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Insurance - Houston & Harris P C S Inc - 2021-01-13HOUS&HA-01 SGUILLEN CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) THIS 1/13/2021 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). CONCT PRODUCER License # OC36861 ! TA NAME: Inland Empire-Alliant Insurance Services, Inc. I PHONE g09 886-9861 FAx 909 886-2013 (A/c, No, Ext): ( ) (A/C, No):(909) 685 Carnegie Dr Ste 265 San Bernardino, CA 92408 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Colony Insurance Company 39993 INSURED INSURER B: Nationwide Mutual Insurance Company ;23787 Houston & Harris P C S Inc INSURER C :Travelers Casualty and Surety Company of America ;31194 21831 Barton Road INSURER D : Cypress Insurance Company 10855 Grand Terrace, CA 92313 INSURER E: Landmark American Insurance Company 1!33138 INSURER F: Westchester Surplus Lines Insurance Com an 10172 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. 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. AUTHORIZED REPRESENTATIVE INSR TYPE OF INSURANCE 'ADDL SUBR, POLICY NUMBER POLICY EFF ! POLICY EXP LIMITS LTR INSD WVD' MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1'000'000 CLAIMS -MADE X OCCUR '103GLOO24297-02 6/24/2020 6/24/2021 DAMAGE TO RENTED 100,000 X PREMISES (Ea occurrence) $ - ------ ---- --- MED EXP (Anyone person) $ 5,000 PERSONAL & ADV INJURY $ — 1,000,000 ~GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ 2'000'000 POLICY X JERCOT J LOC PRODUCTS -COMP/OP AGG $ 2'000'000 OTHER: S B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _(Ea accident) - -- $---------- 1,000,000 - --- j X ;ANY AUTO ACP3066645740 6/24/2020 6/24/2021 BODILY INJURY (Per�erson� $- _.----------- _ -_ OWNED - SCHEDULED AUTOS ONLY ^ AUTOS BODILY INJURY (Per accident X HIRED i X NON -OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY ' I $ C UMBRELLA LIAR X OCCUR EACH OCCURRENCE 4,000,000 X EXCESS LIAR CLAIMS -MADE' ZUP-41N13398-20-NF 6/24/2020 6/24/2021AGGREGATE $ 4'000'000 I X 10,000 DED RETENTION $ $ D i WORKERS COMPENSATION X PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY Y/ N ! HOWC116572 9/1/2020 9/1/20211,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ —_ OFFICER/MEMBER EXCLUDED? HN/Ai , (Mandatory in NH) — E.L. DISEASE - EA EMPLOYEE; S 1'000'000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S E !Prof Liability ,LHR840572 6/24/2020 j 6/24/2021 Agg/Each Claim Limit 2,000,000 F ;Pollution Liability G71468926002 12/19/2019 6/24/2021 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Job: All Operations pertaining to named insured for Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and em ployees. . The Costa Mesa Sanitary District, its elected and appointed officials, agents, officers, volunteers and employees are additional insured/primary and non-contributory as respects general liability of the Named Insured as required by written contract, per endorsements attached. Any other insurance maintained by the Costa Mesa Sanitary District shall be excess and non-contributing with the insurance provided by this policy. Cancellation applies, per endorsement attached. CANCELS AND REPLACES THE CERTIFICATE ISSUED ON 1/12/2021. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) © 1988-2015 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 -nom 290 Paularino Avenue 1/Y� I� w THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa, CA 92626 u� AUTHORIZED REPRESENTATIVE 44, ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 103GL0024297-02 COMMERCIAL GENERAL LIABILITY CG 20 12 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: All persons or organizations as required by written contract with the Named Insured 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 any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 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. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or 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 103GL0024297-02 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 © Insurance Services Office, Inc., 2012 Page 1 of 1 103GL0024297-02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION This endorsement modifies insurance provided under the following: OUTPUT POLICY COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EXCESS LIABILITY POLICY FARM COVERAGE PART FARM UMBRELLA LIABILITY POLICY LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART PROFESSIONAL LIABILITY COVERAGE PART Paragraph A. 2. Cancellation of the COMMON POLICY CONDITIONS is deleted and replaced by the following: 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancellation if we cancel for one or more of the follow- ing reasons: (1) nonpayment of premium or failure to pay a premium when due; (2) conviction of an insured of a crime arising out of acts increasing the hazard insured against; (3) violation of any local fire, health, safety, building or construction regulation or ordinance which increases the hazard insured against under the policy; (4) any willful or reckless act or omission by an insured increasing the hazard insured against; (5) omission or concealment of fact relating to an insurance application, rating, claim or coverage under this policy; (6) failure or refusal of an insured to: (a) provide information necessary to confirm exposure or determine the policy premium; or (b) comply with underwriting requirements; (7) a substantial change in the risk covered by the policy; (8) loss of reinsurance or substantial decrease in reinsurance; (9) the cancellation is for all insureds under such policies for a given class of insureds; or (10) any reason determined by the insurance commissioner. b. 30 days before the effective date of cancellation if we cancel for any other reason. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U173AS-0708 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission.