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Insurance - TTS Engineering-2014-07-15a� °® CERTIFICATE OF LIABILITY INSURANCE 7/15/2014 ' 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 CONTACT Kathleen Bisko NAME: PHONE (559) 222 FAX N (559)222 -1'124 James G Parker Insurance Associates License #0554959 goDRes:kathleenbisko @jgparker. com INSURERS AFFORDING COVERAGE NAICN P Q BOX 3947 INSURERA:Starr Indemnity & Liability Co 38318 Fresno CA 93650 INSURED INSURER BNavl ators Specialty Insurance 36056 INSURER C: T T S Engineering Inc, DBA: West Coast Backhoe INSURER D: /30/2015 16835 Algonquin St #453 INSURER E : MED EXP(My one person) $ 10,000 1 INSURER F: $ 1,000,000 Huntington Beach CA 92649 COVERAGES CERTIFICATE NUMBER:14 -15 GL EX TTS 5mm umb 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 ADDL SU POLICY NUMBER PO DOYWYYY MMID POLICY YYP, LIMITS 628 W 19th GENERAL LIABILITY AUTHORIZED REPRESENTATIVE Costa Mesa, CA 92627 COYP},"( EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXIOCCUR X SISINRGO0090914 /30/2019 /30/2015 DAMAGE TO RENTED PREMISES Ea occurrence) $ 100,000 MED EXP(My one person) $ 10,000 PERSONAL B ADV INJURY $ 1,000,000 X XCU Included X $5,000 Deductible OCC GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGO $ 2,000,000 POLICY X PRO- LOC IFCT Per Project Cap $ 5,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS $ X 4 UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 B EXCESS LIAB CLAIMS -MADE DED X RETENTION $ E14EXC7845411V /30/2014 /30/2015 WORKERS COMPENSATION I WC STATU- OTH- MM AND EMPLOYERS' LIABILITY VIN ANY PROPRIETORIPARTNEPoEXECUTIVE F-1 OFFICERIMEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Contractors Pollution SISIIRRG00090914 /30/2014 /30/2015 $5,000 Deductible $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Costa Mesa Sanitary District, its directors, officers, engineers, employees and authorized agents are named as Additional Insured as per form CG2010 0413, 0G023 0611 Primary and Non - Contributory including waiver of subrogation, and CG2503 0509 Per Project Aggregate as attached. This certificate replaces and supersedes the previous issued on 5/30/2014 RECEIVED CERTIFICATE HOLDER JUL 1 6 7H14 CANCELLATION ACORD 25 (2010/05) (D 1988 -2010 ACORD CORPORATION. All rights reserved. INSC25bmnns) m Tho Ar.npn nnma nnH Innn nm ronicforod mnr4c of arnpn COSTA MESA SANITARY ISIR411 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District 628 W 19th Street \ AUTHORIZED REPRESENTATIVE Costa Mesa, CA 92627 COYP},"( J Parker III /EATBIS ��'•'� r� �� ACORD 25 (2010/05) (D 1988 -2010 ACORD CORPORATION. All rights reserved. INSC25bmnns) m Tho Ar.npn nnma nnH Innn nm ronicforod mnr4c of arnpn POLICY NUMBER: SISNRGO0090914 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations As required by written contract As required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, 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 B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 2. 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 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 subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 sE *Starr Indemnity & Liability Company Dallas, TX 1.866 -519 -2622 Primary and Non•contrlbutory, Additional Insured and Waiver of Subrogation Polley Number: SISNRGO0O9O914 Effective Date: 5 130/2014 at 12'01 AN. Named Insured: This endorsement modlfles the Insurance coverage form(s) Rated below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective pollcy(les) carefully, Commercial General Liability Coverage Form Owners and Contractors Protective Liability Coverage form ProductslCompletod Operations Liability Coverage Form Contractors Pollution Liability Coverage Form Professional Liability Coverage Form Site Pollution Liability Coverage Form SCHEDULE All as required by written, signed or executed contract, A, SECTION It - WHO IS AN INSURED Is amended to Include as an Insured the person or organlzatlon shown in the schedule of this endorsement, but only with respect to liability arising out of "your work" for that Insured by or for YOU. 0, As respects additional Insureds as defined above, this Insurance also applies to "bodily Injury" or "property damage" arising out of your negligence when the following written contract requirements are applicable; 1. Coverage available under this coverage part shall apply as primary Insurance. Any other Insurance available to these additional Insured's shalt apply as excess and not contribute as primary to the Insurance afforded by this endorsement, a. We waive any right of recovery we may have against these additional Insured's because of payments we make for Injury or damage arising out of "yourwoA" done under a written oontraotwlth the additional Insured, S, The term Insured Is used separately and not collectively, but the Inclusion of more than one Insured shall not Increase the limits or coverage provided by this Insurance, Insureds and Agents are advised that oerUficates of Insurance should be used only to provide evidence of Insurance In lieu of an actual copy of the applicable Insurance policy. Certlgcates should not be used to amend, expand or otherwise alter the terms of the actual policy, ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Signed for STARR INDEMNITY & LIABILITY COMPANY an Charles H. Dangelo, Pro sldenf Honors M. Keane, General Counsel 00.029 (06f11) page 1 of 1 Capyrlgla ®QV. store & Company and Starr lndamnity& tdabillly Company, Alirlghtamsorvad, Inraudos sapyrlghtod matorlsl of 180 proportroo, Inc., uoedwlth Its permiseloo, POLICY NUMBER: SISNRG00090914 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): As required bywritten contract subject to a $5,000,000 annual aggregate cap. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section t — Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard ", and for medical expenses under Coverage C regardless of the number of; a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits ". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations; such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. CG 25 03 05 09 0 Insurance Services Office, Inc., 2008 Page 1 of 2 ❑ B. For all sums which the Insured becomes legally C. obligated to pay as damages caused by "occurrences" under Section 1— Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical D. expenses shall reduce the amount available under the General Aggregate Limit or the Products - completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. E. When coverage for liability arising out of the "products- completed operations hazard" is provided, any payments for damages because of "bodily injury" or 'property damage" included in the 'products- completed operations hazard" will reduce the Products- completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. The provisions of Section III Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 26 03 05 09 ❑