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Insurance - Environmental Engineering & Contracting - 2013-10-30CERTIFICATE OF LIABILITY INSURANCE I DATE (M MID DNM) 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 PRODUCER Services R E C E NOV 0 4 INSURED Environmental Engineering & Contracting, Inc. 501 Parkcenter Drive Santa Ana CA 92705 COVFRAr:FS CFRTIFICATE NUMBERS 9R9niAAA 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 LTR TYPE OF INSURANCE AODL SUER POLICY NUMBER MMIDDYIYfff EXP R /YYYY MM/ODY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F✓ OCCUR GLP2006942 -11 10/31/2013 10131/2014 EACH OCCURRENCE $ 5,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP Any one person) $ 5,000 PERSONAL S ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'LAGGREGATE LIMIT APPLIES PER POLICY PRO- LOG JET PRODUCTS - COMPIOPAGG $ 5,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED eSCHEDULED AUTOS NON TOS OWNED HIRED AUTOS AUTOS CBP9589097 4/30/2013 4/30/2014 CO MBB, EDISINGLE LIMIT $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOPJPARTNEWEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WCA2008815 -10 5/24/2013 5/24/2014 WC STATU- OTFI- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,00() E.L. DISEASE EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT I $ 1,000,000 D Pollution Liability Professional Liability CCP2006941 -11 10/31/2013 10131/2014 Each Poll Occurrence $5,000,000 Each Prof Liab Claim $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is added as Additional Insured and this insurance is primary per ENV2154AO906 attached. As respects General Liability coverage, a Waiver of Subrogation is hereby included per CG24040509 attached. CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District ry1 628 W. 19th Street ' J Costa Mesa CA 92627 11 l SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Gdff Griffith 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD CERT NO.: 18201464 Marione Roma 10/30/2013 12:32:29 PM Page 1 of 3 GLP2006942 -11 Environmental Engineering & Contracting, Inc. ENDORSEMENT This endorsement forms a part of the policy to which it is attached. Please read it carefully. ADDITIONAL INSURED - BLANKET - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Who is An Insured (Section II) is amended to include as an insured any person(s) or organizations, for whom you are performing operations under a written contract or agreement, which is in effect prior to the performance of your work which is the subject of such written contract or agreement, that such person(s) or organization(s) be added as an additional insured on your policy, but Only with respect to liability for bodily injury, property damage or personal and advertising injury caused, in whole or in part, by: 1. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured; or 2. Your work performed for such person(s) or organizations(s) and included in the products - completed operations hazard, only when required by the written contract or written agreement. With respect to damages caused by your work, as described above, the coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above, but only when required by written contract or agreement. © 2006 by Berkley Specially Underwriting Managers LLC, an affiliate of Nautilus Insurance Company and Great Divide Insurance Company. All rights reserved. m 1985 -2006 by Insurance Services Office, Inc., material used by permission. ENV 2154 A 09 06 Page 1 of 1 CERT NO.: 18201464 Masisse Roma 10/30/2013 12:32:29 PM Page 2 of 3 Environmental Engineering & Contracting, Inc. 10/30/2013 POLICY NUMBER: GLP2006942 -11 COMMERCIAL GENERAL LIABILITY CG 24 04 06 08 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Oroanization: Blanket where required by written contract or agreement. Such written contract or agreement must be in effect prior to the performance of your work which is the subject of such written contract or agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following Is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown In the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or 'your work" done under a contract with that person or organization and included In the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 06 08 © Insurance Services Office, Inc., 2008 CERT NO,: 18201969 Marissa Romo 10/30/2013 12:32:29 PM Page 3 of 3 Page 1 of 1 SENTRY SELECT INSURANCE COMPANY STEVENS POINT, WISCONSIN RECEIVED (A PARTICIPATING STOCK COMPANY) A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES ® vnv n 7 9013 CERTIFICATE OF INSURANCE ACCOUNT NU14gtWAA1Q9IJMjJ This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies below. Name and Address of Name and Address Certificate Aggregate Holder of the Insured COSTA MESA SANITARY DISTRICT MUNICIPAL MAINTENANCE 628 W 19TH STREET EQUIPMENT INC COSTA MESA, CA 92627 2360 HARVARD ST SACRAMENTO, CA 95815 This certificate is issued an 12 -15 -2013 and is effective until 12 -15 -2014. It certifies that policies of insurance listed below have been issued to the insured named above. 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. Coverage Provided General Liability Bodily Injury and Property Damage Combined Automobile Liability Includes: Bodily Injury and Property Damage Combined -Any Auto Excess /Umbrella Liability Workers' Compensation and Employer's Liability Policy Number Coverage Limits 49- 67776 -12 General Aggregate S 1,500,000 Products Aggregate S 1,500,000 OCCURRENCE Pers /Adv Injury S 500,000 Each Occurrence $ S 500,000 Premises Damage S 100,000 Medical Expense $ 5,000 49- 67776 -12 Each Accident $ 500,000 49- 67776 -12 Each Occurrence S 3,000,000 General Aggregate S 9,000,000 Products Aggregate $ 9,000,000 49- 67776 -14 Statutory Each Accident $ 500,000 Each Disease /Employee $ 500,000 Each Disease /Policy $ 500,000 Should any of the above described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. 80 -C1035 (MECH) MUN 49 -67776 10 -16 -2013 PAGE 1 (0116) 01- 117204 LDI COI 269628 -1 02 11 O1T19ORG 02063 SENTRY SELECT INSURANCE COMPANY THE SENTRY PLAN STEVENS POINT, WISCONSIN POLICY (A PARTICIPATING STOCK COMPANY) A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES GENERAL LIABILITY DECLARATIONS NAME INSURED: MUNICIPAL MAINTENANCE EQUIPMENT INC ADDITIONAL INSURED SCHEDULE POLICY NUMBER 49- 67776 -12 The following information is required to complete the accompanying additional insured endorsement which forms a part of the Named Insured's COMMERCIAL GENERAL LIABILITY COVERAGE PART. ADDITIONAL INSURED ENDORSEMENT EFFECTIVE COSTA MESA SANITARY DISTRICT CG 20 10 04 13 FROM DECEMBER 15, 2013 628 W 19TH STREET TO DECEMBER 15, 2014 COSTA MESA, CA 92627 (CERTIFICATE NUMBER 0116) LOCATION(S) OF COVERED OPERATIONS ALL LOCATIONS FOR ENDORSEMENT TEXT, SEE OVER. CG 89 01 11 85 (MECH) MUN 49- 67776 -12 40 131 10 -16 -2013 (000 0116) om..a. 02361 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 o1nsNR2