Loading...
Insurance - Sancon Engineering Inc. - 2015-10-01AIl Dr CERTIFICATE OF LIABILITY INSURANCE 10/l/20IY5 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 P NAMEamela De Guzman : PHONEN X, (800) 578-8802 PAX o: (818)499-9331 Poms & Associates Insurance Brokers, Inc. CA License #0814733EMAIL S.PDeguzman@pomsassoc.com INSURERS AFFORDING COVERAGE NAICN 5700 Canoga Ave. #400 RECEIVE INSURER A:Travel era Indemnity Cc of Ame 25674 Woodland Hills CA 91367 INSURED OCT 0 5 2015INSURER B:Travelers Indemnity Cc of CT 25682 INSURER C: INSURER O: Sancon Engineering, Inc. 5841 Engineer Drive INSURER E; T22-CO-9181R93A-TCT-15 1 INSURER F: ,Huntington Beach CA 92649 COVERAGES CERTIFICATE NUMBER:15-16 MASTER 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 SUER POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP MM/DDNYYY LIMITS AUTHORIZED REPRESENTATIVE GENERAL LIABILITY Costa Mesa, CA 92627-2716 ��h EACH OCCURRENCE $ 11000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMSWADE OCCUR X T22-CO-9181R93A-TCT-15 0/1/2015 0/1/2016 DAMAGE TO RENTED PflEMISES Ea c rrence$ 300,000 occurrence) MED EXP (Any one person $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ 2,000,000 POLICY FXPRO-IPCT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 000 000 BODILY INJURY (Per person) $ BALL 1xx ANY AUTO OWNED SCHEDULED AUTOS AUTOSAUTOS X A9181R93A-15-CNS 0/1/2015 0/1/2016 BODILY INJURY (Per accident) $ HIRED AUTOG NX NON -OWNED PROPERTY DAMAGE$ PeraccitlentComp $ $1000 Coll $1000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 A EXCESS LIAB CLAIMS -MADE DED X RETENTION 10,000 TSM-CUP-9181R93A-TIL-15 0/1/2015 0/1/2016 $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICEWMEMBER EXCLUDED? (Mandatory in NH) N/A TJ-UB-9181R93A-TIL-15 0/1/2015 0/1/2016 X WC STATU- OTH- 51' E.L. EACH ACCIDENT $ 1 000.000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: CMSD Project #194 Pump Station Coating and Manhole Rehabilitation The Costa Mesa Sanitary District and its Employees and Agents are Included as Additional Insured. Said Insurance is Primary Non -Contributory. Waiver of Subrogation for the General Liability and Workers Comp applies in favor of same entities. Endorsements per attached. (30) Day Notice of Cancellatio, (10) Day Notice for Non -Pay Premium CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) INS025 (201005).o1 ®1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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. Attn: General Manager AUTHORIZED REPRESENTATIVE 628 W. 19th Street Costa Mesa, CA 92627-2716 ��h P De Guzman/CJORDA --- ACORD 25 (2010/05) INS025 (201005).o1 ®1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: DT22-C0-9181R93A-TCT-15 COMMERCIAL GENERAL LIABILITY ISSUE DATEI0 - 0 1- 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): The Costa Mesa Sanitary District, Its Employees and Agents 628 W. 19th Street Costa Mesa, Ca 92627-2716 PROJECT/LOCATION OF COVERED OPERATIONS: CMSD Project #194 Pump Station Coating and Manhole Rehabilitation 1. WHO IS AN INSURED — (Section II) is amended b) The insurance provided to the additional in- to include the person or organization shown in the sured does not apply to "bodily injury", "prop - Schedule above, but: erty damage" or "personal injury" arising out a) Only with respect to liability for "bodily injury", of the rendering of, or failure to render, any "property damage" or "personal injury"; and professional architectural, engineering or sur- b) If, and only to the extent that, the injury or veying services, including: damage is caused by acts or omissions of I. The preparing, approving, or failing to you or your subcontractor in the performance prepare or approve, maps, shop draw - of "your work" on or for the project, or at the ings, opinions, reports, surveys, field or - location, shown in the Schedule. The person ders or change orders, or the preparing, or organization does not qualify as an addi- approving, or failing to prepare or ap- tional insured with respect to the independent prove, drawings and specifications; and acts or omissions of such person or organiza- If. Supervisory, inspection, architectural or tion. engineering activities. 2. The insurance provided to the additional insured c) The insurance provided to the additional in - by this endorsement is limited as follows: sured does not apply to "bodily injury" or a) In the event that the Limits of Insurance of "property damage" caused by "your work" this Coverage Part shown in the Declarations and included in the "products -completed op - exceed the limits of liability required by a erations hazard" unless a "written contract "written contract requiring insurance" for that requiring insurance" specifically requires you additional insured, the insurance provided to to provide such coverage for that additional the additional insured shall be limited to the insured, and then the insurance provided to limits of liability required by that "written con- the additional insured applies only to such tract requiring insurance". This endorsement "bodily injury" or "property damage" that oc- shall not increase the limits of insurance de- curs before the end of the period of time for scribed in Section III — Limits Of Insurance. which the "written contract requiring insur- ance" requires you to provide such coverage CG D2 47 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible 'other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if a "written contract requiring insurance" for that ad- ditional insured specifically requires that this in- surance apply on a primary basis or a primary and non-contributory basis, this insurance is pri- mary to 'other insurance" available to the addi- tional insured which covers that person or organi- zation as a named insured for such loss, and we will not share with that 'other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible 'other insurance", whether pri- mary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional in- sured under such 'other insurance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an 'occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: I. How, when and where the 'occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and Ill. The nature and location of any injury or damage arising out of the 'occurrence" or offense. b) If a claim is made or "suit' is brought against the additional insured, the additional insured must: 1. Immediately record the specifics of the claim or "suit' and the date received; and ff. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit' to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to 'other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 47 08 05 COMMERCIAL GENERAL LIABILITY 2. This insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Rupture, bursting, or operation of pres- sure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from wa- ter; c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 3. Paragraph 6. of LIMITS OF INSURANCE (Section 111) is deleted and replaced by the following: Subject to 5. above, the Damage To Prem- ises Rented To You Limit is the most we will pay under COVERAGE A. for the sum of all damages because of "property damage" to any one premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: fire; explosion; light- ning; smoke resulting from such fire, explo- sion, or lightning; or water. The Damage To Premises Rented To You Limit will apply to all "property damage" proximately caused by the same "occurrence", whether such damage results from: fire; explosion; lightning; smoke resulting from such fire, explosion, or light- ning; or water; or any combination of any of these causes. The Damage To Premises Rented To You Limit will be the higher of: a. $300,000; or b. The amount shown on the Declarations for Damage To Premises Rented To You Limit. 4. Paragraph a. of the definition of "insured con- tract" (DEFINITIONS — Section V) is deleted and replaced by the following: a. A contract for a lease of premises. How- ever, that portion of the contract for a lease of premises that indemnifies any person or organization for damage to premises while rented to you, or tempo- rarily occupied by you with permission of the owner, caused by: fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water, is not an "Insured contract'; 5. This Provision B. does not apply if coverage for Damage To Premises Rented To You of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section 1— Coverages) is excluded by endorsement. C. BLANKET WAIVER OF SUBROGATION We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: premises owned or occupied by or rented or loaned to you; ongoing operations performed by you or on your behalf, done under a contract with that person or organization; "your work'; or "your products". We waive this right where you have agreed to do so as part of a written contract, executed by you before the "bodily injury" or "property damage" occurs or the "personal injury" or "advertising injury" offense is committed. D. BLANKET ADDITIONAL INSURED — MANAG- ERS OR LESSORS OF PREMISES WHO IS AN INSURED (Section 11) is amended to include as an insured any person or organization (referred to below as "additional insured") with whom you have agreed in a written contract, exe- cuted before the "bodily injury" or "property dam- age" occurs or the "personal injury" or "advertis- ing injury" offense is committed, to name as an additional insured, but only with respect to liability arising out of the ownership, maintenance or use of that part of any premises leased to you, subject to the following provisions: 1. Limits of Insurance. The limits of insurance afforded to the additional insured shall be the limits which you agreed to provide in the writ- ten contract, or the limits shown on the Decla- rations, whichever are less. 2. The insurance afforded to the additional in- sured does not apply to: a. Any "bodily injury" or "property damage" that occurs, or "personal injury" or "adver- tising injury" caused by an offense which is committed, after you cease to be a ten- ant in that premises; b. Any premises for which coverage is ex- cluded by endorsement; or c. Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. 3. The insurance afforded to the additional in- sured is excess over any valid and collectible Page 2 of 6 Copyright, The Travelers Indemnity Company, 2004 CG D3 16 07 04 COMMERCIAL GENERAL LIABILITY b. "Bodily injury" or "property damage" in- cluded in the "products -completed opera- tions hazard". 1. OTHER INSURANCE CONDITION A. COMMERCIAL GENERAL LIABILITY CON- DITIONS (Section IV), paragraph 4. (Other Insurance) is deleted and replaced by the fol- lowing: 4. Otherinsurance If valid and collectible "other insurance" is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: Page 4 of 6 a. Primary Insurance This insurance is primary except when b. below applies. If this insur- ance is primary, our obligations are not affected unless any of the "other insurance" is also primary. Then, we will share with all that "other insur- ance" by the method described in c. below. b. Excess Insurance This insurance is excess over any of the "other insurance", whether pri- mary, excess, contingent or on any other basis: (1) That is Fire, Extended Coverage, Builder's Risk, Installation Risk, or similar coverage for "your work"; (2) That is Fire insurance for prem- ises rented to you or temporarily occupied by you with permission of the owner; (3) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or tempo- rarily occupied by you with per- mission of the owner; or (4) If the loss arises out of the main- tenance or use of aircraft, "autos", or watercraft to the ex- tent not subject to Exclusion g. of Section I — Coverage A — Bodily Injury And Property Damage Li- ability; or insured under any other policy, including any umbrella or excess policy. When this insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" if any provider of "other in- surance" has a duty to defend the in- sured against that "suit". If no pro- vider of "other insurance" defends, we will undertake to do so, but we will be entitled to the insured's rights against all those providers of "other insurance". When this insurance is excess over "other insurance", we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such "other insurance" would pay for the loss in the absence of this in- surance; and (2) The total of all deductible and self-insured amounts under that "other insurance". We will share the remaining loss, if any, with any "other insurance" that is not described in this Excess Insur- ance provision. c. Method Of Sharing If all of the "other insurance" permits contribution by equal shares, we will follow this method also. Under this approach each provider of insurance contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, which- ever comes first. If any of the "other insurance" does not permit contribution by equal shares, we will contribute by limits. Under this method, the share of each provider of insurance is based on the ratio of its applicable limit of insur- ance to the total applicable limits of insurance of all providers of insur- ance. B. The following definition is added to DEFINITIONS (Section V): "Other insurance": (5) That is available to the insured a. Means insurance, or the funding of losses, when the insured is an additional that is provided by, through or on behalf of: Copyright, The Travelers Indemnity Company, 2004 CG D3 16 07 04 .,v WORKERS COMPENSATION AND EMPLOYERS LIABLffy POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 2 % of the California worirers' compensation pre. mlum. Schedule Person or Organisation Job Description Any person for whom the Named Insured Blanket Waiver has agreed by written contract to furnish this waiver. This endorsernent changes the policy to which it is attached and is effective on the date Issued unless otherwise stated, (The Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective 10-01-15 Policy No DTJUB-91811393-A-15 .JEmdom went No. Insured Sancon Engineering, Inc. PrenilUrn INCL. Insurance Company Travelers Property Casualty Countersigned by -- Company of America DATE OF ISSUE: ST ASSIGN: CA page 1 Of 1 OD4201 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Paragraphs 2. and 3. of the Cancellation Com- mon Policy Condition are replaced by the follow- ing: 2. All Policies In Effect For 60 Days Or Less If this policy has been in effect for 60 days or less, and is not a renewal of a policy we have previously issued, we may cancel this policy by mailing or delivering to the first Named In- sured, at the mailing address shown in the policy, and to the producer of record, advance written notice of cancellation, stating the rea- son for cancellation, at least: a. 10 days before the effective date of can- cellation if we cancel for: (1) Nonpayment of premium; or (2) Discovery of fraud by: (a) Any insured or his or her repre- sentative in obtaining this insur- ance; or (b) You or your representative in pursuing a claim under this pol- icy. b. 30 days before the effective date of can- cellation if we cancel for any other rea- son. 3. All Policies In Effect For More Than 60 Days a. If this policy has been in effect for more than 60 days, or is a renewal of a policy we issued, we may cancel this policy only upon the oc- IL 02 70 09 12 currence, after the effective date of the policy, of one or more of the following: (1) Nonpayment of premium, including pay- ment due on a prior policy we issued and due during the current policy term cover- ing the same risks. (2) Discovery of fraud or material misrepre- sentation by: (a) Any insured or his or her representa- tive in obtaining this insurance; or (b) You or your representative in pursu- ing a claim under this policy. (3) A judgment by a court or an administra- tive tribunal that you have violated a Calk fornia or Federal law, having as one of its necessary elements an act which materi- ally increases any of the risks insured against. (4) Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards, by you or your repre- sentative, which materially increase any of the risks insured against. (5) Failure by you or your representative to implement reasonable loss control re- quirements, agreed to by you as a condi- tion of policy issuance, or which were conditions precedent to our use of a par- ticular rate or rating plan, if that failure 0 Insurance Services Office, Inc., 2012 Page 1 of 3 materially increases any of the risks in- sured against. (6) A determination by the Commissioner of Insurance that the: (a) Loss of, or changes in, our reinsur- ance covering all or part of the risk would threaten our financial integrity or solvency; or (b) Continuation of the policy coverage would: (i) Place us in violation of California law or the laws of the state where we are domiciled; or (ii) Threaten our solvency. (7) A change by you or your representative in the activities or property of the commer- cial or industrial enterprise, which results in a materially added, increased or changed risk, unless the added, in- creased or changed risk is included in the policy. b. We will mail or deliver advance written notice of cancellation, stating the reason for cancel- lation, to the first Named Insured, at the mail- ing address shown in the policy, and to the producer of record, at least: (1) 10 days before the effective date of can- cellation if we cancel for nonpayment of premium or discovery of fraud; or (2) 30 days before the effective date of can- cellation if we cancel for any other reason listed in Paragraph 3.a. B. The following provision is added to the Cancella- tion Common Policy Condition: 7. Residential Property This provision applies to coverage on real property which is used predominantly for residential purposes and consisting of not more than four dwelling units, and to cover- age on tenants' household personal property in a residential unit, if such coverage is writ- ten under one of the following: Commercial Property Coverage Part Farm Coverage Part — Farm Property — Farm Dwellings, Appurtenant Structures And Household Personal Properly Coverage Form a. If such coverage has been in effect for 60 days or less, and is not a renewal of cov- erage we previously issued, we may can- cel this coverage for any reason, except as provided in b. and c, below. b. We may not cancel this policy solely be- cause the first Named Insured has: (1) Accepted an offer of earthquake cov- erage; or (2) Cancelled or did not renew a policy issued by the California Earthquake Authority (CEA) that included an earthquake policy premium sur- charge. However, we shall cancel this policy if the first Named Insured has accepted a new or renewal policy issued by the CEA that includes an earthquake policy premium surcharge but fails to pay the earthquake policy premium surcharge authorized by the CEA. c. We may not cancel such coverage solely because corrosive soil conditions exist on the premises. This restriction (c.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1) Commercial Property Coverage Part — Causes Of Loss — Special Form; or (2) Farm Coverage Part — Causes Of Loss Form — Farm Property, Para- graph D. Covered Causes Of Loss — Special. C. The following is added and supersedes any pro- visions to the contrary: Nonrenewal 1. Subject to the provisions of Paragraphs C.2. and C.3. below, if we elect not to renew this policy, we will mail or deliver written notice, stating the reason for nonrenewal, to the first Named Insured shown in the Declarations, and to the producer of record, at least 60 days, but not more than 120 days, before the expiration or anniversary date. We will mail or deliver our notice to the first Named Insured, and to the producer of re- cord, at the mailing address shown in the pol- icy. 2. Residential Property This provision applies to coverage on real property used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household property contained in a residential unit, if such coverage is written under one of the following: Page 2 of 3 © Insurance Services Office, Inc., 2012 IL 02 70 09 12