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Insurance - C & R Drains - 2015-09-10A� " CERTIFICATE OF LIABILITY INSURANCE 9/10/2015TE(MMI DM") 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 Wigmore Insurance Agency, Inc. Harbor Blvd. #215 R E,C�INVE D Lice License #0811959 CONTACTNAME: Ken Naden, CPCU PRONE . 714-979-6543 FAX ,No1, 714-549-2943 E-MAIL @Wj .commerciamoreins.com l g INSURER 5 AFFORDING COVERAGE NAIC p Costa Mesa CA 92626 _ wsURERA,JAMES RIVER INS CO 12203 SEP 14 205 INSUREDp0 C & R Drains, Inc. LAA, iilJwildARYDISTRICT INSURER B WERCURY CAS CO 11908 INSURERC:NATIONAL UNION FIRE INSURANCE COMPA 51908 Ronco 1525 W. MacArthur Blvd. #11 Plumbing, Inc. 1525 INSURERD:INSURANCE CO OF THE WEST 27847 INSURER E: Costa Mesa CA 92626 INSURER F: COVERAGES CERTIFICATE NUMBER. 601012480 REVISION NIIMRFR- 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 000448495 9/10/2015 9/10/2016 EACH OCCURRENCE $1,000,000 -MADE ❑X OCCUR _CLAIMS DAMAGETORENTED PREMISES Ea occurrence E50,000 MED EXP (Any one person) SExcluded PERSONAL &ADV INJURY $1,000,000 NEN'L AGGREGATE LIMIT APPLIES PER. POLICY JECT LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - CDMPIOP AGO $2,000,000 E OTHER: B AUTOMOBILE LIABILITY N N CCA0000776 9/19/2015 9/19/2016I E Ea accident 1,000,000 BODILY INJURY (Per person) 5 X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( I HIRED AUTOS NON -OWNED AUTOS PROPERTYDAMAGE $ Per accident E C UMBRELLA LIAB N OCCUR Y Y EBU014626603 9/10/2015 9/10/2016 EACH OCCURRENCE $1,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $1,000,000 DED I I RETENTION$ Is D WORKERS COMPENSATION AND EMPLOYERS' L4IABILITY ANv PROPRIETOR/PARTNER/EXECUTIVE OFPICERIMEMBER EXCLUDED' N/A Y WPL502449102 9/10/2015 9/10/2016X PER 0TH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEd $1,000,000 (M andatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 $1,090,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe 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. COSTA MESA SANITARY DISTRICT —;75 00101 628 W 19TH ST ,.Yy COSTA MESA CA 92627 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I&r ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 000�gtgq� N 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 Organization(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 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 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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage' occurring after: 1. All work, including materials, parts or equip- ment 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 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. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 13