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Insurance - Pacific Building Care - 2013-12-09CERTIFICATE OF LIABILITY INSURANCE,,,, „ I DATE (MM nD rYYY) 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 pollcy(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 PRODUCER Lockton Companies. LLC Denver u.O.NT 8110 E. Union Avenue Suite 700 Denver CO 80237 (303) 414 -6000 1345173 Pacific Building Care, Inc. dba Commercial Cleaning Systems 1375 Sunflower Avenue, #200 Costa Mesa, CA 92626 DEC 10 2013 CU51A MESA SANITARY DISIM INSURERA: COVERAGES PBCH000 CERTIFICATE NUMBER: 12702269 REVISION NUMBER: XXXXXXX 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. ILSp TYPE OF INSURANCE INSR SUER POLICYNUMBER MWDDYEFF MMIODYEXP LIMITS A GENERAL LIABILITY Y Y SISIGCS06001213 10/1/2013 1011/2014 DAMAGE TO RENTED PREMISES(Ee occurrence) $ 0 MMERCIAL GENE BILIN MED UP An one erson CLAIMSMADE OCCUR t$xx250K PERSONAL &ACV INJURY $ 1,000 000 SIR Included GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG s 2,000,000 POLICY X PRO LOC JECT $ B AUTOMOBILE LIABILITY N N ACP7515806934 10/1/2013 10/1/2014 ING $ X INJURY Person) $ xxxxxxx ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS RY Per ecdtlant AMAGE n1d $XXXXXXX HIRED AUTOS AUTOSWNED $XXXXXXX A X UMBRELLA LIAR J{ OCCUR N N 1000010211 10/1/2013 10/1/2014 RENCE $ j 000 000 $ EXCESS LIAR CLAIMSMADE DEO I X I RETENTION$ $0 $ XX A WORKERS COMPENSATION YIN AND EMPLOYERS' LIABILITY Y 1000001054 10/1/2013 10/1/2014 ii TWO STA U ER E.L. EACH ACCIDENT $ OFFICERIMEM ER EEXCLUDED ?ECUTIVE NIA E.L. DISEASE -EA EMPLOYE $ 1 000 000 (Mandatory in NH) deecnbe untler a ce-o E.L. DISEASE- POLICY LIMIT $ ' D DE RIPT10 OF OPERATIONS below C Employee Theft Incl. N N UC21341024.13 5/1/2013 5/1/2014 $1,000,000 Limit Employ. Theft of Client $25,000 Deductible Prop. DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is mqulmd) The Costa Mesa Sanitary District, its officials, officers, employees, agents and volunteers are included as Additional Insured and coverage is Primary as respects General Liability, if required by written contract. Waiver of Subrogation applies as respects Workers Compensation, if required by written contract. 12702269 Costa Mesa Sanitary District 628 W. 19th Street Costa Mesa, CA 92627 The ACORD name and logo are SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. C r *Starr Indemnity & Liability Company Dallas, TX 1- 866 - 519 -2522 ADDITIONAL INSURED- WHERE REQUIRED UNDER CONTRACT OR AGREEMENT Policy Number: SISIGCS06001213 Effective Date: October 1, 2013 Named Insured: Commercial Cleaning Systems Holdings, LLC This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION II - WHO IS AN INSURED, is amended to include as an additional insured: Any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy , but only with respect to liability arising out of your operations or premises owned by or rented to you. However, the insurance provided will not exceed the lesser of: • The coverage and /or limits of this policy, or • The coverage and /or limits required by said contract or agreement. All other terms, exclusions, and conditions of this policy remain unchanged. OG 184 (04/12) Page 1 of 1 Copyright ®C.V. Starr & Companyand Starr Indemnity& Liability Company. All rights reserved. Includes copyrighted materialof ISO Properties, Inc., used with its permission. Miscellaneous Attachment. M481128 canificate ln: 12702288 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ CAREFULLY REVISED AMENDMENT OF LIMITS OF INSURANCE (Per Project or Per Location Aggregate Limit) FORM A Policy Number: SISIGCS06001213 Effective Date: 10/1/2013 at 12:01 A.M. Named Insured: Commercial Cleaning Systems Holdings, LLC This endorsement modifies insurance provided under the following form: COMMERCIAL GENERAL LIABILITY COVERAGE FORM I. Your policy is amended to include either a Per Project General Aggregate Limit, a Per Location General Aggregate Limit or a Per Project and Per Location General Aggregate Limit. Please select only one of the following: [X] Per Project General Aggregate Limit $ 2,000,000 [ ] Per Location General Aggregate Limit $ [ ] Per Project and Per Location General Aggregate Limit IF NEITHER OF THESE BOXES ARE CHECKED, THIS ENDORSEMENT IS VOID. IF MORE THAN ONE OF THE THESE BOXES ARE CHECKED, THIS ENDORSEMENT IS VOID, SECTION III LIMITS OF INSURANCE, is amended to include the following: 1. The Limits of Insurance and the rules below fix the most we will pay regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or C. Persons or organizations making claims or bringing "suits ". 2. The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of'bodily injury" or "property damage" included in the products - completed operations hazard'; and Miscellanoous Attachment: M481516 Certificate ID: 12162269 c. Damages under Coverage B 3. The Products - Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the 'products - completed operations hazard ". 4. Subject to 2. above, the Personal and Advertising Injury Limit is the most we will pay under Coverage B for the sum of all damages because of all "personal and advertising injury" sustained by any one person or organization. 5. Subject to 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Coverage C because of all "bodily injury" and "property damage" arising out of any one "occurrence ". 6. Subject to 5. above, the Damage to Premises Rented To You Limit is the most we will pay under Coverage A because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner. 7. Subject to 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person. 8. Subject to 2., 4., 5., 6.. and /or 7. above, the Per Project Aggregate Limit is the most we will pay under Coverages A, B, and C combined for the sum of: a. Damages under Coverage A; b. Damages under Coverage B; and C. Medical Expenses under Coverage C arising out of any single Project described above 9. Subject to 2., 4., 5., 6., and /or 7. above, the Per Location Aggregate Limit is the most we will pay under Coverages A, B, and C combined for the sum of: a. Damages under Coverage A; b. Damages under Coverage B; and C. Medical expenses under Coverage C Miscellaneous Attachment: M461516 Certificate ID: 12702269 arising out of the any single Location described above. The Limits of Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. II. The Limits of Insurance shown in the Declarations are deleted in their entirety and replaced by the Limits of Insurance set forth below. Limits of Insurance: General Aggregate Limit $ 15,000,000 Each Occurrence Limit $ 1,000,000 Products - Completed Operations Aggregate Limit $ 2,000,000 Personal & Advertising Injury Limit $ 1,000,000 Damage to Premises Rented To You $ Excluded Medical Expense Limit $ Excluded Per Project General Aggregate Limit, Per Location $ 2,000,000 General Aggregate Limit or Per Project and Per Location General Aggregate Limit IV. Section V - DEFINITIONS is amended to include the following: 23. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway, or right -of -way railroad. All other terms and conditions of the policy remain unchanged. Miscellaneous Attachment: M461516 Certificate 10: 12702269 POLICY NUMBER: SISIGCS06001213 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 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 Organization: Where Required by Written Contract 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 above. CG 24 04 05 09 Miscellaneous AttacM1ment: M461040 Canificate ID: 12702269 © Insurance Services Office, Inc., 2008 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04 -84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Description Job ANY PERSON OR ORGANIZATION TO WHOM YOU BECOME OBLIGATED TO WAIVE YOUR RIGHTS OF RECOVERY AGAINST, UNDER ANY CONTRACT OR AGREEMENT YOU ENTER INTO PRIOR TO THE OCCURRENCE OF LOSS. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) WC 04 03 06 (Ed. 04 -84) Page 1 of 1 Miscellaneous Attachment: M481519 Certificate ID: 12702289