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Insurance - Revize LLC - 08-24-2020AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 08/24/2020 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 Phone: (248) 862-2127 Fax: (248) 886-9091 INSURCO INSURANCE AGENCY 5600 WEST MAPLE RD., SUITE C-310 WEST BLOOMFIELD MI 48322 CONTACT Insurco Insurance Agency PHONE FAX /C No Ext): (248) 862-2127 A/c No (248) 886-9091 E-MAIL ADDRESS: Ivan@insurcomi.com INSURER(S) AFFORDING COVERAGE NAIC # NON -OWNED INSURER : Valley Forge Insurance Company 20508 7 AUTOS INSURED REVIZE LLC INSURER B : The Continental Insurance Company 35289 INSURER C : Continental Casualty Company 20443 150 KIRTS BLVD STE B TROY, MI 48084 INSURER D: INSURER E AGGREGATE $ INSURER F ko`JVCKAt7r_0 t+CK1II-IUAIC NUIVItiCK: 00ly KtV151UN NUMOLK: 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 ADDL; SUBR; POLICY EFF POLICY EXP _r --_ _-(MM/DD/YYYY) j (MM/DD/YYYY) S LTR IVSD WVD _.POLICY NUMBER LIMIT — A ! X COMMERCIAL GENERAL LIABILITY 6021635658 09/10/19 09/10/20 EACH OCCURRENCE $ 2,000,000 — CLAIMS -MADE X OCCUR DAMAGE TO RENTED 300 000 PREMISES (Ea occurence) $ e GEN'L AGGREGATE LIMIT APPLIES PER: X? POLICY --J JECOT LOC OTHER: -- - ----- GENERAL AGGREGATE $ A AUTOMOBILE LIABILITY PRODUCTS - COMP/OP AGG $ ANY AUTO – ;ALL OWNED SCHEDULED 'AUTOS AUTOS X i HIRED AUTOS X NON -OWNED 7 AUTOS UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE DED IRETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y i N OFFICER/MEMBER EXCLUDED? Y N / A (Mandatory in NH) --- If yes, describe under DESCRIPTION OF OPERATIONS below MED. EXP (Any one person) $ 10,000 ~PERSONAL & ADV INJURY + $ 2,000,000 -- - ----- GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP/OP AGG $ 4,000,000 6021635658 09/10/19 09/10/20 .COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) !$ � PROPERTY DAMAGE �$ (per accident) EACH OCCURRENCE • $ AGGREGATE $ 6021635689 09/10/19 ! 09/10/20 sTaruTE— E.L. EACH ACCIDENT i $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 C PROFESSIONAL LIABILITY/ CYBER LIABILITY 6021626488 09/10/19 1 09/10/20 PER CLAIM $1,000,000 RETENTION $10,000 'AGGREGATE $2,000,000 DESCRIPTION OF OPERATIONS ! LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Costa Mesa Sanitary District, It's elected and appointed officials, agents, officers, volunteers and employees are additional insureds. 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. Any other insurance maintained by the Costa Mesa Sanitary District shall be excess and non-contributing with the insurance provided by this policy..... CERTIFICATE HOLDER CANCELLATION COSTA MESA SANITARY DISTRICT 290 Paularino Ave., Costa Mesa, California 92626 Attention: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN C710 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I I IVAN F KILANO ACORD 25 (2014/01) @ 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CNA Connect Endorsement Declaration POLICY NUMBER COVERAGE PROVIDED BY B 6021635658 VALLEY FORGE INSURANCE COMPANY 151 N Franklin CHICAGO, IL 60606 INSURED NAME AND ADDRESS REVIZE LLC 150 KIRTS BLVD STE B TROY, MI 48084-5312 AGENCY NUMBER AGENCY NAME AND ADDRESS 055732 INSURCO INSURANCE AGENCY INC 5600 W MAPLE RD STE C310 WEST BLOOMFIELD, MI 48322 Phone Number: (248)886-9090 BRANCH NUMBER BRANCH NAME AND ADDRESS 060 MICHIGAN BRANCH ONE TOWN SQUARE, 10T ONE TOWNE SQUARE SUITE 1075 SOUTHFIELD, MI 48076 Phone Number: (800)262-2710 FROM - POLICY PERIOD - TO 09/10/2020 09/10/2021 This policy becomes effective and expires at 12:01 A.M. standard time at your mailing address on the dates shown above. This endorsement changes your policy. Please read it carefully. This Endorsement Results In No Change In Premium. The Named Insured is a Corporation. Audit Period is Not Auditable INSURED Page 1 of 4 POLICY NUMBER INSURED NAME AND ADDRESS B 6021635658 REVIZE LLC 150 KIRTS BLVD STE B TROY, MI 48084-5312 SCHEDULE OF LOCATIONS AND COVERAGE LOCATION 1 BUILDING 1 1890 Crooks Rd #340 TROY, MI 48084 Construction:Joisted Masonry Class Description: WEB SITE DESIGN AND DEVELOPMENT SERVICES Inflation Guard 3% INSURED Page 2 of 4 POLICY NUMBER INSURED NAME AND ADDRESS B 6021635658 REVIZE LLC 150 KIRTS BLVD STE B TROY, MI 48084-5312 ADDITIONAL INTEREST SCHEDULE LOCATION 1 BUILDING 1 The following has been added to your policy effective 09/10/2020 Type: State or Political Subdivisions - Permits relating to Premises Additional Interest Name and Address: COSTA MESA SANITARY DISTRICT 290 PAULARINO AVE. COSTA MESA / CA 92626 INSURED Page 3 of 4 POLICY NUMBER INSURED NAME AND ADDRESS B 6021635658 REVIZE LLC 150 KIRTS BLVD STE B TROY, MI 48084-5312 FORMS AND ENDORSEMENTS SCHEDULE The following list shows the Forms, Schedules and Endorsements by Line of Business that are a part of this policy. COMMERCIAL GENERAL LIABILITY The following forms have been added to your policy, effective 09/10/2020 FORM NUMBER FORM TITLE SB300184B 04/2014 Addl Insrd - State/Political Subdivision -Premises Chairman of the Board Countersignature 6>4:2� Secretary SB -146895-A (Ed. 01/06) INSURED Page 4 of 4 SB300184B (Ed. 04/14) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS RELATING TO PREMISES This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM SCHEDULE State Or Political Subdivision COSTA MESA SANITARY DISTRICT * Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section C. Who Is An Insured is amended to include as an insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of the following hazards for which the state or political subdivision has issued M a permit or authorization in connection with premises you own, rent, or control and to which this insurance applies: 00 M a. The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or co decoration and similar exposures; 0 0 CD0 b. The construction, erection, or removal of elevators; or M c. The ownership, maintenance, or use of any elevators covered by this insurance. However, if coverage for the additional insured is required by written contract or agreement, then subject always to the terms and conditions of this policy, including the limits of insurance, we will not provide such additional insured with: 1. Coverage broader than required by such contract or agreement; nor 2. A higher limit of insurance than required by such contract or agreement. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. SB300184B (Ed. 04/14) Page 1 of 1 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. t • •' AcoR"' CERTIFICATE OF LIABILITY INSURANCE DATE (MM/OD/YYYY) 08/24/2020 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 Phone: (248) 862-2127 Fax: (248) 886-9091 INSURCO INSURANCE AGENCY 5600 WEST MAPLE RD., SUITE C-310 WEST BLOOMFIELD MI 48322 CONTACT Insurco Insurance Agency PHONE — FAX A/c No. Ext. (248) 862-2127 (A/c No): (248) 886-9091 _ E-MAIL ivan@insurcomi.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 2 000 000 r INSURER : Valley Forge Insurance Company 20508 DAMAGE TO RENTED — - INSURED REVIZE LLC INSURER B : The Continental Insurance Company 35289 150 KIRTS BLVD STE B INSURER C : Continental Casualty Company 20443 TROY, MI 48084 INSURER D: INSURER E INSURER F 2,000,000 ..-.v r.v vVF%1n MOM _ 1w1r1WGlt. VJLV RCVIJIVIV IVUIYI6G111: -� YIN -- ----- ANY PROPRIETOR/PARTNER/EXECUTIVE 'E.L. EACH ACCIDENT $ 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. 1,000,000 C PROFESSIONAL LIABILITY/ CYBER LIABILITY 6021626488 09/10/20 09/10/21 PER CLAIM INSR TYPE OF INSURANCE ADDL � SUBR' POLICY EFF POLICY EXP LTR _ POLICY NUMBER— ) LIMITS $2,000,000 A X ;COMMERCIAL GENERAL LIABILITY 6021635658 09/10/20 09/10/21 - EACH OCCURRENCE I $ 2 000 000 r CLAIMS -MADE X I OCCUR DAMAGE TO RENTED 300,000 — -- PREMISES (Ea occurence) _ MED EXP (Anyone person) $ 10,000 i PERSONAL & ADV INJURY 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:'GENERAL --- AGGREGATE 4,000,000 X ;POLICY ` PRO- JECT LOC — — — - PRODUCTS - COMP/OP AGG $ 4,000,000 OTHER: --- - — — AUTOMOBILE LIABILITY A 6021635658 09/10/20 09/10/21 COMBINED SINGLE LIMIT i (Eataccident) $ 1,000,000 ANY AUTO SCHEDULED _ BODILY INJURY (Per person) $ ALL OWNED — AUTOS AUTOS � BODILY INJURY (Per accident) $ X HIRED AUTOS ~X NON -OWNED — — — —-- PROPERTY DAMAGE $ - --- - -- —1 AUTOS (per accident) UMBRELLA LIAB OCCUR -- ---- EACH OCCURRENCE $ - — EXCESS LIAB CLAIMS -MADE; AGGREGATE $ _ DED RETENTION $ $ B AND KERS EMPLOYERSEN LAABIL TY 4 NSTION 6021635689 09/10/20 09/10/21 STATUTE ERH -� YIN -- ----- ANY PROPRIETOR/PARTNER/EXECUTIVE 'E.L. EACH ACCIDENT $ 1,000,000 1 OFFICER/MEMBER EXCLUDED?— (Mandatory in NH) Y N / A iE.L. DISEASE -EA EMPLOYEE $ 1,000,000 If yes, describe under — DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 C PROFESSIONAL LIABILITY/ CYBER LIABILITY 6021626488 09/10/20 09/10/21 PER CLAIM $1,000,000 ;RETENTION $10,000 AGGREGATE $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The Costa Mesa Sanitary District, It's elected and appointed officials, agents, officers, volunteers and employees are additional insureds. 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. Any other insurance maintained by the Costa Mesa Sanitary District shall be excess and non-contributing with the insurance provided by this policy. taK I IrlUA I C MULULK CANCELLATION COSTA MESA SANITARY DISTRICT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 290 Paularino Ave., THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa, California 92626 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Attention: IVAN F KILANO ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD