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Insurance - AKM Consulting Engineers - 2015-09-18rronfle- oTe AKMCONSUI ACORD. CERTIFICATE OF LIABILITY INSURANCE 09/18/2a1DlYYYY) 19/18/2015 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 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 Dealey, Renton &Associates P. O. Box 12675 Oakland, CA 94604-2675 ON T NAME: Nancy Ferrick ucONri,Eat,510 465.3090 aC.No:510 452.2193 E-MAILnerrick deale ADDRESS:frenton.com Y INSURER(S) AFFORDING COVERAGE NAIC# 510 465-3090 INSURER A: Sentinel insurance Co. LTD 11000 INSURED AKM Consulting Engineers, Inc. INSURER B: American Automobile Ins. Co. 21849 Surety Travelers Casualty & SureCo. 31194 INSURER C: •) •l 553 Wald Street Irvine, CA 92618.4627 INSURER D: INSURER E 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 CONTRACTOR 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. LTR TYPE OF INSURANCE ADDLSUBR NSR WD POLICY NUMBER POLICY EFF MM/DDNYYY Y EXP LIMITS A GENERALLIABILITY X X 57SBWLU8719 9/20/2015 09/20/201 EACH OCCURRENCE $2000O0O X COMMERCIAL GENERAL LIABILITY PREMISES Ea occur ance $1,OD0,696 CLAIMS -MADE OCCUR MED EXP(Anyone person) $10,000 PERSONAL &ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 PRODUCTS-COMP/OPAGG $4,000,000 GEWL AGGREGATE LIMIT APPLIES PER: POLICY X PRO_ LOC JE"A $ AUTO MOBILE LIABILITY X X 57SBWLU8719 9/20/2015 09/20/201 Ea aBIINEDtSINGLE LIMIT $2,000,000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per aocident) $ AUTOS NON -OWNED X AUTOS X PROPERTYDAMAGE $ HIRED AUTOS AUTOS Par accident A X UMBRELLALIAB X OCCUR X X 57SBWLU8719 W2012015 09/201201C EACH OCCURRENCE $1000000 EXCESS UAB CLAIMS -MADE AGGREGATE $1,000,000 OED I I RETENTION$ $ B WORKERS COMPENSATION X WZP81028663 9/20/2015 09120/2016 X WC VTDmn ERH AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVER E.L. EACH ACCIDENT $1009000 OFFICER/MEMBER EXCLUDED/ N NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,009000 If yes, describe under 0 E CRI PTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,060,000 C Professional 105344511 9/20/2015 09/2012016 $2,000,000 per Claim Liability $2,000,000 Annl Aggr. DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more spars Is required) General Liability Policy excludes claims arising out of the performance of professional services. Ref: Irvine Pump Station Backbay Spill Project. BUSINESS LIABILITY, NON -OWNED and HIRED AUTOMOBILE LIABILITY ADDITIONAL INSURED: Costa Mesa Sanitary District, its directors, officials, officers, employees, agents and volunteers and any other person named (See Attached Descriptions) Costa Mesa Sanitary District 628 W. 19th Street Costa Mesa, CA 92627 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN IiQ ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) 1 of 2 The ACORD name and logo are registered marks of ACORD #S1466031/M1465849 NMF All rights reserved DESCRIPTIONS (Continued from Page 1) in the written contract between the Named Insured and the Certificate Holder. The coverage afforded is pursuant to Section C., Who Is An Insured, Sub -Section f. Additional Insureds by Contract, Agreement or Permit, of the Business Liability Coverage Form, Form No. SS 00 08. General and Auto Liability is primary per policy form. A Waiver of Subrogation applies to Workers' Compensation. 243 (2010/09 2 of 2 #S1466031IM1465849 Insured: AKM Consulting Engineers, Inc. Insurer: Sentinel Insurance Co. LTD Policy Number: 57SBWLUB719 Policy Effective Date: 09/2012015 Casts Mesa SanAay Dial aAadirscon,,affidals,officers, anapbyeea, agents and vobnteers Additional Insured EXCERPTS FROM: Hartford Form SS 00 08 04 05 BUSINESS LIABILITY COVERAGE FORM C. WHO IS AN INSURED 6. Additional Insureds When Required By Written Contract, Written Agreement Or Permit The person(s) or organization(s) identified in Paragraphs a. through f. below are additional insureds when you have agreed, in a written contract, written agreement or because of a permit issued by a state or political subdivision, that such person or organization be added as an additional insured on your policy, provided the injury or damage occurs subsequent to the execution of the contract or agreement, or the issuance of the permit. A person or organization is an additional insured under this provision only for that period of time required by the contract, agreement or permit. f. Any Other Party (1) Any other person or organization who is not an insured under Paragraphs a. through e. above, but only with respect to liability for "bodily injury, "property damage' or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (a) In the performance of your ongoing operations; (b) In connection with your premises owned by or rented to you; or (c) In connection with "your work" and included within the "products- completed operations hazard, but only if (i) The written contract or written agreement requires you to provide such coverage to such additional insured; and (ii) This Coverage Part provides coverage for "bodily injury' or "property damage" included within the "products -completed operations hazard. (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to: "Bodily injury, "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: inspection, or engineering E.5. Separation of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this policy to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom a claim is made or."suit" is brought. E.7.b.(7).(b) Primary And Non -Contributory To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement or permit that this insurance is primary and non- contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. E.8.15. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. EXCERPT FROM Hartford Form SS 04 38 06 01 HIRED AUTO AND NON -OWNED AUTO B. With respect to the operation of a "non -owned auto", WHO IS AN INSURED is replaced by the following: The following are "insureds": d. Anyone liable for the conduct of an "insured", but only to the extent of that liability. Insured: AKM Consulting Engineers, Inc. Policy Number: WZP81028663 Effective Date: 09/20/2015 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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 % of the California workers' compensation premium otherwise due on such remuneration. Person or Organization Costa Mesa Sanitary District 628 W. 19th Street Costa Mesa, CA 92627 SCHEDULE Job Description Ref: Irvine Pump Station Backbay Spill Project. SCHEDULE CONTINUED: Costa Mesa Sanitary District, its directors, officials, officers, employees, agents and volunteers Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: Policy Expiration Date: