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Insurance - Technology Resource Center, Inc. - 2013-03-19 RECEIVED MAR 2 5 2013 � ® DATE(MM/DDIYYYY) A�o CERTIFICATE OF LIABILITY INSUI I,�,gigojsJ Cr 3(MM/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 Garrett/Mosier/Griffith/Sistrunk CONTACT NAME: Risk Management& Insurance Services PHONE(A/C,No,Ext): (949)559-6700 FAX(A/C,No): (949)559-6703 12 Truman Irvine, CA 92620 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# www.gmgs.com OB84519 INSURER A: Scottsdale Insurance Company INSURED INSURER B: Golden Eagle Insurance Corporation Technology Resource Center, Inc. 601 N. Parkcenter Drive, Suite 209 INSURER c: Insurance Company of the West Santa Ana CA 92705 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 15769228 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER (MM/DD/YYYY) {MM/DD/YYYY) LIMITS LTR INSR YYVD _ A GENERAL LIABILITY BCS0029832 3/20/2013 3/20/2014 EACH OCCURRENCE $ 1,000,000 ,/ COMMERCIAL GENERAL LIABILITY PR TO RENTED 100,000 a PREMISES(R occurrence) $ CLAIMS-MADE I OCCUR MED EXP(Any one person) $ Excluded PERSONAL&ADV INJURY _$ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 —1 POLICY PRO- JECT $ _ JECT B AUTOMOBILE LIABILITY BA8831788 3/20/2013 3/20/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ✓ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE ,/ HIRED AUTOS ,/ AUTOS (Per accident) $ _ ✓ Physical Damage $1,000 Comp Ded. $1,000 Coll Ded. $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ — EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED _ RETENTION$ $ C WORKERS COMPENSATION WSD500697801 10/1/2012 10/1/2013 I WCSTATU- IOJH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS OR - AND• PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (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 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) All operations of the named insured subject to the terms and conditions of the policies. As respects General Liability coverage,Costa Mesa Sanitary District,its officers,agents,officials,employees and volunteers are added as Additional Insured per CG20330704 attached. CERTIFICATE HOLDER CANCELLATION All Operations SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District �\\117 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 628 W. 19th Street \ ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa CA 92627 AUTHORIZED REPRESENTATIVE arramp... Griff Griffith ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CERT NO.: 15769228 Marissa Romo 3/19/2013 3:28:59 PM Page 1 of 2 Technology Resource Center, Inc. Policy No. BCS0029832 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or or- additional insureds, the following additional exclu- ganization for whom you are performing opera- sions apply: tions when you and such person or organization This insurance does not apply to: have agreed in writing in a contract or agreement that such person or organization be added as an 1. "Bodily injury", "property damage" or "personal additional insured on your policy. Such person or and advertising injury" arising out of the ren- organization is an additional insured only with re- dering of, or the failure to render, any profes- spect to liability for "bodily injury", "property dam- sional architectural, engineering or surveying age" or "personal and advertising injury" caused, services, including: in whole or in part, by: a. The preparing, approving, or failing to pre- 1. Your acts or omissions; or pare or approve, maps, shop drawings, 2. The acts or omissions of those acting on your opinions, reports, surveys, field orders, behalf; change orders or drawings and specifica- tions; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. A person's or organization's status as an addi- 2. "Bodily injury" or "property damage" occurring tional insured under this endorsement ends when after: your operations for that additional insured are completed. a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sured(s) at the location of the covered operations has been completed; or b. That portion of"your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcon- tractor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ CERT NO.: 15769228 Marissa Romo 3/19/2013 3:28:59 PM Page 2 of 2