Insurance - Kilbride - 2002-01-16 1M1-16-02 09.4641 FROM- T-156 P 001/002 F-162
ACORD CERTIFICATE OF LIABILITY INSUIRAN6t11 PID 51 01/16/02
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ood- ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
License ce-set i067 Insurance Brokers HOLDER.THIS CERTIFICATE DOES HOT AMEND,EMEND OR
2 F anklin63 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
4192 Franklin Ave Suite 200
:ustin CA 92780 7044 INSURERS AFFORDING COVERAGE
phone 714 505-7000 Fax-714 573 1770 iNSURERA Gemini Insurance Co
JSURED
',NSU0.ER B'
NSURER C.
Mike Bo341 LTD INSURER D.
P 0 Box 3c1
Newport Beach CA 92659 INSURER E.
1
OVERAGES
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 CLAJMS,
TYPE OF INSURANCE POLICY NUMBER DATE MMIDO • DATE MWDDT LRAMs LTR
GENERAL LI EACH OCCURRENCE S 1000000
A X COMMERC RCUL GENERAL LVJ31uTY VCGP002646 l0/30/01 10/30/02 FIRE DAMAGE(Any one se) I 550000
C MADE OCCUR MED EXP(Any one person) S$0 0 0
ke
PERSONAL SADVIWURr 61000000
X Blanket AI Endt GENERAL AGGREGATE s 1000000
PRODUCTS-COMP/OP AGG s 1 0 0s 10 0 0
000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S
IN (Ea acddenq
ANY 4UT0
■ .DOWNED AUTOS BODILY INJURY S
(Pe Person)
SCHEDULED AUTOS L
HIRED AUTOS $
■ NON-OWNED AUTOS
PROPERTY DAMAGE S
(Per accident)
AUTO ONLY EA ACCIDENT S
III ANY GARAGE LIABILITY C S
OTHER THAN
Ell Y AUTO S
EACH OCCURRENCE $
EXCESS LIABILRY
AGGREGATE $
■ OCCUR G CLAIMS MADE 13
$
II DEDUCTIBLE
IIIRETENTION S
RENTION S TORY LIMITS■
WORKERS COMPENSATION AND
EMPLOYERS LIABILITY EL EACH ACCIDENT S
E.L.DISEASE-EA EMPLOYEE S ,
EL.DISEASE POLICY UNIT S
OTHER I
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/OCCLUSIONS ADDED BY ENDORSEMENT/SPEOAL PROVISIONS
*10 Days Notice of Cancellation for Non Payment of premium or non reporting
of Payroll
CERTIFICATE HOLDER N ADDITIONAL INSURED;INSURER LETTER:_ CANCELLATION
COSTAO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIC
Costa Mesa Sanitary District DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO NAL *30 DAYS WRITTEN
Attn Joan Revak NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
Fax_ 714-200-1436 IMPOSE NO OBLIGATION OR uABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
P 0 Box 1200 REPRESENTATIVES
Costa Mesa CA 92628 1200 AUTrIOAp.D REPRE,CMATN
I Eric P- Magee 47/7/T /A/L"�'
/e ORE cORPORATION 1988
ACORD 25-S p197)
JAN-16-02 09.46AM FROM- T-156 P 002/002 F-162
IMPORTANT
If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)muss be endorsed.A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain polices may
require an endorsement.A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s),authorized representative or producer and the certificate holder, nor does it
affirmatively or negatively amend,extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-S(7197)