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Insurance - Cesar Vargas & Asociates - 2023-04-05'4C CC) �® DATE (MM/DD/YYYY CERTIFICATE OF LIABILITY INSURANCE ) 04/05/2023 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 CONTACT Sariah Devereaux-Barrientos StateFar NAME: Sariah Devereaux-Barrientos PHONE 714-541-7280 FAx A/C No Ext : AIC No): wwli 1417 S. Broadway ADDRESS: sariah.devereaux.t8lb@statefarm.com INSURER(S) AFFORDING COVERAGE NAIC # INSURED Santa Ana CA 92707 INSURER A: State Farm General Insurance Company4 25151 MENTE INC INSURER B: INSURER C 12664 CHAPMAN AVE UNIT 1419 INSURER D: INSURER E: GARDEN GROVE CA 928404034 INSURER F: 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. INSRA D SUB P IC E F POLIC E P LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence 3 $ 00,000 -- -- --- -- ------ MED EXP (Any one person) $ 5,000 Q` � Y N 92 -EK -V825 -4 ------- i 05/16/2022 05/16/2023 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY CT LOC OTHER: PRODUCTS - COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO Ea accident $ OWNED SCHEDULED BODILY INJURY (Per person) $ AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DMAGE-- Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION $ WORKERS COMPENSATION $ PER OTH- AND EMPLOYERS' LIABILITY $ ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. EACH ACCIDENT $ NH) Mandatory in NH E.L. DISEASE - EA EMPLOYE $ If yes, describe un DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa Sanitary District ACCORDANCE WITH THE POLICY PROVISIONS. 290 Paularino Avenue p AUTHORIZED REPRESENTATIVE Costa Mesa CA 92626 This form was system -generated on 04/05/2023 , ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 2005 155279 205 01-19-2023 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY CMP -4786.1 ADDITIONAL INSURED (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 -EK -V825-4 Named Insured: MENTE INC 12664 CHAPMAN AVE UNIT 1419 GARDEN GROVE, CA 92840 Name and Address of Additional Insured Person Or Organization: Costa Mesa Sanitary District 290 Paularino Avenue, Costa Mesa, CA 92626 The Costa Mesa Sanitary District, It's elected and appointed officials, agents, officers, volunteers and employees are additional insureds. 1. SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to include, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", or "personal and advertising injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or CMP -4786.1 Page 2 of 2 (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for that additional insured; or b. Products — Completed Operations "Your work" performed for that additional insured and included in the "products- completed operations hazard". However, Paragraph 1. above is subject to the following a. The insurance afforded to the additional insured only applies to the extent permitted by law; b. If coverage provided to the additional insured is required by a contract or agreement, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured; and C. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a defense or indemnity obligation by California Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such additional insured. We have no duty to defend or indemnify the additional insured under this endorsement until a claim or "suit" is tendered to us. 2. Any insurance provided to the additional 3. With respect to the insurance afforded to insured shall only apply with respect to a the additional insured, the following is claim made or a "suit" brought for damages added to SECTION II — LIMITS OF for which you are provided coverage. INSURANCE: 4 If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the applicable Limits Of Insurance shown in the Declarations. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occurrence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or offense; b. Tender the defense and indemnity of any claim or "suit" to us and to a other insurers who may have insurance potentially available to the additional insured; and CMP -4786.1 Page 2 of 2 C. Agree to make available any other insurance the additional insured has for defense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the additional insured, the following replaces SECTION II LIABILITY- of paragraph 7. Other insurance of SECTION II- COMMON POLICY CONDITIONS: a. This insurance company is primary to and will not seek contribution from any other insurance available to the additional insured is a named insured under such other insurance. b. regardless of any agreement between you and the additional insured, this insurance excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on other policies. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. Costa. Mesa Sanitary District 290 Paularino Avenue, Costa Mesa, CA 92626 In order to comply with District requirements, you are required to provide proof of Workers' Compensation Insurance. If you have no employees, this form must be signed and returned to: Costa Mesa Sanitary District 290 Paularino Avenue Costa Mesa, CA 92626 I certify that I do not employ any person in any manner so as to become subject to California Workers' Compensation Insurance requirements. I authorize the Costa Mesa Sanitary District to immediately and retroactively revoke any Agreement/Contract under this declaration if I hire any employee(s) or become subject to the provision of the laws requiring Workers' Compensation Insurance. Applicant/Company Name: _ Address:. e Applicant's Signature: Title: 6xik V'r`A Date Signed: 3 1 �31a3 661A�L VA4,cA 6 � � 5 oc-1 A -r 6� Phone Number: t $`�� `t 9,7 �t Email Address: &A\T,40-0-45 0 0a -l -.A% L..... �e-k IDProtecting our community's health and the environment by providing solid waste and sewer collection services. www.crosdca.gov StateFarm State Farm Specialty Products Telephone: (866) 737-6877 Facsimile: (847) 572-6262 BINDER OF INSURANCE Page: 1 PER THE TERMS OF THIS DOCUMENT — COVERAGE IS IN FORCE AND PREMIUM IS BEING EARNED 1. Delivered To: Araceli Cazales SARIAH GEORGINA DEVEREAUX 1417 S Broadway Santa Ana, CA 92707-1712 Producer Code #: 750810 Producer Facsimile: (714) 384-3892 Coverage is bound pursuant to the following terms and conditions: 2. Named Insured: MENTE, INC DBA CESAR VARGAS & ASSOCIATES 8502 East Chapman Avenue #302 Orange, CA 92869 Client Code #: 212061 3. Binder Period: This binder expires automatically on the date stated unless extended in writing by State Farm Specialty Products or unless superceded by the Policy or Renewal Declarations. Binder Effective Date: April 13, 2023 Binder Expiration Date: Until replaced by Policy 12:01 A.M. standard time at the address of the Named Insured as shown above. 4. Policy Provisions: The Policy or Renewal Declarations will be issued to incorporate the following provisions, provided all conditions of this binder have been met. Policy #: PS0000007332200 Policy Period: From: April 13, 2023 To: April 13, 2024 12:01 A.M. standard time at the address of the Named Insured as shown above. Insurer: State Farm Fire and Casualty Company Program: Miscellaneous Errors & Omissions Professional Liability Insurance Coverage Type: Claims — Made Defense Costs: Defense Costs Within Limits Retroactive date: Policy Inception Limit of Liability Retention Each Wrongful Act Total Limit of Liability Each Wrongful Act $1,000,000 $1,000,000 $2,500 5. Premium Payment & Terms: (Invoice to Follow Under Separate Cover) Premium Payment Plan: Annually Policy Period Premium: $816.00 Total Premium: $816.00 222 South Riverside Plaza, Suite 2400, Chicago, IL 60606 April 27, 2023 Arace|Cozaleo SAR|AHGECJRG|NA[}EVEREAU){ 141TSBroadway Santa Ana, CA 92707-1712 Producer Facsimile: (714)384'3082 RE: MEhJTE.INC DBA CE8ARVARGAS&ASSOCIATES COVERAGE: Miscellaneous Errors & Omissions Professional Liability Insurance CLIENT NO.: 212061 POLICY NUMBER: P80000007332200 BINDER EXPIRATION DATE: Until replaced by Policy Dear Cesar: Thank you for your order on the captioned account. The Binder of Insurance is enclosed. The Invoice for the premium will be mailed directly to the Insured. Please review the Binder carefully and advise if you note any discrepancies or have any questions. Please note, coverage is in force and premium is being earned. Please do not hesitate to contact us if you have any questions or comments. Again, thank you for this order and vvalook forward to being of further service. Best Regards, AreceUCezaleo 222 South Riverside Plaza, Suite 24OO.Chicago, |L 60606 Tel: 866-737-6877 Fax: 847-572-6262 StateFarm Telephone: (866) 737-6877 Facsimile: (847) 572-6262 State Farm Specialty Products b!NL1CK UI- INZOUKANUM Page: 2 6. Schedule of Insured Services: Translation and interpretation services 7. Applicable Forms & Endorsements: PSMS4000(01/01) Miscellaneous Errors and Omissions Liability Insurance Policy .___._... �_ _____. _ .. �_ �_ __ __N..-. _ PS1030(01 /01) Changes Endorsement PS 1044 (02/21) U.S. Treasury Department's Office Of Foreign Assets Control ("OFAC") Advisory Notice To Policyholders PS1045 (02/21) Trade Or Economic Sanctions PSMS4049CA(12/02) ; California Amendatory Endorsement 8. Special Conditions: • Not Applicable 9. Subjectivities: Subject to our receipt & approval of the following requirements: • : Not Applicable This binder requires payment of premium to State Farm Specialty Products, at the location listed on the invoice, on the premium due date shown in the invoice. This binder may be cancelled if payment is not received by the premium due date on the invoice. In the event of cancellation or expiration of this binder without a Policy or Renewal Declarations Page being issued, the Insurer shall be entitled to an earned premium for the time in force as calculated by the Insurer in accordance with the provisions of the applicable specimen policy or expiring policy. Date of Issue: May 4, 2023 By: � a* �- Authorized Representa . 222 South Riverside Plaza, Suite 2400, Chicago, IL 60606