Insurance - Western A/V Inc- 2021-08-10RENEWAL DECLARATIONS (CONTINUED)
Home Product Sales Pol'c for COSTA MESA SANITARY DISTRICT
't • '4Y-D812-0
_•• Accounts Receivable (Off Premises) $5,000
Back -Up Of Sewer Or Drain $15,000
Money And Securities (Off Premises) $5,000
Money And Securities (On Premises) $10,000
b Outdoor Property $5,000
Property Of Others (applies only to those premises provided Coverage B - Business $2,500
Personal Property)
Signs $5,000
' Valuable Papers and Records (On Premises) $10,000
Valuable Papers and Records (Off Premises) $5,000
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
Loss Of Income And Extra Expense
$1,000
12 months
$35,000
$5,000
$10,000
Actual Loss Sustained - 12 Months
Prepared
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RENEWAL DECLARATIONS (CONTINUED)
Home Product Sales Policy for COSTA MESA SANITARY DISTRICT
Policy Number 92-GY-D812-0
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 II - 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.
CMP-4101
Businessowners Coverage Form
FE-6999.3
*Terrorism Insurance Cov Notice
CMP-4260.1
Amendatory Endorsement -CA
CMP-4261
Amendatory Endorsement
CMP-4705.2
Loss of Income & Extra Expense
CMP-4710
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-4786.1
Addl Insd Owners Lessee Sched
CMP-4610
General Agg Limit Per Proj
CMP-4746.1
Hired Auto Liability
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Ins
RENEWAL DECLARATIONS (CONTINUED)
CMP-4990.1
Identity Restoration Coverage
plv;x�
CMP-4994
Data Compromise
CMP-4787
Waiver of Trans Rgt of Recov
CMP-4875
Loss Payable
CMP-4793.1
Al State Political Perm Prem
CMP-4788.1
Addl Insd Mgrs Lessor of Prem
FD-6007
Inland Marine Attach Dec
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.
'" . 4W& C441#
Secretary President
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 Farm` Executive Customer Service
PO Box 2320
Bloomington IL 61702
Phone # I -800-STATEFARM (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&A._qov/0j -consumers
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RENEWAL DECLARATIONS (CONTINUED)
Home Product Sales Pofic for COSTA MESA SANITARY DISTRICT
Policy Number 92-4Y-D812-0
NOTICE TO POLICYHOLDER:
For a comprehensive description of coverages and forms, please refer to your policy.
Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date
of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage
forms attached to this notice are also effective on the Renewal Date of this policy.
Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an
endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date.
If, during the past year, you've acquired any valuable property items, made any improvements to insured property,
or have any questions about your insurance coverage, contact your State Farm agent.
Please keep this with your policy.
Prepared
AUG 10 2021
CMP-4000
(0 Copyright, State Farm Mutual Automobile Insurance Company, 2008
Includes copyrighted material of Insurance Services Office, Inc,, with its permission.
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S -tat "nniI
STATE FARM GENERAL INSURANCE COMPANY
A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS
MA
Pqc 9oxardson, 8539 f� 75085-3925
R,
Named Insured
WESTERN AIV INC
M-23-3535-FB8A F Z
Policy Number 92-GY-D012-0
Policy Period Effective Date Expiration Date
12 Months OCT 31 2021 OCT 31 2022
The policy period begins and ends at 12:01 am standard
time atthe premises T0cation.
Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and
forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in
compliance with the policy provisions or as required by law.
Annual Policy Premium Included
The above Premium Amount is included in the Policy Premium shown on the Declarations,
Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that
apply, including those shown below as well as those issued subsequentto the issuance of this policy.
Forms, Options, and Endorsements
FE-8739 Inland Marine Conditions
FE-6271 Amendatory Endorsement
FE-8745 Inland Marine Computer Prop
See Reverse for Schedule Page with Limits
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ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL
NUMBER COVERAGE INSURANCE AMOUNT PREMIUM
FE-8745 Inland Marine Computer Prop $ 25j.000 $ 500 Included
Loss of Income and Extra Expense $ 2 5 , 0 0 0 Included
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FD-6007
011405
OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY
@ Copyright, State Farm Mutual Automobile Insurance Company, 2008
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
530-606 a.2 05-31-2011 loIt3233ci1