Insurance - Workers Comp - C & R Drains - 2006-04-10 ACORD, CERTIFICATE OF INSURANCE ISSUE DATE
04/10/2006
PRODUCER Certificate
below.
information only rights
R E C F 'Oct ar to d r. T Certificate does not amend,extend the COMPANIES OF HOUSTON afforded is coverage 5847 SAN FELIPE,SUITE 320
HOUSTON,TX 77057 APR 2 0 2006 COMPANIES AFFORDING COVERAGE
COSTA MESA SANITM Y Olgigfiny American Home Assurance Co
INSURED Company
ADMINISTAFF COMPANIES,INC. B
19001 CRESCENT SPRINGS DRIVE
KINGWOOD,TX 77339 Company
SEE BELOW C
Company
D
Company
F
This is to certify that the policies of insurance described herein have been issued to the Insured named herein for the policy period indicated. Notwithstanding
any requirement,term or condition of 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,conditions and exclusions of such policies. Limits shown may have been reduced by paid claims
CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE LIMITS OF LIABILITY
LT EXPIRATION
GENERAL LIABILITY EACH OCCURRENCE $
❑
Comma al General Liability FIRE DAMAGE $
❑Claims Made ❑Oc
El Own nd Conlr cto Protectlo MEDICAL EXPENSE $
❑ PERS AND ADVERTISING INJURY $
❑ GENERAL AGGREGATE $
Ge al Aggregate Limn app" pe PRODUCTS AND COMP OPER AGG. $
❑pa cy ❑Pro ❑Lo eec
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
❑Any Au omobile BODILY INJURY(Per person) $
❑ Automobile BODILY INJURY(Per accident) $
El Sc Scheduled d Automobile
tired Automobile PROPERTY DAMAGE(Per accident) $
No owned Automobile COMPREHENSIVE
❑ COLLISION
A WORKERS'COMPENSATION 1375983 10/01/2005 WC Statutory Limit X Other
AND EMPLOYERS'LIABILITY 10/01/2006 EL EACH ACCIDENT $ 1,000,000
EL DISEASE(Each employee) $ 1,000,000
EL DISEASE(Policy Limit) $ 1,000,000
EXCESS LIABILITY EACH OCCURRENCE $
❑Occu El Claims Made AGGREGATE $
$
C&R DRAINS,INC.(1379500)IS COVERED THROUGH BLANKET ALTERNATE EMPLOYERS ENDORSEMENT FOR ALL EMPLOYEES UNDER CLIENT
SERVICE AGREEMENT
CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
Authorized Representative
COSTA MESA SANITATION DISTRICT
A7T TOM:RO FAUTH
77 FAIR M ��
7
COSTA MESA, CA 92627
Page 1 of 1 Certificate IDN 1DBXF515