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Insurance - Emergency Power Controls - 2015-05-01EMERG-1 OP ID: JP '4l` �" CERTIFICATE OF LIABILITY INSURANCE °0510112015ATE ' CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 05/01/2015 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain prequire an endorsement A statement on this certificate does not confer rights to the maFIVFTI certificate holder in lieu of such endorsers (s). PRODUCER CONTACT NAME: COmmefClal Lines Dept. Fullerton Insurance Service MAY 2 12015 CDI#0596796 A/CDNNo E :714-577-5800 ac No: 714-047-0011 aooRess: rec fullertoninsurance.com P.O.Box 4064 Fullerton, CA 928344054 CusiA (V1tJA SANITNIV INSURER(S) AFFORDING COVERAGE NAICIs Jimmy Williams DISIRI INSURER A: Sentinel Insurance Co. 11000 MED EXP (Any one person) $ Exclude INSURED Emergency Power Controls, Inc. INSURER B:.Scottsdale Insurance 41297 P.O. Box 545— INSURER C: National Union Fire Ins. of PA 19445 Yorba Lindada,, CA 92886 - INSURER D: Mercury Casualty Company 11908 INSURERS: PERSONAL B ADV INJURY $ 1,000,00 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 LTR TYPE OF INSURANCE ADDL B POLICY NUMBER POLICY EFF IMMJDD/YYYYl POUCY EXP IMMVDDNYYYlLIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I—XI OCCUR X BCS0031781 05/01/2014 10/01/2015 EACH OCCURRENCE $ 1,000,08 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ Exclude PERSONAL B ADV INJURY $ 1,000,00 GENT AGGREGATE LIMIT APPLIES PER: X POLICY Ll JEST F-1 LOC GENERAL AGGREGATE $ 2,000,00 PRODUCTS-COMP/OP AGG $ 2,000,00 Emp Ben. $ 1,000,00 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 1.000,00 D !( ANY AUTO BA040000009528 10/01/2014 10/01/2015 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accitlent ( ) $ NON -OWNED HIRED AUTOS AUTOS PROPERTYDAMAGE $ Per accitlent Is UMBRELLA LIABX OCCUR EACH OCCURRENCE $ 5,000,00 C X EXCESS LIAR CLAIMS -MADE EBU063176587 05/01/2014 10/0112015 AGGREGATE $ 5,000,00 DED RETENTION$ $ A WORKERS COMPENSATION ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED'! FYI NIA X 72WECGA8053 10/01/2014 10101/2015 RTE. STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The District, its directors, officials, officers, employees, agents and volunteers are named as additional insureds as respectB to the general liability policy limits per endorsements CG2033 and CG2037 attached to the policy with coverage primary. (continued on page 2) COSTAME SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa MBSe Sanitary District 628 ta 19th Street ACCORDANCE WITH THE POLICY PROVISIONS. I� r� Costa Mesa, CA 92627 ',,,Iq/` AUTHORIZED REPRESENTATIVE U 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: BCS0031781 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION WHEN YOU AND ALL LOCATIONS SUCH PERSON OR ORGANIZATION HAVE AGREED IN WRITING IN A CONTRACT OR AGREEMENT, EXECUTED PRIOR TO THE "OCCURRENCE" TO WHICH THIS INSURANCE APPLIES, THAT SUCH PERSON OR ORGANIZATION BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sche- dule of this endorsement performed for that addi- tional insured and included in the 'products - completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ 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 include as an additional insured any person or or- ganization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an addi- tional insured on your policy. Such person or or- ganization is an additional insured only with re- spect 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 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are com- pleted. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury", ',property damage" or "personal and advertising injury" arising out of the render- ing of, or the failure to render, any professional architectural, engineering or surveying servic- es, including: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opi- nions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: 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 subcontrac- tor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑ rI THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 72 WEC GA8053 Endorsement Number: Effective Date: 10/01/14 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: EMERGENCY POWER CONTROLS PO BOX 545 YORBA LINDA, CA 92885 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 premium otherwise due on such remuneration. Person or Organization ANY PERSON OR ORGANIZATION WRITTEN CONTRACT OR AGREEMENT RIGHTS FROM US." SCHEDULE 5 % of the California workers' compensation Job Description FROM WHOM YOU ARE REQUIRED BY TO OBTAIN THIS WAIVER OF Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 09/24/14 Policy Expiration Date: 10/01/15 Jok" SCOTTSDALE INSURANCE COMPANY ENDORSEMENT NO. ATTACHED TO AND FORMING A PART OF ENDORSEMENT EFFECTIVE DATE POLICY NUMBER (12:01 A.M. STANDARD TIME) NAMED INSURED AGENT NO. BCS0031781 1 5/1/14 EMERGENCY POWER CONTROLS INC I 047BE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS SPECIAL CONDITION For coverage provided in the following endorsements as indicated by an "x" in the box below: ❑ Additional Insured—Owners, Lessees Or Contractors—Scheduled Person Or Organization (CG 20 10). X Additional Insured—Owners, Lessees Or Contractors—Automatic Status When Required In Construction Agreement With You (CG 20 33). X Additional Insured --Owners, Lessees Or Contractors—Completed Operations (CG 20 37). The insurance provided is amended to be (indicated by an "x' in one box below): X Primary and noncontributory. ❑ Primary. ❑ Noncontributory. AUTHORIZED REPRESENTATIVE DATE GLS -294s (3-10) Page t of 1