Loading...
Insurance - TTS Engineering - 2015-05-21111. O CERTIFICATE OF LIABILITY INSURANCE `� DATE (MM DDIYYYY) 5/21/2015 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(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 - James G Parker Insurance Associates License #0554959 P O BOX 3947 Fresno CA 93650 CONTACT AME: CarrieStubblefield CISR PHONE (559)222-7722 We, N1: (559)222-1724 (rieStubblefield@' EMAIL C arker. com ADDRESS: JgP INSURERS AFFORDING COVERAGE NAIC p INSURERA:Starr Indemnity & Liability Cc 38316 INSURED T T S Engineering Inc; D B Equipment LLC 16835 Algonquin St #453 Huntington Beach CA 92649 INSURER B:Navi ators Insurance Company 42307 INSURER c:Travelers Property Casualty Co 25674 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 GL BA IM UMB TTS 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 UBR POLICY NUMBER POLICY EFF MMIDDPY POLICY EXP MMIDDNYYYI LIMITS /� GENERAL LIABILITY ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa, CA 92627 EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7x OCCUR X 1000090218151 /30/2015 /30/2016 DA A E T RENTED PREMISES fE. occurrence) $ 100,000 MED FXP(Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 'X X,C,U Included X $5,000 Deductible OCC GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO $ 2,000,000 - POLICY FX PRO- LOC Per Project Aggregate Cap $ 5,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 A X ANY AUTO ALLOWNEDOSCHEDULED AUAUTOS ISIPCA08331815 /30/2015 /30/2016 BODILY INJURY (Per person) $ BODILY INJURY Per accident $ X HIREDAUTOS X AUTOSNOMOWNED PROPERTYDAMAGE $ Uninsured motorist combined $ 1.000,000 X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 B EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ E15EXC784541IV /30/2015 /30/2016 WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N PROPRIETORPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA IMTANY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below _ C Rented/Leased Equipment T6609F063627 /30/2015 /30/2016 $2,500 Deductible $200,000 A Contractors Pollution 1000090218151 /30/2015 /30/2016 $5,000 Deductible $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/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. RECEIVED JUN 0 12015 Parker III/CARRIE 4 &`>�^'�'�S (C 7988.2010 ACORD CORPORATI0M All rinhfe mmr..od INS025nn1nn51n1 The ACr1Rn nemn and Innn am rcni�fnrnd mnr4c of ArORn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa 628 W 19th Sanitary District Street /� ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa, CA 92627 AUTHORIZED REPRESENTATIVE Parker III/CARRIE 4 &`>�^'�'�S (C 7988.2010 ACORD CORPORATI0M All rinhfe mmr..od INS025nn1nn51n1 The ACr1Rn nemn and Innn am rcni�fnrnd mnr4c of ArORn POLICY NUMBER: 1000090218151 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 s where required by written All covered locations. ontract prior to loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to B. 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 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: 1. 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 0 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 Aco^izo® CERTIFICATE OF LIABILITY INSURANCE elferivery J N (t O 2M DATE (MM/D 6/5/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTSiUPONAMMISM91PATE 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 SUBROGRATION 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 OnPoint Underwriting Inc. CONTACT NAME: Steven McComb 8390 E Crescent Pkwy, Suite 200 PHONE (A/C, No Ext): (360) 828-0644 FAX (FVC, NO): (360) 8'28-0699 Greenwood Village, CO 80111 - - - -- - - - EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A ACE American Insurance Company 22667 INSURER B: INSURED Barrell Business Services, Inc. UC/F INSURER C: TTS ENGINEERING, INC. INSURER D: 16835 ALGONQUIN STREET #453 INSURER E: HUNTINGTON BEACH, CA 92649 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 ISSUES 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 INSR SUER WVD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CtA1M5-MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurence) $ MED EXP (Any one person) $ PERSONAL B ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ POLICY PROJ- LOC ECT $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT E. amilim0 $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY IN,17Y(Per person) $ HIRED AUTOS NON -OWNED AUTOS B BODILY INJURY (Per awidenl) $ PROPERTY DAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAa OCCUR AGGREGATE $ DEO RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN RWG 646552663 06/01/15 06/01/2016 �/ WCSTATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $2,000,000 ANY PROPRIETOMPARTNEW EXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory In yes,TIONdescribe N / A Covered states: CA E.L. DISEASE - EA EMPLOYEE $2,000,000 E.L. DISEASE- POLICY LIMIT $2,000,000 OFNH) OIf DESCRIPTION OF OPERATIONS below below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mare space is required) In the event of any payment under this policy for a Loss for which the named insured has waived the right of recovery in a written contract entered into prior to the Loss, insurer hereby agrees to also waive our right of recovery but only with respect to such Loss. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Costa Mesa Sanitary District EXPIRATION DATA THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 628 W 19th Street AUTHORIZED REPRESENTATIVE Costa Mesa CA 92627 �1 Richard Poling c) 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD. Starr Indemnity & Liability Company Dallas, TX 1-866-519-2522 Primary and Non-contributory, Additional Insured and Waiver of Subrogation Policy Number: 1000090218151 Effective Date: 5/30/2015 at 12:01 A.M. Named Insured: TTS Engineering Inc This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(ies) carefully. Commercial General Liability Coverage Form Owners and Contractors Protective Liability Coverage form Products/Completed 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 II - WHO IS AN INSURED is amended to include as an insured the person or organization 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. B. 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 shall apply as excess and not contribute as primary to the insurance afforded by this endorsement. 2. 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 "your work" done under a written contract with the additional insured. 3. 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 certificates of insurance should be used only to provide evidence of insurance in lieu of an actual copy of the applicable insurance policy. Certificates 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 Charles H. Dangelo, resident Nehemiah E. Ginsburg, General ounsel OG - 023 (06/11) Page 1 of 1 Copyright© C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. POLICY NUMBER: 1000090218151 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 by written contract subject to a $5,000,000 annual aggregate cap. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by damages or under Coverage C for medical "occurrences" under Section I — Coverage A, and expenses shall reduce the Designated for all medical expenses caused by accidents Construction Project General Aggregate Limit under Section I — Coverage C, which can be for that designated construction project. Such attributed only to ongoing operations at a single payments shall not reduce the General designated construction project shown in the Aggregate Limit shown in the Declarations Schedule above: nor shall they reduce any other Designated 1. A separate Designated Construction Project Construction Project General Aggregate Limit General Aggregate Limit applies to each for any other designated construction project designated construction project, and that limit shown in the Schedule above. is equal to the amount of the General 4. The limits shown in the Declarations for Each Aggregate Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, General Aggregate Limit shown in the except damages because of "bodily injury" or Declarations, such limits will be subject to the "property damage" included in the applicable Designated Construction Project "products -completed operations hazard", and General Aggregate Limit. 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". CG 25 03 05 09 © 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. 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. E. 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 25 03 05 09 ❑