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Insurance - Roberts Consulting Group Inc - 2020-08-19ACCM H CERTIFICATE OF LIABILITY INSURANCE DAT (M /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 NAME: Wigmore Insurance PHONE. Ext: (714) 979-6543 FAC, NO: (14)549-2943 Wigmore Insurance Agency Inc. E-MAIL commercial@wigmoreins.com ADDRESS: 880 W. 19th St. INSURER(S) AFFORDING COVERAGE NAIC # License #0811959 INSURERA:Sentinel Insurance Co LTD ol"11000 Costa Mesa CA 92627 INSURED INSURERB:State Compensation Ins. Fund 0060 Roberts Consulting Group Inc INSURERC:RLI Insurance Company ✓ 13056 INSURER D: P O BOX 1127 INSURER E: Rancho Mirage, CA 92270 INSURER F: MED EXP (Any one person) $ 10,000 COVERAGES CERTIFICATE NUMBER:20/21 All Lines 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 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 LTR TYPE OF INSURANCE SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXPLIMITS MM/DD/YYYYX COMMERCIAL GENERAL LIABILITY rADDL EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE FX OCCUR DAMAGE TORENTED 1,000,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 10,000 Y 72SBAAP5644 4/1/2020 4/1/2021 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO ❑ LOC JECT PRODUCTS-COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident BODILY INJURY (Per person) $ p' ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS X y 72SRAAP5644 4/1/2020 4/1/2021 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X NON -OWNED HIRED AUTOS X AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY Y / N OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE B OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A 1735802-20 4/1/2020 4/1/2021 E.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 RTP0017281 4/1/2020 4/1/2021 $1,000,000 Each Claim Retro Date 12/1/2004 $2,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED PER THE BUSINESS LIABILITY COVRAGE FORM SS00080405 ATTACHED TO THE GENERAL LIABILITY POLICY. PRIMARY AND NON-CONTRIBUTORY LANGUAGE PER FORM SS00080405. CERTIFICATE HOLDER CANCELLATION DBojarski@crosdca.gov Costa Mesa Sanitary District / n^ ' 290 Paularino Avenue d Costa Mesa, CA 92626 ` 11 ACORD 25 (2014/01) INS025 (201401) 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 Timothy Wigmore/G128 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMENTS/REMARKS Costa Mesa Sanitary District, its directors, officials, officers, employees, agents and volunteers are included as additional insured. OFREMARK COPYRIGHT 2000, AMS SERVICES INC.