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Insurance - Mike Kilbride, LTD Coast Water and Power - 2020-11-07I ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 1110712020 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: (714) 325-6002 CONTACT M. L. Adams Insurance Services M. L. ADAMS INSURANCE SERVICES NAME_ _ ----- RnH/c No EAI: (714) 325-6002 A/c No): rDAMAOE TO F2ENTED $ 100,000 ' E-MAIL www.miadamsins.com _ADDRESS,– -- -- ------ ----- — - ----- ----- - REC(� �(j EIVED ED INSURER(S) AFFORDING P2ERAGE NAIC # Agency Lic#: 0609232 INSURER A Colony Insurance Co INSURED MIKE KILBRIDE, LTD. INSURER B State Compensation Insuran a Fund 35076 INSURER C Colony Insurance Co COAST WATER AND POWER P.O. BOX 3341 PERSONAL & ADV INJURY $ 1,000,000 NEWPORT BEACH CA 9240Sta Mesa Sanitary District INSURER D: INSURER E : GENERAL AGGREGATE $ 2,000,000 INSURER F : COVERAGES CERTIFICATE NUMBER: 23800 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 ADDL INSD SUBR POLICY NUMBER POLICY EFF WVD ' MM/DD POLICY EXP I LIMITS MM/DD/YYYY A X I COMMERCIAL GENERAL LIABILITY X X 600GL0015876-04 10/30/20 10/30/21 j EACH OCCURRENCE $ 1,000,000 i CLAIMS -MADE X UCCUK ; j rDAMAOE TO F2ENTED $ 100,000 ' PREMISES (Ea occurence) MED. EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 -- � � � -- POLICY I I JE LOC ; PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: I j $ AUTOMOBILE LIABILITY ! COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED ( BODILY INJURY (Per accident) $ AUTOS AUTOS i NON -OWNED HIRED AUTOS j I PROPERTY DAMAGE $ ( — –AUTOS (per accident) $ C UMBRELLA LIAR X OCCUR XS172707 10/30/20 10/30/21 EACH OCCURRENCE $ 2,000,000 i EXCESS LIAR CLAIMS -MADE . AGGREGATE $ 2,000,000 DED , ]RETENTION $ ! $ B WORKERS COMPENSATION X 9087110-20 1 10/01/20 PER 10/01/21 I X STATUTE I EOR 1,000,000 AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN ! -- E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? , I""– J I N / A ( – i E.L. DISEASE -EA EMPLOYEE $ INCLUDED (Mandatory In NH) If yes, describe under I _ f E.L. DISEASE -POLICY LIMIT $ INCLUDED DESCRIPTION OF OPERATIONS below j DESCRIPTION OF OPERATIONS t LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: ALL OPERATIONS THE COSTA MESA SANITARY DISTRICT, IT'S ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSUREDS PER FORM CG 20 12 0413 ATTACHED. PRIMARY WORDING PER FORM CG 20 01 0413 ATTACHED. 30 DAYS NOTICE OF CANCELLATION PER FORM ATTACHED. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) U 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 290 PAULARINO AVENUE ` /� COSTA MESA, CA 92626 `�/��/a0 a Attention: ACCORDANCE WITH THE POLICY PROVISIONS. ALJTHOR17FD REPRFSFNTATIVF Z. Michael L. (Mike) Adams ACORD 25 (2014/01) U 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 600 GL 0015876-04 COMMERCIAL GENERAL LIABILITY CG 20 12 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governme gency Or Subdivision Or Political Subdivision: TA MESA S RY D ICT, ITS ELECTED AND APPOINTED OFFICIALS AND EMPLOYEES 628 W 19TH AVE COSTA MESA, CA 92627 Info--rplete this Schedule, if not shown above, will be shown in the Declarations. ' A. Section II — Who Is An Insured is amended to 2. This insurance does not apply to: include as an additional insured any state or a. "Bodily injury", "property damage" or governmental agency or subdivision or political "personal and advertising injury" arising out subdivision shown in the Schedule, subject to the of operations performed for the federal following provisions: government, state or municipality; or 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. 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. "Bodily injury" or "property damage" included within the "products -completed operations hazard". 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 12 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 600 GL 0016876-04 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 0104 13 ©!nsurance Services Office, Inc., 2012 Page 1 of 1