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Insurance - Western A/V Inc - 2020-10-31S ta, ka filnm STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED OCT 31 2020 RchoaOrM'o'n3,'R 75085-3925 Addl Insured -Section 11 Only M-23-3535-17138A F Z 003052 3123 COSTA MESA SANITARY DISTRICT THEIR ELECTED & APPOINTED OFFICIALS, OFFCIERS, VOLUNTEERS & EMPLOYEES 290 PAULARINO AVE COSTA MESA CA 92626-3314 Home Product Sales Policy Policy Number 92-GY-D812-0 Policy Period Effective Date Expiration Date 12 Months OCT 31 2020 OCT 31 2021 The pol' y Period betins and ends at 12:01 am standard time at le premises cation. Named Insured WESTERN A/V INC 1592 N BATAVIA ST STE 2 ORANGE CA 92867-3554 Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically miums, rules ani forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mort:919VIVe'Wwritten notice in compliance with the policy provisions or as required by law. Entity: Corporation Reason for Declarations: Endorsement Premium Discounts Applied: Renewal Year Years in Business Protective Devices Claim Record A NJ fm ,Costa Mesa Sanitary - 01strict Prepared NOV 16 2020 Oc Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 025288 290 Al Continued on Reverse Side of Page N Page 1 of 7 530-686 a.2 05-31 2011 (oW Home Product Sales Pol'c for COSTA MESA SANITARY DISTRICT Policy Number 92.4Y.D812.0 -SECTION-1 --PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase - Premises Coverage A - Coverage B " Business Buildings Business #ersonal Personal Property Property 001 1592 N BATAVIA ST STE 2 No Coverage $ 248,400 25% ORANGE CA 92867-3554 * As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I - INFLATION COVERAGE INDEWES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES — N/A 260.3 Basic Deductible $2,500 Special Deductibles: Money and Securities $250 Data Compromise $1,000 Employee Dishonesty $250 Equipment Breakdown $2,500 Other deductibles may apply - refer to policy. Prepared NOV 16 2020 (D Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 025288 Continued on Next Page Page 2 of 7 Staote Fairm. DECLARATIONS (CONTINUED) Home Product Sales DISTRICT Policy MESAMESASANITARYSANITADISTRICTy� Po1U��ummber 92~��Y~D812~0 SECTION I - E2jTENSIQNS OF COVERAGE - LIMIT OF INSULIANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, Cq but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $10`000 Off Premises $5,000 Arson Reward $5.000 Back -Up [fSewer OrDrain $15,000 Collapse Included Damage ToNon-Owned Buildings From Theft, Burglary (]rRobbery Coverage BLimit Debris Removal 25% ofcovered loss Equipment Breakdown Included Fire Department Service Charge $2'500 Fire Extinguisher Systems Recharge Expense $5.000 Forgery OrAlteration $10.000 Glass Expenses Included Increased Cost OUConstruction And Demolition Costs (applies only when buildings are 10% insured onareplacement cost basis) Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property(applies only if this policy provides $100.000 CoveraQeB-BusineaoPeraona|Propodv) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250'000 Coverage A -Buildings) Prepared NOV 16 2020 c»mninht State Farm Mutual Automobile Insurance Company, 2008 CMp-4000 Includes copyrighted material ofInsurance Services Office, |nn,with its permission. DECLARATIONS (CONTINUED) Home Product Sales Policy for COSTA MESA SANITARY DISTRICT Policy Number 92-GY-D812-® Ordinance Or Law - Equipment Coverage Outdoor Property Personal Effects (applies only to those premises provided Coverage B - Business Personal Property) Personal Property Off Premises Pollutant Clean Up And Removal Preservation Of Property Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Signs Valuable Papers And Records On Premises Off Premises Included $5,000 $2,500 $25,000 $10,000 30 Days $2,500 $10,000 $5,000 SECTION I -,,EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. Data Compromise Legal And Forensic Information Technology Review Per Occurrence Dependent Property - Loss Of Income Employee Dishonesty Identity Restoration Other Expenses Case Management Services Per Occurrence Lost Wages And Supervision Expenses Utility Interruption - Loss Of Income Prepared NOV 16 2020 C) Copyright, state Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 025289 Continued on Next Page LIMIT OF INSURANCE $5,000 $50,000 $5,000 $10,000 $1,000 12 months $35,000 $5,000 $10,000 Page 4 of 7 M DECLARATIONS (CONTINUED) Loss Of Income And Extra Expense Actual Loss Sustained - 12 Months SECTION 11 - DEDUCTIBLES co 0 Business Liability - Property Damage $1,000 Other deductibles may apply - refer to policy. SECTION 11 - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $2,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $4,000,000 General Aggregate $4,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section 11 - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-41 01 Businessowners Coverage Form CMP-4786.1 *Addl Insd Owners Lessee Sched CMP-4787 *Waiver of Trans Rgt of Recov FE-6999.2 Terrorism Insurance Cov Notice Prepared NOV 16 2020 (D Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 025290 290 Continued on Reverse Side of Page N Page 5 of 7 11]XII 1; 11, 0 111, 1 Home Product Sales Polic for COSTA MESA SANITARY DISTRICT Policy Number 92-4Y-D812-0 CMP-4260.1 Amendatory Endorsement -CA CMP-4261 Amendatory Endorsement CMP-4705.2 Loss of Income & Extra Expense CMP-471 0 Employee Dishonesty CMP-4709 Money and Securities CMP-4698 Back -Up of Sewer or Drain CMP-4704.1 Dependent Prop Loss of Income CMP-4703.1 Utility Interruption Loss Incm CMP-4610 General Agg Limit Per Proj CMP-4746.1 Hired Auto Liability CMP-4990.1 Identity Restoration Coverage CMP-4994 Data Compromise CMP-4875 Loss Payable FD-6007 Inland Marine Attach Dec NOTICE: INFORMATION CONCERNING CHANGES IN YOUR POLICY LANGUAGE IS INCLUDED. PLEASE CALL YOUR AGENT IF YOU HAVE ANY QUESTIONS. * New Form Attached This policy is issued by the State Farm General Insurance Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm General Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. M - ce rA� C-424/# Secretary President Prepared NOV 16 2020 (D Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 025290 Continued on Next Page Page 6 of 7 M DECLARATIONS (CONTINUED) Home Product Sales Policy for COSTA MESA SANITARY DISTRICT Policy Number 92-GY-D812-0 IMPORTANT NOTICE: California law requires us to provide you with information for filing complaints with the State Insurance Department regarding the coverage and service provided under this policy. Your agent's name and contact information are provided on the front of this document. Another option is to reach out by mail or phone directly to: State FarmO Executive Customer Service o PO Box 2320 Bloomington IL 61702 Phone # 1 -800-STATE FARM (1 -800-782-8332) Department of Insurance complaints should be filed only after you and State Farm or your agent or other company representative have failed to reach a satisfactory agreement on a problem. California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles, CA 90013 Phone # 1-800-927-HELP (4357) or visit www.insurance.ca.-ciov/01 -consumers Prepared NOV 16 2020 CMP-4000 Cc Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 025291 290 N Page 7 of 025291 / Stete��D-i STATE FARM GENERAL INSURANCE COMPANY xSTOCK COMPANY WITH HOME OFFICES m/aoOOwmVGrON,u/INOIS INLAND MARINE ATTACHING DECLARATIONS 85 75o85-3m25 Named Insured WESTERN A/V INC 1592 N 8ATAVIA ST STE 2 ORANGE CA 92867-3554 ��ATTACHING INLAND MARINE Policy Number 92-GY-D812-0 Pol Period Effective Date Expiration Date M-23'3585-FB8A F Z12 icy The policy Period bey0ins and ends at 12:01 am standard time at the premises cation. Automatic Renewal -|fthe policy period imshown ea12 months, this policy will berenewed automatically suNecttothe premiums, rules enc forms in eff ect for each succeeding policy period. If this policy is terminated, we will give you and the M ortgagee/Lien holder written notce in compliance with the || provisions required bvlaw. Annual Policy Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarabons. Your policy consists ofthese Declarations, the INLAND MARINE CONDITIONS shown below, d any other forms and endorsements that apply, including those shown below as well as those issued subsequeritto the issuance of this policy. Forms, and Endorsements FE-8739 Inland Marine Conditions FE-8271 Amendatory Endorsement FE-8745 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared NOV 16 2020 Oc Copyright, State Farm Mutual Automobile |omumncv Compmnxzo08 FD_8007 Includes copyrighted material ofInsurance Services Office, /nu,with its permission, 025292 r4 r 1 , 1 1■ ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8745 Inland Marine Computer Prop 2 5, 0 0 0 $ 500 Included Loss of Income and Extra Expense 25,000 Included Prepared NOV 16 2020 FD-6007 025292 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY C7 Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 530 686 a.2 05-31-2011 (W323301