Loading...
Insurance - JIMNI - 2005-11-16 � JIMNSYS-01 PACR • ACRD„ CERTIFICA F LIABILITY INSURAI:CE DATEivzoo) PRODUCER (562)923-9631 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bowermaster&Associates Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE _ HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 10631 Paramount Blvd. R E C V E ID Downey, CA 90241-0100 INSURERS AFFORDING COVERAGE NAIC# INSURED Jimni Systems, Inc. INSURER A'Colony Insurance Company 25295 Cinnamon Road COSTA MESA SANITARY�ISiRICT INSURER B.Progressive Casualty Ins Co Lake Forest, CA 92630 INSURER C TOPA Insurance Company INSURER D' INSURER E. COVERAGES 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION] LTR NSRD TYPE OF INSU•ANCE DATE MOD/1(n_ D• M D'IYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X X COMMERCIAL GENERAL LIABILITY GL163408 4/1/2005 4/1/2006 1:9\11TAGET6RENTED PREMISES(Ea occurence) $ 100,000 CLAIMS MADE X OCCUR MED EXP(Any o e person) $ excluded PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L.AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG $ 1,000,000^ POLICY I PROT- LOC JFC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 B ANY AUTO 020973584 10/14/2005 4/14/2006 (Ea c,denl) X ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Pe cddent) PROPERTY DAMAGE (Pe c,dent) GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,000 C X OCCUR CLAIMS MADE XL1823101 4/1/2005 4/1/2006 AGGREGATE $ 2,000,000 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETORIPARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED' E L DISEASE EA EMPLOYEE $ It yes,de cnb under SPECIAL PROVISIONS below Et DISEASE POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS If this poicy cancels for non-payment the company will issue 10 day notice of cancellation. City of Costa Mesa Sanitary District is Additional Insured as respects to General Liability, per form U156-0702 attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Costa Mesa Sanitary District DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Attn: Tom Fauth 628 West 19th Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Costa Mesa, CA 92627 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE �q e ACORD 25 (2001/08) ©ACORD CORPORATION 1988 In ered:.limni Systems, Inc • Policy#( 3408 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization(Additional Insured): All persons or organizations as required by written contract with the named insured. A SECTION II —WHO IS AN INSURED is amended and the following added: The person or organization (called additional insured") shown in the Schedule is also an insured but only a. with respect to indirect liability caused by or resulting from your ongoing operations performed for that 'additional insured(s)' and b. when you and the person or organization shown in the Schedule have agreed in writing in a contract or agreement that such person or organization be added as an 'additional insured' on your policy A person's or organization's status as an 'additional insured' under this endorsement ends when their contract or agreement with you ends. B SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY 2. Exclusions is amended and the following added: This insurance does not apply to: Additional Insured Contractual Liability 'Bodily injury or 'property damage for which the additional insured(s)' are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations or Work 'Bodily injury' or 'property damage (1) occurring after 'your work' including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the 'additional insured(s)' at the site of the covered operations has been completed; or (2) occurring after that portion of 'your work' out of which the injury or damage arises has been put to its intended use by any person or organization. Negligence of Additional Insured 'Bodily injury' or 'property damage directly arising out of or resulting from the sole negligence of the 'additional insured(s)' ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED U156-0702 Page 1 of 1 ris M SG CERTHOLDER COPY STATE P O. BOX 420807 SAN FRANCISCO,CA 94142-0807 COMPENSATION INSURANCE. FLiw i V D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE 10-28-2005 GROUP. 000013 POLICY NUMBER: 0000426-2005 CERTIFICATE ID: 109 CERTIFICATE EXPIRES: 04-01-2006 04-01 2005/04-01-2006 CITY OF COSTA MESA SG 77 FAIR DRIVE COSTA MESA CA 92526 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon30 days advance written notice to the employer We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of Insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. c AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS $1 000 000 PER OCCURRENCE ENDORSEMENT #1600 BARBARA PLEASANTS SEC EXCLUDED ENDORSEMENT #1600 JAMES W PLEASANTS PRES TRES EXCLUDED ENDORSEMENT X2065 ENTITLED CERTIFICATE HOLDERS NOTICE EFFECTIVE 04-01-2000 IS ATTACHED TO AND FORMS A PART OF THIS POLICY EMPLOYER JIMNI SYSTEMS INC SG 25295 CINNAMON RD LAKE FOREST CA 92630 (B19,SCI weva-051 PRINTED 10-28 2005