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Insurance - C & R Drains - 2014-09-10 ACD® CERTIFICATE OF'LIABILITY INSURANCE °ATE(MM.°°�Y"'' ia..a- 9/10/2014 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(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(s). PRODUCER RECEIVED® CONTACT NOME: Ken Noden, CPCU Wigmore Insurance Agency, Inc. PHONE 714-979-6543 FAX 2970 Harbor Blvd.#215 • (Arc Nn Ext)• I(A1C.No): 714-549-2943 o EMAIL commercial wi moreins.com License#0811959 an _ADDRESS:commercial@wigmoreins.com Costa Mesa CA 92626 U INSURER(S)AFFORDING COVERAGE NAIC# lt.61A tVitai.. Apithig INSURER A:James River Insurance Company I INSURED piaci- INSURER B:Mercury Casualty Co 11908 C&R Drains, Inc. INSURER C:Insurance Co of the West ROnco Plumbing, Inc. INSURER D:National Union Fire Ins I 1525 W.MacArthur Blvd.#11 Costa Mesa CA 92626 INSURER E: INSURER F: - COVERAGES CERTIFICATE NUMBER: 1838271743 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 ADDLISIJBRI POLICY EFF POLICY EXP LTR INK) D/ WVP I POLICY NUMBER IMM/DYYYY) IMMIDD/YYYY)I LIMITS A x I COMMERCIAL GENERAL LIABILITYY Y 00448494 9/10/2014 9/10/2015 I EACH OCCURRENCE $1,000,000 — CLAIMS-MADE I X I OCCUR I DAMAGE TO RENTED PREMISES(Ea occurro* $50,000 I MED EXP(Any one person) $Excluded PERSONAL&ADV INJURY $1,000,000 ' GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JE0 I LOC I PRODUCTS-COMP/OP AGG $2,000,000 OTHER: I I$ B IAUTOMOBILE LIABILITY N N CCA0000776 9/19/2014 '9/19/2015 CUMti, SINGLE LIMIT $1,000,000 X I ANY AUTO - I BODILY INJURY(Per person) I$ ALL OWNED FHEES ULED BODILY INJURY(Per accident) $ A •UTOS • -- NON-OWNED `PROPERWYOAMAGE HIRED AUTOS _AUTOS I(Per accident) $ $ D I UMBRELLA LIAR + X I OCCUR Y Y EBU032459208 9/10/2014 9/10/2015 I EACH OCCURRENCE $1,000,000 X EXCESS LIAB I I CLAIMS-MADE ,AGGREGATE $1,000,000 DED RETENTION$ I I $ C WORKERS COMPENSATION y WPL502449101 .9/10/2014 '9/1012015 I X I 3 ATUTE I I ERH I AND EMPLOYERS'LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE - - E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? $1,000,000 NIA A (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(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED WHEN REQUIRED BY-WRITTEN CONTRACT OR AGREEMENT (GENERAL LIABILITY)PER FORM CG2010-0704.COMPLETED OPERATIONS LANGUAGE PER FORM CG2037-0704.WAIVER OF SUBROGATION AS REQUIRED BY CONTRACT(GENERAL LIABILITY)PER FORM AP5004US-1106.PRIMARY AND NON-CONTRIBUTORY LANGUAGE PER FORM AP5031US-0410.WORKERS COMPENSATION INCLUDES BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT FORM WC 99 06 34. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COSTA MESA SANITARY DISTRICT ACCORDANCE WITH THE POLICY PROVISIONS. 628 W 19TH ST COSTA MESA CA 92627 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved.. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD t POLICY NUMBER: CO0 L1,t4t ci'3 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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 Org_anization(s): Locations)Of Covered Operations where required by written contract or agreement 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only Bions apply: with respect to liability for"bodily injury", "property This insurance does not apply to"bodily injury"or damage" or "personal and advertising injury" "property damage"occurring after caused,in whole or in part, by: 1. Your acts or omissions;or 1. All work, including materials, parts or equip- ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project(other than service,maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed;or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CO 2010 07 04 ©ISO Properties,Inc.,2004 Page 1 of 1 0 .i30NTkACTGRS.STATE LIC ( '. h+i ACTIVE I e"=i ' •' ` -` • .m:�.�., 53'x .CORP ; ,0 C & R.DRAINS INC • • :�..<.�.., C36 • • . 06/30/2016 www.csib.ca.gov• �t • • • 1 • • • 1