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Insurance - Michale Balliet Consulting, LLC - 2021-09-09 (2)ACOR"® CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) `6*1 --�' 9/20 09/09/2021 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 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 CONTNAME: Michael Kosmerl Professional Ins. Associates/Ability Insurance Agency Inc. PHO:X (A/CNEExt): 714/968-9600 -_ a , No):____ 74133 EI Paseo, Suite 8 ADDRESS: mike abilit ins.com INSURER(S) AFFORDING COVERAGE �NAIC # Palm Desert, CA 92260 INSURER A : Hartford Casualty Insurance Company-_____ 29424 - _21000 INsuREoINSURER B: Hartford Casualt Insurance Com an 29424 INSURERC: Michael Balliet Consulting, LLC 30181 Outpost Road INSURER D: _ San Juan Capistrano, CA 92675 INSURER E: NON -OWNED X ( HIRED AUTOS X INSURER F : Hiscox Insurance Corngany 10200 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. INSR ADDL SUBR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP MM/DD/YYYYMM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 110001000 X+ COMMERCIAL GENERAL LIABILITY DAMAGES ( RENTED PREMISES (Ea occurrence)100,000 X CLAIMS -MADE OCCUR Y Y 57S BAB F8296 MED EXP (Any one person) $ 10/26/2020 10/26/2021 A — -- ---- - ---- -- -- -- PERSONAL & ADV INJURY �-$ 1 OOO OOO - -- GENERAL AGGREGATE $ - 2,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS _COMP/OP AGG $ OOO PRO- X - _21000 POLICY 'T LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident)______- $ 1 '000,000 ANY AUTO _ BODILY INJURY (Per person) $ B ALL OWNED SCHEDULED y y 57SBABF8296 AUTOS AUTOS 10/26/20201 10/26/20211BODILY INJURY (Per accident) NON -OWNED X ( HIRED AUTOS X PROPERTY DAMAGE $ i I ! AUTOS (Per accident) UMBRELLA LIAB !, OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE; AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION j WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N ER LIMITS _ ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A - -----— (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE! $ If yes, describe under-- DESCRIPTION OF OPERATIONS below — -- --- -- E.L. DISEASE - POLICY LIMIT $ ;Professional Liability F N N UDC -4214172 -EO -20 07/19/2021 07/19/2022 Liability Limit $1,000,000 Policy Deductible $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees listed as Additional Insured - pursuant to attached endorsement. CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 290 Paularino Avenue y �') % THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa, CA 92626 `�')j�, 01IR-719 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Tw I 07/06/202C,' ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD (6) When You Are Added As An Additional Insured To Other Insurance That is other insurance available to you covering liability for damages arising out of the premises or operations, or products and completed operations, for which you have been added as an additional insured by that insurance; or (7) When You Add Others As An Additional Insured To This Insurance That is other insurance available to an additional insured. However, the following provisions apply to other insurance available to any person or organization who is an additional insured under this Coverage Part: (a) Primary Insurance When Required By Contract This insurance is primary if you have agreed in a written contract, written agreement or permit that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in c. below. (b) Primary And Non -Contributory To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement or permit that this insurance is primary and non-contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured. When this insurance is excess, we will have no duty under this Coverage Part to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. BUSINESS LIABILITY COVERAGE FORM When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self- insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method Of Sharing If all the other insurance permits contribution by equal shares, we will follow this method also. Under this approach, each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 8. Transfer Of Rights Of Recovery Against Others To Us a. Transfer Of Rights Of Recovery If the insured has rights to recover all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. This condition does not apply to Medical Expenses Coverage. b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. Form SS 00 08 04 05 Page 17 of 24