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Insurance - MTM - 2011-09-27 ACORD CERTIFICATE OF LIABILITY INSURANCE DA'E'"IW°D""") 09/27/2011 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(les)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 NMIEADT CIC, Frank Dungan Fifth Avenue Insurance Services PHONE EXt). 619 640 3130 ac No1619 640 3120 P 0. Box 600550 Aoorsess: fdungan @Sthaveins com San Diego, CA 92160-0550 _ INSURER(S)AFFORDING COVERAGE NAM INSURER A. Rockhill Insurance Co INSURED McAdams Mark INSURER B. Travelers 0101 DBA. M T M Construction INSURERC. 3151 Terra Seca Trail INSURERD. Jamul CA 91935 INSURERE INSURER F. COVERAGES CERTIFICATE NUMBER: 11 12 Master 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. LNTR TYPE OF INSURANCE IINNSR WVD POLICY NUMBER (MMND/YYYYY) (POLICY MID /Y EXP LIMITS GENERAL LIABILITY R PKG E 005797-0009/2012011 09/20/2012 EACH OCCURRENCE 5 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE X OCCUR MED EXP(Any o a person) $ 5,000 A X PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENII AGGREGATE LIMB APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 70 POLICY n J CT n LOC AUTOMOBILE LIABILITY BA6A820776 09/24/2011 09/24/2012 (Ee aia1 L ING E LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Par person) $ ALL OWNED X AUTOS SCHEDULED AUTOS GODLY INJURY(Pe accident) $ B _ (P Oat a DAMAGE HIRED AUTOS NON.OWNED O $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE DED I I RETENTION — 5 5 WORKERS COMPENSATION WC STAN- 0TH- AND EMPLOYERS'LIABILITY Y/N I TORY LIMITS I ER ANY PROPRIETOR/PARTNER/EXECUTNE0 E L.EACH ACCIDENT 5 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E L.DISEASE-EA EMPLOYEE $ tt yes descnbe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT 5 Professional Liability R PKG E 005797-0009/20/2011 09/20/2012 $1,000 000 Per Claim A $2 000 000 Annual Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule If more space Is required) As required by written and signed contract certificate holder will be included as additional insured per CG 20 10 07 04 Waiver of Subrogation is provided per form RHIC 6058 01 10 Primary Non-Contributory Wording is provided per form RHIC 6048 07 08 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District AUTHORIZED REPRESENTATIVE 628 W 19th St Costa Mesa, CA 92627 Frank Dungan, CIC ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD