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Insurance - Hamers - 2013-04-26 ROBIBHA-01 . LEEELI AC®I?CY .CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/26/2013 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 ELOW. `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 RECEIVE® CONTACT .. ' (MP)Heffernan Insurance Brokers PHONE FAX 1460B O'Brien Drive (A/C,No,E:t):1 (650)842-5200 (A/C,No): 1 (650)842-5201 E-MAIL Menlo Park,CA 94025 APR 2 9 2013 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# . Iii,i[:u .rij'riOM thslim INSURER A:Travelers Property Casualty Co.of America 25674 INSURED INSURER B:Hanover American Insurance Company 36064 Robin B.Hamers&Associates, INSURER C:Atlantic Specialty Insurance Company 234 E.17th Street,Suite 205 INSURER D: ■ Costa Mesa,CA 92627 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. INSR ADDL SUBR POLICY EFF 1 POLICY EXP TYPE OF INSURANCE LTR INSR WVD POLICY NUMBER JMM/DD/YYYY W MM/DD/YYYYL LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X 6808291N502 6/1/2012 6/1/2013 DAMAGE TO REN I ED 1,000,000, PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR •. . MED EXP(Any one person) . $ 19,o oo • _ .. PERSONAL&ADV INJURY $ . 1;000,000 .�'��•.' - - GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER - ••-"- - - . ' PRODUCTS-COMP/OP AGG $ ' 2,000,000, PRO-'. - - $ POLICY X JECT -LOC .. , • AUTOMOBILE LIABILITY ,. ' . COMBINED SINGLE LIMIT 1,000,000 _ • (Ea accident) $• A ANY AUTO 6808291N502 6/1/2012 6/1/2013 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X MVO-OWNED PROPERTY DAMAGE JPER ACCIDENT) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X WC STATU- 0TH- AND EMPLOYERS'LIABILITY TORY LIMITS ER J B ANY PROPRIETOR/PARTNER/EXECUT!VE 1---1 WZF901252902 I 3/23/2013 1 3/23/2014 ' E.L.EACH ACCIDENT $. 1,000,0001 . OFFICER.`MEMUER EXCLUDED? , /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 $ 1,000,000 C Professional Liab. DPL166712 7/27/2012 7/27/2013 Per Claim 1,000,000 C Professional Liab. DPL166712 7/27/2012 7/27/2013 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Operations as per contract on file with Insured. General Liability only:Costa Mesa Sanitary District is named as Additional Insured but only as respects liability arising out of the Named Insured's operations. 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 0 ' \\21 ACCORDANCE WITH THE POLICY PROVISIONS. 628 W.19th Street Costa Mesa,CA 92627 — \\ AUTHORIZED REPRESENTATIVE . fil ----. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 6808291N502 COMMERCIAL GENERAL LIABILITY DATE ISSUED: 08/02/2012 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): Costa Mesa Sanitary District PROJECT/LOCATION OF COVERED OPERATIONS: Operations as per contract on file with Insured. PROVISIONS A. The following is added to WHO IS AN INSURANCE (Section III) for this INSURED (Section II): Coverage Part. The person or organization shown in the B. The following is added to Paragraph a. of 4. Schedule above is an additional insured on Other Insurance in COMMERCIAL this Coverage Part, but only with respect to GENERAL LIABILITY CONDITIONS (Section liability for"bodily injury", "property damage" or IV): "personal injury" caused, in whole or in part, by your acts or omissions or the acts or omissions However, if you -specifically agree in a of those acting on your behalf: "contract or agreement requiring insurance" 1110 that, for the additional insured shown in the a. In the performance of your ongoing Schedule, the insurance provided to that operations; additional insured under this Coverage. Part b. In connection with premises owned by or must apply on a primary basis, or a primary rented to you; or and non-contributory basis, this insurance is c. In connection with "your work" and primary to other insurance that is available to included within the "products-completed such additional insured which covers such operations hazard". additional insured as a named insured, and we will not share with the other insurance, Such person or organization does not qualify provided that: as an additional insured for "bodily injury", "property damage" or "personal injury" for (1) The "bodily injury" or "property damage" which that person or organization has for which coverage is sought occurs; and assumed liability in a contract or agreement. (2) The "personal injury" for which coverage is sought arises out of an offense The insurance provided to such additional committed; insured is limited as follows: after you have entered into that "contract or d. This insurance does not apply to the agreement requiring insurance" for such rendering of or failure to render any additional insured. But this insurance still is "professional services". excess over valid and collectible other insurance, whether primary, excess, e. The limits of insurance afforded to the contingent or on any other basis, that is additional insured shall be the limits which you agreed in that "contract or available to the additional insured when the agreement requiring insurance" to additional insured is also an additional insured provide for that additional insured, or the under any other insurance. • limits shown in the Declarations for this Coverage Part, whichever are less. This C. The following is added to Paragraph 8. endorsement does not increase the limits Transfer Of Rights Of Recovery Against of insurance stated in the LIMITS OF CG D3 82 09 07 ©2007 The Travelers Companies, Inc. Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. POLICY NUMBER: 6808291N502 COMMERCIAL GENERAL LIABILITY DATE ISSUED: 08/02/2012 Others To Us in COMMERCIAL GENERAL • LIABILITY CONDITIONS (Section IV): We waive any rights of recovery we may have against the additional insured shown in the Schedule above because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" on or for the project, or at the location, shown in the Schedule above, performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that additional insured. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insurance" with that additional insured entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury"offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement under which you are required to include the person or organization shown in the Schedule as an additional insured on this Coverage • Part, provided that the "bodily injury" and "property damage" occurs, and the "personal injury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. • CG D3 82 09 07 ©2007 The Travelers Companies, Inc. Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission.