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Insurance - Revize LLC - 2023-08-31AC"J?6' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `.�•� 08/31/2023 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 NAME: Insurance Providers of Michigan, Inc. a/j ONNo�Ext�_ 248-325-9469 FAX Not. 248-504-5580 -- 3001 W. Big Beaver Rd. Suite 117 E-MAIL @g ADDRESS: p tdinsurance roviders mail.com MED EXP (Any one person) S INSURER(S) AFFORDING COVERAGE NAIC # Troy MI 48084 INSURER A: Hartford INSURED__ Revize, LLC _. _...... INSURER B : Hartford 1890 Crooks Rd INSURER C: Hartford Troy MI 48084-5506 INSURER D 4,000,000 _ INSURER E: S INSURER F: COVERAGES CERTIFICATE NUMBER: 20230831114827215 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 _. _ POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,000 CLAIMS -MADE XOCCUR1 DAMAGE TO RENTED PREMISES (Ea occurrence) 000,000 MED EXP (Any one person) S 10,000 A Y N 35SBAAZOAOF 09/10/2023 09/10/2024 PERSONAL & ADV INJURY S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S 4,000,000 PRO- X POLICY JECT LOC PRODUCTS - COMP/OP AGG S 4,000,000 _ OTHER: S AUTOMOBILE LIABILITY jEa EDt�SINGLE LIMIT S 2,000,000 MBI _---- ANY AUTO BODILY INJURY (Per person) S OWNED SCHEDULED A ; AUTOS ONLY AUTOS Y N 35SBAAZOAOF 09/10/2023 09/10/2024 BODILY INJURY (Per accident) S X HIRED X NON -OWNED /� /� PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY CPer-accident) _ X UMBRELLA LIAR X. OCCUR EACH OCCURRENCE S 1,000,000 B EXCESS LIAB CLAIMS -MADE' Y N 35SBAAZOAOF 09/10/2023 09/10/2024 AGGREGATE S 1,000,000 DED X , RETENTIONS 10,000 s WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y/N STATUTE, ER ANYPROPRIETOR/PARTNER/EXECUTIVE C OFFICER/MEMBER EXCLUDED? YY N/A N 35WECAZOABB 09/10/2023 09/10/2024 E L. EACH ACCIDENT S _- 1,000,000 (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 S 1,000,000 Professional liability &Cyber liability Per claim $2.000.000 D Y N 357E561865 09/10/2023 09/10/2024 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Costa Mesa Sanitary District, it's elected and appointed officials, agents, officers, volunteers and employees are additional insureds. Said policy shall not terminate, nor shall it be canceled nor the coverage reduced, until 30 days after written notice is given to the District. Any other insurance maintained by the Costa Mesa Sanitary District shall be excess and non-contributing with the insurance provided by this policy CERTIFICATE HOLDER CANCELLATION 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. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: 35 SBA AZOAOF Policy Holder Name: Revize, LLC Enclosed please find information pertaining to your policy. Please contact us if you have any questions or concerns. Thank you for selecting The Hartford for your business insurance needs. Sincerely, The Hartford SC 50 53 10 18 AUGUST 31, 2023 If you have questions, you can reach The Hartford the following ways: ONLINE BY VISITING https:Hagency.thehartford.com POLICY QUESTIONS 1-866-467-8730, Monday - Friday 7 a.m. - 7 p.m. CT 24 HOUR CLAIMS HOTLINE 1-800-327-3636, always open � l Policy Change: THE Business Owner 7 i V :_ 0 : D Policy Number: 35 SBA AZOAOF Insurer: Hartford Underwriters Insurance Company, a Policy Period: 09/10/2023 to 09/10/2024 property and casualty company of The Hartford Named Insured and Mailing Address: Revize, LLC, 1890 CROOKS RD, TROY, MI 48084-5506 Policy Change Number: 1 One Hartford Plaza, Hartford, CT 06155 Name of Agent/Broker: INSURANCE PROVIDERS OF MI INC 3001 W BIG BEAVER RD STE 117 TROY, MI 48084 Policy Change Effective Date: 09/10/2023, Effective hour is the same as stated in the Code: 35357295 Declarations Page of the Policy. Coverage Parts Affected: Liability Common This is NOT a bill. However, any changes in your premium will be reflected in your next billing statement. You will receive a separate bill from The Hartford. If you are enrolled in repetitive EFT draws from your bank account, changes in premium will change future draw amounts. Countersigned by: �S'� cX7 08/31/2023 Authorized Representative Date Form SC 00 06 10 18 Page 1 of 2 Process Date: 08/31/2023 © 2018, The Hartford Policy Expiration Date: 09/10/2024 (May include copyrighted material of Insurance Services Office, Inc., with its permission) Policy Change: THE ol HARTFORD Business Owner's Policy The following has been atltletl. Notice of Cancellation to Certificate Holder(s) - Blanket with Disclaimer The following Additional Insured has been added as an Additional Insured - State or Governmental Agency or Subdivision or Political Subdivision - Permits or Authorizations. COSTA MESA SANITARY DISTRICT AND ITS ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS AND EMPLOYEES, 290 PAULARINO AVE, COSTA MESA, CA 92626 Policy is amended to add the following Endorsement Forms reflecting the changes made to your policy. SC 00 06 10 18 POLICY CHANGE Common ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SL 30 40 10 18 SUBDIVISION OR POLITICAL Liability SUBDIVISION - PERMITS OR AUTHORIZATIONS SL 90 13 10 18 NOTICE OF CANCELLATION TO Liability CERTIFICATE HOLDER(S) Form SC 00 06 10 18 Page 2 of 2 Process Date: 08/31/2023 © 2018, The Hartford Policy Expiration Date: 09/10/2024 (May include copyrighted material of Insurance Services Office, Inc., with its permission) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. x; THE HARTFORD GOVERNMENTALADDITIONAL INSURED - STATE OR • . SUBDIVISION OR POLITICAL SUBDIVISION PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply. A. The following is added to Section C. WHO IS AN INSURED: Additional Insured — State Or Governmental Agency Or Subdivision Or Political Subdivision - Permits Or Authorizations a. Any state or governmental agency or subdivision or political subdivision shown in the Declarations as an Additional Insured — State Or Governmental Agency Or Subdivision Or Political Subdivision — Permits Or Authorizations is also an additional insured, but 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. b. If coverage provided to these additional insureds is required by a written contract or written agreement, or when required by a written permit or authorization issued by a state or governmental agency or subdivision or political subdivision, the insurance afforded to these additional insureds will not be broader than that which you are required by the contract, agreement, permit, or authorization to provide for these additional insureds. c. The insurance afforded to these additional insureds only applies to the extent permitted by law. B. With respect to the insurance afforded to such additional insured(s) by this endorsement, the following additional exclusion is added to Section B. EXCLUSIONS: This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the state or governmental agency or subdivision or political subdivision; or b. "Bodily injury" or "property damage" included in the "product -completed operations" hazard. Form SL 30 40 10 18 © 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE" HARTFORD NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other than for non-payment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. B. If this policy is cancelled by the company for non-payment of premium, or by the insured, notice of such cancellation will be provided within ten (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. Form SL 90 13 10 18 © 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) Page 1 of 1