construction, erection, or removal of advertising signs, awn- ings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures: or 2. The construction, erection, or removal of elevators: or 3. The ownership, maintenance, or use of any elevators covered by this insurance. CG 20 13 11 85 Copyright, Insurance Services Office, Inc.. 1984 Page 1 of 1 POLICY NUMBER: 680-2x705893-19-42 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 03/15/2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -STATE OR POLITICAL SUBDIVISIONS -PERMITS RELATING TO PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State or Political Subdivision: COSTA MESA SANITARY DISTRICT 290 PAVLARINO AVE COSTA MESA CA 92626 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to 1. The existence, maintenance, repair, construction, include as an insured any state or political sub- erection, or removal of advertising signs, awn - division shown in the Schedule, subject to the follow- ings, canopies, cellar entrances, coal holes, ing additional provision: driveways, manholes, marquees, hoist away This insurance applies only with respect to the follow- openings, sidewalk vaults, street banners, or ing hazards for which the state or political sub- decorations and similar exposures; or division has issued a permit in connection with 2. The construction, erection, or removal of premises you own, rent, or control and to which this elevators; or insurance applies: 3. The ownership, maintenance, or use of any elevators covered by this insurance. CG 20 13 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 TRAVELERSJ' One Tower Square, Hartford, Connecticut 06163 CHANGE ENDORSEMENT INSURING COMPANY: TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA Named Insured: LAN WAN ENTERPRISE INC Policy Number: Policy Effective Date: Policy Expiration Date: Issue Date: Premium $ 680-2H705893-17-42 08/19/2017 08/19/2018 03/15/2018 NIL Effective from 03/07/18 at the time of day the policy becomes effective. THIS INSURANCE IS AMENDED AS FOLLOWS: The name and address of the following Additional Insured is changed as shown: CG 20 13 - OLD NAME: PER IL T8 04 ADDRESS: 628 W. 19TH ST. 92627 - NEW NAME: COSTA MESA SANITARY DISTRICT ADDRESS: 290 PAULARINO AVE COSTA MESA . CA 92626 The name of the following Additional Insured is changed as shown: CG 20 13 - OLD NAME: PER IL TS 04 - NEW NAME: COSTA MESA SANITARY DISTRICT The address of the following Additional Insured is changed as shown: CG 20 13 - NAME: COSTA MESA SANITARY DISTRICT 290 PAULARINO AVE COSTA MESA , CA 92626 The following forms and/or endorsements is/are deleted from the policy: IL T8 04 08 17 The following forms and/or endorsements is/are included with this change. These forms are added to the policy or replace forms already existing on the policy: IL TO 07 09 87 CG 20 13 11 85 NAME AND ADDRESS OF AGENT OR BROKER Countersigned by EHAB MAKRAM YASSA 26361 CROWN VALLEY PKWY STE 230 Authorized Representative MISSION VIEJO CA 92691 DATE: 03/15/2018 IL TO 07 09 87 (Page 1 of 2 ) Office: BREA/LA/ORANGE CA