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Insurance - Wester AV Inc - 2022-05-18ACoOR& CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) `r.� 05/18/2022 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 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 CONTANAME: Kari Crespin StateFarm Javier Misiego PHONE714-772 3838 �� t_ (A/C.No Ext_714-0.-,714-808-6431 1661 N. Raymond Ave Suite 102 _ E-MAIL Karl Cres I3n statefarm.com ADDRESS;__pn vacQ@ _ - -_ _ ._ PRODUCTS - COMPlOP AGG $ 4,000,000 _. INSURERS) AFFORDING COVERAGE NAIC # Anaheim CA 92801 INSURER A : State Farm Mutual Automobile Insurance Company -'!25178 INSURED INSURER B : State Farm Fire and Casualty Company 25143 WESTERN AN INCINsuRER State Farm General Insurance Company — -- - — _ ; BODILY INJURY (Per accident): $ C : 25151 1592 N BATAVIA ST STE 2 INSURER D ORANGE, CA 92867 INSURER E : $ INSURER F : COVERAGES CERTIFICATE NUMBER: RFVISInN NIIMRFR- 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'i 1ADOLSUBR LTR: TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP MMIDD/YYYY : MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES -(Ea occurrence) $ 300,000 MED EXP (Any one person) $ 5,000 - - - -- - C Y 92-GY-D812-0 i 10/31/2022 10/31/2023 PERSONAL & ADv INJURY $ 1,000,000 ---- --- -- - -- - - GEN'L AGGREGATE APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X ( POLICY ECT _ ; LOC _ ._ PRODUCTS - COMPlOP AGG $ 4,000,000 _. OTHER: s 248,400 AUTOMOBILE LIABILITY Y Y 675 9458-FO2-751 '- 12/02/2021 06/02/2022 j' COMBINED SINGLE LIMIT : $ 1,000,000 _aaccident)____ _ X ;ANY AUTOI BODILY INJURY (Per person) S OWNED �/SCHEDULED- A ;AUTOS ONLY _X_ AUTOS — -- - — _ ; BODILY INJURY (Per accident): $ HIRED X X NON -OWNED ^_ PROPERTY DAMAGE S AUTOS ONLY /� AUTOS ONLY (Per accident) •. $ X I UMBRELLA LIAB X OCCUREACH OCCURRENCE $ 5,000,000 C EXCESS LIABN/A' N/A 92 -XC -0351-6 CLAIMS -MADE ; 12/14/2021 12/14/2022 ' L _ AGGREGATE $ DED RETENTION $ is WORKERS COMPENSATIONPER OTH- AND EMPLOYERS' LIABILITY Y ! N X - STATUTE ER -- __ ANY PROPRIETOR/PARTNER/EXECUTIVE B OFFICER/MEMBER EXCLUDED? N / A Y 92 -MW -F673-9 E L. EACH ACCIDENT S 1,000,000 01 /01 /2022 01 /01 /2023 - -- - --- --- -- - (Mandatory in NH) E L. DISEASE - EA EMPLOYEE S 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT , 1,000,000 SURETY BOND B 92-W6-8753-3 i 11/17/2021 11/17/20221 $15,000 DESCRIPTION OF OPERATIONS t LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUDIO VISUAL SYSTEMS INTEGRATION Business Location 1592 N Batavia St., Ste 2, Orange, CA 92867 It is agreed that is is the intention of the Company to provide 30 days written notice prior to the cancellation of the policy designated in this certificate. However, the Company assumes no liability for failure to do so. All operations: Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees listed as Additional Insured — Pursuant to attached endorsement CERTIFICATE HOLDER cANCFI I ATInN ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.13 04-22-2020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District -96 5116IIIlla7- THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 290 Paularino Avenue Costa Mesa, CA. 92626 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.13 04-22-2020 TF Policy No. 92 GYD812 0 75-61F8 CMP -4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP -4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 GYD812 0 Named Insured: WESTERN A/V INC 1592 N BATAVIA ST STE 2 ORANGE CA 92867-3554 Name And Address Of Additional Insured Person Or Organization: COSTA MESA SANITARY DISTRICT THEIR ELECTED & APPOINTED OFFICIALS, OFFCIERS, VOLUNTEERS & EMPLOYEES 290 PAULARINO AVE COSTA MESA CA 92626-3314 1. SECTION II — WHO IS AN INSURED of b. If coverage provided to the additional in - SECTION 11 — LIABILITY is amended to in- sured is required by a contract or agree- clude, as an additional insured, any person or ment, the insurance provided to the organization shown in the Schedule, but only additional insured will not be broader than with respect to liability for "bodily injury", "property "personal that which you are required by the contract damage", or and advertis- ing injurycaused, in whole or in part, by: or agreement to provide for such addition- al insured; and a. Ongoing Operations c. If the contract or agreement between you (1) Your acts or omissions; or and the additional insured is governed by (2) The acts or omissions of those acting California Civil Code Section 2782 or on your behalf; 2782.05, the insurance provided to the in the performance of your ongoing opera- additional insured is the lesser of thatwhich: tions for that additional insured; or b. Products – Completed Operations (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali - "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability; or completed operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the agreement to provide for such addi- following: tional insured. a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement un - ted by law; til a claim or "suit" is tendered to us. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED CMP -4786.1 Page 2 of 2 2, Any insurance provided to the additional in- (3) The nature and location of any injury sured shall only apply with respect to a claim or damage arising out of the "occur - made or a "suit" brought for damages for rence" or offense; which you are provided coverage. b. Tender the defense and indemnity of any 3. With respect to the insurance afforded to the claim or "suit" to us and to all other insur- additional insured, the following is added to ers who may have insurance potentially SECTION II -- LIMITS OF INSURANCE: available to the additional insured; and If coverage provided to the additional insured c. Agree to make available any other insur- is required by contract or agreement, the most ance the additional insured has for de - we will pay on behalf of the additional insured fense or damages for which we would will be the lesser of the amount of insurance: provide coverage under SECTION II — a. Required by the contract or agreement; or LIABILITY. b. Available under the applicable Limits Of 5, With respect to the insurance afforded the ad - Insurance shown in the Declarations. ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other This endorsement shall not increase the ap- Insurance of SECTION I AND SECTION 11 — plicable Limits Of Insurance shown in the COMMON POLICY CONDITIONS: Declarations. a. This insurance is primary to and will not 4. With respect to the insurance afforded to the seek contribution from any other insurance additional insured, the following is added to available to the additional insured, provided Paragraph 3. Duties In The Event Of Occur- that the additional insured is a named in- rence, Offense, Claim Or Suit of SECTION sured under such other insurance. 11— GENERAL CONDITIONS: b. Regardless of any agreement between The additional insured must: you and the additional insured, this insur- ance is excess over any other insurance a. See to it that we are notified as soon as whether primary, excess, contingent or on practicable of an "occurrence" or an of- any other basis for which the additional in- fense which may result in a claim. To the sured has been added as an additional in - extent possible, notice should include: sured on other policies. (1) How, when and where the "occur- There will be no refund of premium in the event rence" or offense took place; this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP -4786.1 1007033 148011 08-21-2014 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission.