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Insurance - Houston & Harris P C S Inc - 2021-06-23HOUS&HA-01 SGUILLEN ,d►`CORv CERTIFICATE OF LIABILITY INSURANCE DATE (M 6/23//20212021 YY) 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(les) 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). PRODUCER License # OC36861 CONTACT NAME: Inland Empire-Alliant Insurance Services, Inc. PHONE FAX N 909 886-2013 (A/C, No, Ext): (909) 886-9861 ac, - o).( ) 685 Carnegie Dr Ste 265 -- _ ( San Bernardino, CA 92408 E-MAIL ADDRESS: __ INSURERjS� AFFORDING COVERAGE NAIC # ECEIVE INSURER A: Scottsdale Insurance Company �� 41297 INSURED INSURER B: Nationwide Mutual Insurance Com ny i 23787 Houston & Harris P C S IncZ INSURER C : Cypress Insurance Company 10. 855 21831 Barton Road JUL 0 INSURERD:------ Grand Terrace, CA 92313 INSURER E : Costa Mess �. R - C(1VFRAf:FS r_9=0T1=1rAT9: IUI IMRt=R- oc�nc�nw� wn �seQ�o. 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. NSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER I POLICY 11 EFF POLICY EXP LIMITS LTR IN WVD /DD M / A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X I OCCURVRS0005296 X 6/24/2021 6/24/2022 DAMAGE TO RENTED 100,000 PREMISES _(Ea occurrence) $ _ - MED EXP _(Any one person) _ $ 5,000 PERSONAL & ADV INJURY $ 11000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 21000'000 POLICY f PRO - X ] [ ,LOC 2'000'000 I JECT PRODUCTS - COMP/OP AGG $ OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) 1,000,000 $ X ANY AUTO ACP3076645740 6/24/2021 6/24/2022 BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED X NON -OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ A CCUR UMBRELLA LIAB X[CC EACH OCCURRENCE $ 4,000,000 X EXCESS LIAB LAIMS-MADE VES0003420 6/24/2021 6/24/2022 AGGREGATE $ 4'000'000 DED X RETENTION $ $ - -- _ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITYSTATUTE Y / N _ ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE HOWC116572 9/1/2020 9/1/2021 E.L. EACH ACCIDENT 1,000,000 $ OFFICER/MEMBER EXCLUDED? [ , (Mandatory in NH) N / A _ 1,000,000 If yes, describe under DFSCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYE - - - E.L. DISEASE -POLICY LIMIT $ $ 1,000,000 A Professional Liab VRS0005296 6/24/2021 6/24/2022 Claims Aggregate Lmt 2,000,000 A Pollution Liability VRS0005296 6/24/2021 6/24/2022 Claims Aggregate Lmt 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 employees.. 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. Costa Mesa Sanitary District 290 Paularino Avenue Costa Mesa, CA 92626 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 3/a AUTHORIZED REPRESENTATIVE 64.)kJL44, ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: VRS0005296 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 Governmental Agency Or Subdivision Or Political Subdivision: Any person or organization that the insured is required by contract to name as an additional insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - 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 2012 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1