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Insurance - Jimni Systems Inc. - 2013-03-28 �-� 1 ' ' _ ,`- `! C DUHA kilECEIvEri '`�l _°RO� CERTIFICATE OF LIABILITY INSIJR I ' EmiAnDISIRIC�A3/28/2013 ) 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 (888)825-4322 NAME: Christine Smiley . • Bowermaster&Associates (A//C,No,Ext):714-733-6200 214 FAX (A/C,No): 714-252-8253 P.O. Box 6026 E-MAIL 10805 Holder Street-Suite 350 PRODUCER smiley @bowermaster.com Cypress,CA 90630 CUSTOMER ID B:SOCPAC-003 INSURER(S)AFFORDING COVERAGE NAIC# INSURED Jimni Systems, Inc. INSURER A:Scottsdale Insurance Company 11161 Jeffrey Rd INSURER B:General Ins.Co. of America Irvine,CA 92602 INSURER C:Zurich American Insurance Company INSURER D: 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. LTR TYPE OF INSURANCE I INSR SWVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DDIYYYY) (MMIDDIYYYY) GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 A X COMMERCIAL GENERAL LIABILITY X BCS0029878 4/1/2013 4/1/2014 PPREMISESOERa occu ence) $ 100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) • $ Excluded ' PERSONAL&ADV INJURY 5 1,000,000 ' GENERAL AGGREGATE 5 2,000,000 r GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG 5 2,000,000 I POLICY I X I JEGT LOC w', S AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT $ 1,000,000 B ANY AUTO 24CC3006272 4/1/2013 4/1/2014 (Ea accident) BODILY INJURY(Per person) $ ALL OWNED AUTOS ' BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ IS UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 A XLS0087482 4/1/2013 4/1/2014 DEDUCTIBLE $ X RETENTION 5 Nil $ WORKERS COMPENSATION X WC STATU- I OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER C ANY PROPRIETOR/PARTNER/EXECUTIVE WC656047500 4/1/2013 4/1/2014 E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 S 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Costa Mesa Sanitary District is Additional Insured as respects General Liability per form GLS294S310 and Auto Liability per form CA7110307. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa Sanitary District 4f4((., ACCORDANCE WITH THE POLICY PROVISIONS. 628 W.19th Street Costa Mesa,CA 92627- AUTHORIZED REPRESENTATIVE I ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD SGQTTSDALE INSURANCE COMPANY ENDORSEMENT NO. Attached to.and forming a part of Endorsement Effective Date 04/01/2013 Policy No. BCS0029878 12:01 A.M., Standard Time Named Insured JIMNI SYSTEMS, INC . AgentNo. 0477'6': THIS.ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS SPECIAL CONDITION For coverage provided in the following endorsements as.indicated by an "x"in the box below: ;Additional'Insured—Owners, Lessees Or Contractors-Scheduled Person-Or Organization (CG 20 10). X Additional Insured—Owners, LesseesOr Contractors-Automatic Status When Required In Construction Agreement With.You (CG 20 33). X Additional Insured—Owners, Lessees Or Contractors—Completed Operations(CG 20 37).. The insurance provided is amended to be(indicated by an "x'in one box below): X Primary and noncontributory. Primary. Noncontributory. j If this box is checked,this endorsement applies only to the following additional.insured(s): AUTHORIZED REPRESENTATIVE DATE GLS-294s(3-10) Page 1 of 1 Insured Copy REPRINT ED FROM Ti iE FORMS LIBRARY•••• Jinini Systems,Inc. Rsx � G CO V O !nJ ra n ce COMMERCIAL AUTO CA 71 10 03 OT THiS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply'unless m.otlified by the endorsement.., EXTENDED CANCELLATION CONDITION BLANKET ADDITIONAL INSURED Paragraph 2:b. .of the CANCELLATION Common SECTION II — LIABILITY COVERAGE. A.1.WHO Polley Condition is replaced by the following_ IS AN INSURED provision is amended by the addition._ of the following: b. 60 days before the effective`date of cancellation if we cancel for any other reason. e. Any person or organization for whom you.are re- quired by an "insured contract" to provide incur, TEMPORARY SUBSTITUTE AUTO — PHYSICAL ance is an "insured", subject to the follotyirig DAMAGE COVERAGE additional provisions: Under paragraph:C. — CERTAIN TRAILERS, MO- (1) The "insured contract" must be .in effect during the policy period shown in the Decla- BILE EQUIPMENT AND TEMPORARY SUBSTITUTE rations, and must have been,executed prior AUTOS of SECTION 1 COVERED AUTOS; the to the "bodily injury" or °property damage".- following is added: (2) This person or organization is an insured If Physical Damage doverageis provided.by this,Coy- only to the extent.you are liable-due to your erage Form, then you have coverage for: ongoing operations for that insured,whether the work is performed by you or for you,and:. Any "auto"you do not own while used with the per- only to the extent you are held liable for an mission of its owner as a.temporary substitute for a "accident"occurring while a covered "auto" covered "auto" you own:that.is out of service he- is being driven by you or one of.your em- cause of its breakdown , repair, servicing, "toss" or ployees. destruction. (3) There is no coverage provided to this person or organization for "bodily injury" to its ern- BROAD FORM,NAMED INSURED. ployees, nor for "property damage to its property. SECTION. II — LIABILITY COVERAGE — A.1. WHO IS AN INSURED provision is amended by the addition (4) Coverage for this person or organization of the following: shall be limited to the extent of your negli- gence or fault according to the applicable d. Any business entity newly acquired or formed by principles of comparative negligence or fault: you during the policy: period provided you own (5) The defense of any claim or 'suit" must be 50% or more of the business entity and the business entity is not separately insured for tendered by this person or organization as soon as practicable to all other insurers • Business Auto Coverage: Coverage is extended l up to a maximum of 1f30 days following aequisi which potentially provide insurance for such lion or formation of the business entity. Coverage claim or "suit". under this provision is afforded only until the end of the policy period. includes copyrighted material of Insurance Services Office, inc.,with its permission. Copyright, Insurance Services Office, Inc., 1997 Salxo aid Se Saleco lo;o are registered ralEma0s of Safeco-Goiporarron. I. CA 71 10 03 07 Page 1 of 6 EP • '"rtEPHINI EL;FROM IHE FORMS LIBRARY"" (6) The'coverage provided will not exceed the PERSONAL EFFECTS COVERAGE lesser of: - A_ SECTION III — P,HYSICAL. DAMAGE COVER- (a): The'coverage and/or limits of this policy; AGE;• A.4. COVERAGE EXTENSIONS; is or amended by adding the'following (b) The..coverage?rid/or limits required by c. Personal Effects Coverage the "insured.contract". For any Owned "auto that is inVolved In a (7) A person's or organization's status as an covered loss"; we will pay up to $500 for insured" under this subparagraph d ends 'personal effects" that are lost or damaged when your operations for that "insured-are as a result of the covered "loss", without: completed. applying a deductible.. EMPLOYEE AS INSURED: EXTRA EXPENSE — BROADENED COVERAGE 'Under Paragraph A.of Section II LIABILITY COV- Paragraph A. — COVERAGE`. of SECTION III ERAGE item f: is added as'follows: PHYSICAL DAMAGE COVERAGE 'is'. arnended to add: Your "employee"while using his owned "auto", or an "auto" owned by a member of his or her.household; 5. We will pay for the expense of returning a stolen in your business or your personal affairs, provided you covered "auto"to you: do not own, hire or borrow that "auto": This coverage is excess tó;any other collectible insurance coverage. AIRBAG COVERAGE FELLOW EMPLOYEE COVERAGE Under paragraph B 'EXCLUSIONS of SECTION 111; — PHYSICAL DAMAGE COVERAGE, the following_is Exclusion 5.'FELLOW`:EMPLOYEE of SECTION .11 added: LIABILITY COVERAGE —. B. EXCLUSIONS is amended by the addition of the following: The'exclusion:relating to mechanical.breakdown:does not apply to the accidental discharge of an airbag. However; this exclusion does not apply if the "bodily: injury" results from the use of a covered "auto you NEW VEHICLE REPLACEMENT COST own or hire, and:provided that any coverage under: this provision only applies'in excess over any other Under Paragraph C — LIMIT OF INSURANCE of collectible insurance: Section llf —PHYSICAL DAMAGE COVERAGE sec- don 2 is amended as follows: BLANKET WAIVER OF SUBROGATION 2.. An adjustment for depreciation and:physical con- We waive the right of recovery we may have for pay- dilion will be made in determiningi actual cash merits made for "bodily injury" or °property:damage" value in the event of a total loss.However, in the on behalf.of the persons or organizations added,as event of a total loss to your "new vehicle." to "insureds" under Section II —LIABILITY COVERAGE. which this coverage applies, as shown In the A.1.D. BROAD FORM NAMED INSURED and ° declarations,.we will pay at your option: A.1:e.BLANKET ADDITIONAL INSURED. a. The verifiable new vehicle" purchase price you paid for your damaged vehicle, not in- PHYSICAL DAMAGE ADDITIONAL TRANS- chiding any insurance or warranties pur- PORTATION EXPENSE COVERAGE chased; The first sentence of parth A.4.'of SECTION III b. The purchase price, as negotiated by us, of — PHYSICAL DAMAGE COVERAGE is amended as a new vehicle of the same make,.model and follows: equipment, not including any furnishings, parts or equipment not installed by the We will :pay up to $50 per:day to a maximum of manufacturer or manufacturer's dealership_ $1 500 for temporary transportation expense incurred If the same model is not available pay the by you because of the total theft of a covered "auto". purchase-price of the most similar: model of the private passenger type. available,. .. • Page 2 cl 6