Loading...
Insurance - Monitor - 2011-08-22 Fax Server 9/21/2011 11 47 53 AM PAGE 2/002 Fax Server Interinsurance Exchange of the Automobile Club �� Wiling Address:P.O. BOX 25001 SANTA ANA,CALIFORNIA 92799-5001 BINDER OF INSURANCE Name and Address of Lienholder or Additional Insured Policy Number G 7428537 CANTONWINE,TOM NOTICE TO LIENHOLDER IN THE EVENT OF CANCELLATION OF THIS BINDER, THE EXCHANGE WILL GIVE THE LIENHOLDER 10 DAYS' WRITTEN NOTICE OF CANCELLATION. Loan Number The Inter-Insurance Exchange of the Automobile Club hereby acknowledges/self bound to the named insured for the coverages specified in the schedule subject to all the provisions of the Exchange's applicable policy form.The issuance of a policy to the named insured or if a poky is in force, the issuance of an endorsement covering the automobile,boat or traibrdescribed herein shall void this binder.A pm rata premium charge computed for the term of coverage in accordance with the current rates of the Exchange m effect at inception of the birder will be made unless such a pocky or policy endorsement is issued This binder shall not be construed to afford cumulative insurance with any existing policy. Name of Insured: CANTONWINE, TOM DESCRIPTION OF AUTOMOBILE, BOAT,OR TRAILER Car No Year Trade Name Type of Body or Boat IdentIficatbn Number 2 2007 toyota TUNDRA DOUBLE CAB SR5 5TFBT54187X004105 AUTOMOBILE INSURANCE LIMITS OF LIABILITY indicates coverage bound awl afforded Car# Car It Bodily Injury Liability $ 100 thousand dollars,each person 171 ❑ $ 300 thousand dollars,each occurrence Property Damage Liability $ 50 thousand dollars,each occurrence [� ❑ Medical Payments $ each person ❑ ❑ Underinsured/Un insured Motorists Not Less Than$15,000 each personf$30,000 each accident (� ❑ (a)Actual Cash Value less$500 deductible Q( ❑ Comprehensive(ind. Fire and Theft) (b)Limit of Liabiaty of$ less$ deductible ❑ ❑ Collision (a)Actual Cash Value less$500 deductible ❑ m Uninsured Deductible Waiver (b)Lund of Liability of$ less$ deductible ❑ ❑ Uninsured Collision ❑ ❑ WATERCRAFT INSURANCE(Boat) LIMITS OF UABILITY e indicates coverage bound and afforded. Bodily Injury Liability and Property Thousand Dollars,each occurrence Damage Liability Actual cash value not to exceed Lima of Liabidy of D Physical Damage $ less $ deductible Effective Date of Binder• 09212011 12:01 AM Pacific Standard lime This birder shall expire 30 days from the effective date or may be cancelled by the named insured at any time during such 30-day period.The Exchange may cancel this binder by maifing to the named insured at the address shown above written notice stating when,not less than 10 days thereafter,such cancellation shad be effective.The mating of such notice shall be sufficient proof of notice. District Office costa mesa ACSC Management Services,Inc. By OSAMA ELDESOUKEY ATTORNEY-IN-FACT (Authorized Representative) 30510(12110) A`O O' CERTIFICATE OF LIABILITY INSURANCE ATE o8/z212011 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 ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms nd conditions of the policy, ertain policies may equir ndorsement A statement on this certificate does not c nfer rights to the certificate holder in lieu of ch ndorsement(s). PRODUCER Phone (714)838-5835 Fax: (714)8384)166 REACT Chris Campbell CONREY INSURANCE BROKERS PHONE IFAx 17821 E.17TH STREET #100 a No ,EJ_(714)838.5835 I(A6,NP) (714)838-8166 TUSTIN CA 92780 ADDRESS ccampbell @siatt.com PRODUCER 25035 CUSTOMER o Agency lid/0543173 INSURER(S) AFFORDING COVERAGE NAICI INSURED INSURER A Hartford Casualty Insurance Company 29424 THOMAS J CANTONWINE DBA MONITOR VIDEO PRODUCTION SERVICE INSURER B 2054 RIDGEVIEW TERRACE INSURERC . CORONA CA 92882 INSURER El WSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 21342 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, FXC I SIONS AND CONDITION OF SI ICH POI IC S I IMITS SHOWN M•Y AVE• FN RFDUC ❑RY PAID C AIMS NSR ADEN UER POLICY EFF POLICYE%P LyN TYPE OF INSURANCE INSR WVEI POLICY NUMBER _(MILIa01YYYY) fNLVOVYYYY)_ LIMITS A GENERAL LIABILITY 72SBAAE8187 08/01/11 08/01/12 EACH OCCURRENCE I5 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED I$ 1,000,000 � PRemsrs(Ea em,rena) {CLAIMS-MADE =I OCCUR MED EXP(Any one person) $ 10,000 PERSONAL 8ADV INJURY $ 1,000,000 GENERAL AGGREGATE I $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POUCY I LJEC 'WC $ AUTOMO&LE LIABILITY COMBINED SINGLE LIMIT I $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY(Per person) I S BODILY INJURY(Pe accident)I $ SCHEDULED AUTOS PROPERTY DAMAGE IS HIRED AUTOS (Per accident) NON-OWNED AUTOS S I $ UMBRELLA LIAR OCCUR EACH OCCURRENCE MESS LIAS CLAIMS-MADE AGGREGATE 5 DEDUCTIBLE E RETENTION $ I S WORKERS COMPENSATION we sfATU' TORY NEARS F oTR p $ MID EMPLOYERS' LIABILITY ANY PROPRETORmARTNERIEXECUTWE I E.L EACH ACCIDENT I OFFICER/MEMBER EXCLUDED? Mandatory In HI E.L.DISEASE-EA EMPLOYEE IS n yes detente under ES RIPTICN OF OPERATIONS Wow E.L.DISEASE-POLICY UNIT $ • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,AddltIonal Remarks Schedule,If more space Is required) SEE SUPPLEMENTAL CERTIFICATE INFORMATION 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 ACCORDANCE WITH THE POLICY PROVISIONS. 628 W.19th Street Costa Mesa,CA 92627 AuTROREED SENTATIVE Attention: G� ^� �Q Christine Campbell, ccampbell @siatt.com ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SUPPLEMENT TO CERTIFICATE OF LIABILITY INS #21342 AUG 222011 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS GENERAL LIABILITY FORM,SS 00 08 04 05 CONTAINS THE FOLLOWING PROVISIONS: CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED WHEN AGREED IN WRITING OR BY CONTRACT TRANSFER OF RIGHTS TO RECOVERY AGAINST OTHERS TO THE HARTFORD(WAIVER OF SUBROGATION). OTHER INSURANCE THIS COVERAGE IS PRIMARY AND NON-CONTRIBUTORY WHEN AGREED IN WRITING OR BY CONTRACT Certificate# 21342