Insurance - Mighty Oak Technology, DBA: Acorn Technology Services - 2022-03-02DATE JhAN1fDO"YY)
ACC>R0 CERTIFICATE OF LIABILITY INSURANCE
3/2/2022
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 doses not confer rights to the
certificate holder in lieu of such endorsoment(s).
PRODUCERJulie RyEak
NAME.
Kellogg & Moreland Agency, Inc, DBA PHONE (909)'792-8950
Y AFC N Al'
Arroyos Insurance Services E-;AILADEjulier@arroyoin.
s.co
1654 Plum Trane INSURER(S) AFFORDIW COVERAGE I NAIL #
Redlands CA 92374--4532 I+SURERA:Ped>~ral ins Co aS ,.n 120281
IuSu€tEeINSUREAS, lmericau,Fin.ancial Benefit Insuranc r C �164(�r�
Mighty Oak echnology, IAEA; Acorn Technology Services INSURER C: a �
1960 Chicago Aire #E9 INSURER-D.:.-
Riverside
NSURERIs;
Riverside CA 92507 INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER.
THIS IS TO CERT IFYT HAT THE: POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE: FOR THE POLICY PERIOE
INDICATED- NOT'Allf-ISTANDING ANY REOU RENIFNT, TERM CIS CONDITION OF ANY CONT RACT OR OTHER DOCUMENT VViTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED THEREIN IS SUBjECT TO ALL THE TE RMS,
EXCLUSIONS ANIS CONDITIONS OF SUCH POLiC'E5 UIMITS SHOVvN MAY HAVE. BEEN REDUCED BY PAID CLAIMS.
NSR TYPE {3F INSURANCE A3f3L� PCl ICY EFF POLICY EXP LIMITS
LTR S POLICY NUMBER WWOOTYYYY1 IMMIDDIYYYY)
X COM€>JIERCIAL GENERAL LIABILITY EACH CCURkE f
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AGGREGATE �_ 5
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DESCRIPTION OF OPERA71ONS I LOCATIONS I VEHICLES IACORD 101, Additional RerNrka Schedule, Maybe attackhed iE snore €€Pace €s required)
"The Costa. Xesa Sanitary District, its elected and appointed officials, agents, officers, volunteers, and
employees are additional insureds including primary wording per attached form #80022367"
CERTIFICATE HOLDER
Costa Mesa Sanitary' District ?j��/��
290 paularino Avenue
Costa Mesa, CA 92626
ACORD 25 (2014101)
INS025
CANCELLATION
1,000,000
Zxc dad
10,000
1,000,000
2,000,000
2,000,000
1,000,000
10,000,00
10.000,00
1,000,000
11000.000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION GATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE'WITiI THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
Q 1988-2014 ACORD
The ACORD ramie and logo are registered marks of AGGRO)
RATION. All rights
E3 si: Liability Insurance
Endorsement
MARCH 4N?, 2022 TO NJ AE"(A! 20-23
FffU�Clivo Date NIARCH )�,
Poficy,Nuji-7ber
MR111TY OAK H"(1 kN,--)L(
) Js' !)I)A x \COM
A N ( I N4 PA
e� of (,';,r1'pj()Y 1'111)Ff�L-%O!,
1
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Undvt Who, Z ��ift tn,,�un:d, thc folk-,, "Iddod
Additional' Instifed -
S-hcduhI k: illstlrud" < ;,-IC 61survilk f Voi, '111C
U) [)[OVI Oy
Of 0(yarlizabor)
I 10-WCVi:t, L. C.' Ol i� .cl insured oilIv..
and then
t h e x i o c i ii,
M,C
lit ItAim-if"'s th,�
it as all illSurvd,
of Iltl\ltle,� iflat did 110t V, holo or 111 pIll, hchori' dio 00C
i:or,m 8,9-1",12-2367 (P-o*v, 5-07
,"! 1'1� ,, 0C tO Which ti - I, �� , I "
With ri�sfjc--, t ts ,fWc
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N� k uc, insiti-vil m%ihj 061, pr%1vi,.1.,,,1,,
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tor iniiar-,, or wh-
j �Ich (hi�
in the,'....Il or ii-uli. trans.
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contlnj,��j
T--3 9 —P, -,
Liability Endorsement
Nontinuo�,,
Inder t"0110%Vitl"' II)MV11% 11%U "Ill IS Lddcd to com,"fiflon tiflod 01i.hc'r 1t' --u ..
Other Insurance IF vou o blio a ted, fmu ia'; i i �"o I I SC taE„t Cit '-'1t Cec -Iu12 n!, 10 p" fi,k'i "Ic h, e o u 11 il u!
hmi �n m the Schcdtd(� Y, iiii L J i,
Pfirnary, Not) cor, trit)u tory f%rliill IV M'�;irijnco as is illf b° mds poll"'Y' thu-11 it) sw'h case
led 0- -Incary �u 'klle not sk:ck �k--ihuaion Croln w-"UZLLN"tiktblc to sud, PCII-Sim)"i
Schedu
Person Or Organization ion
Sc�edufe
TRE COSTA MESA SANITARY DISTRICT, ITS ELECTED AND
APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS,
AND EMPLOYEES
(CHM, afld L:0!Ah1'0"1S "C"U"1111 U E I -J) ,11
by
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47
Aulhc, rzect
Labh'ty insorance Addit;onal insurad - Sch,-�-XdeC Person Or Organization
FOrrri 80-02-2367(R�-,v
11)
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