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Insurance - Gladwell Governmental Services - 2012-03-15 /- Th OP ID:JL ACORO- CERTIFICATE OF LIABILITY INSURANCE DATE 03/15DrYYYY) 03115/12 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 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 909-435-0230 CONTACT NAME Sawyer Cook Insurance 909-798-7971 PHONE FAX 1200 California St.,Ste 260 1AIC NgEitt: (A/C,No) Redlands,CA 92374 E-MAIL Small Business Unit ADpaess PRODUCER GLADW-1 CUSTOMER ID N. INSURER(S)AFFORDING COVERAGE NAIL a INSURED Gladwell Governmental Services INSURER A.Hartford Insurance Company 22357 Diane Gladwell INSURERB United States Liability Ins 25895 P.O.Box 62 INSURER C. Lake Arrowhead,CA 92352 INSURER 0. INSURER E. 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 ILTR TYPE OF INSURANCE I INSR I WM I POLICY NUMBER I(MMIDD/YYYYI I(MM/DO/YYYY) LIMITS GENERAL LIABILITY I EACH OCCURRENCE 5 1,000,000 A X COMMERCIAL GENERAL LIABILITY X 72SBAFT4487 10/31/11 10/31/12 DAMATOnCRENT D PREMISES(Ea occurrence) S 1,000,000 CLAIMS-MADE I XI OCCUR MEDEXP(Any one person) $ 10,000 I PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG 5 2,000,000 I POLICY I I PRPf fl LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,099 A X ANY AUTO 72UECJR6553 10/31/11 10/31/12 (Ea accident) BODILY INJURY(Per person) 5 ALL OWNED AUTOS BODILY INJURY(Pe acode I) 5 SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS {Pe acode I) 5 NON-OWNED AUTOS 5 s UMBRELLA DAB _ OCCUR EACH OCCURRENCE 5 EXCESS LIAB CLAIMS-MADE AGGREGATE 5 DEDUCTIBLE 5 RETENTION 5 5 WORKERS COMPENSATION WC STATU• OTH- AND EMPLOYERS'LIABILITY YIN I TORY Wig FR ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT 5 OFFICER/MEMBER EXCLUDED' N I A (Mandatory In NH) E L DISEASE EA EMPLOYEE 5 If yes,desmbe under DESCRIPTION OF OPERATIONS below E L.DISEASE POLICY LIMIT 5 B (Prof.Liability SP1020955A 10/31/11 10/31/12 Pe Claim 1,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Aft eh ACORD 101,Addpl nal Remarks Schedule, me spa ,wqu ed) `Except 10 day notice of non payment of premium.Certificate holder is named as additional Insured as their interest may appear. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN Attention: Joan Revak,Clerk ACCORDANCE WITH THE POLICY PROVISIONS. of the Board 628 W.19th St AUTHORIZED REPRESENTATIVE Coasta Mesa,CA 92627 `�!0 -/— ©{19•9F888---280-009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD