Loading...
Insurance - Willdan Engineering - 2015-11-05 (2)1 ® �`� o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YY1'V) 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 policiesmay re ' e an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorse PRODUCER Aon Risk Insurance Services West, Inc. NOV 2U15 Los Angeles CA Office CONTACT NAME: PHONE (866) 283-7122 FAX (800) 363-0105 (AIC. No. Ex[): INC. E-MAIL ADDRESS: 707 Wilshire Boulevard Suite 2600 LOS Angeles CA 90017-0460 USA ,(AI(ILJA„ANARI HMO INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: National Fire Ins. Co. of Hartford 20478 Willdan Engineerinq 2401 East Katella Avenue, Suite 300 Anaheim CA 92606 USA INSURER B: The Continental insurance Company 3$289 INSURER C: Lexington Insurance Company 19437 INSURER D: CLAIMS -MADE X❑DDDDR INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570060056437 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD MD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS B X COMMERCIAL GENERAL LIABILITY 5 11/09/2016 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X❑DDDDR PREMISES Eaoccunence $1,000,000 MED EXP (Any one person) $15,000 PERSONAL B ADV INJURY $1,000,000 GENT AGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $2,000,000 POLICY EJECOT ❑X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER : A AUTOMOBILE LIABILITY 6020541619 11/09/201511/09/2016 COMBINED SINGLE LIMIT $1,000,000 Ea accident BODILY INJURY( Per person) X ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS HIREDAUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE Farami I UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION B e WORKE RSCOMPENSATIONAND LITY YIN ANY PROPRIETOR I PARTNER I EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory m, NH) NIA 6022647422 Workers Compensation AOS 6020541572 Workers Compensation CA 11/09/2015 11/09/2015 11/09/2016 11/09/2016 X SPER TATUTE ETH E.L. EACH ACCIDENT $1,000,006 E.L. DISEASE -EA EMPLOYEE $1,000,000 If One under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 C Contractor Prof 028174912 11/09/2015 11/09/2016 Per Claim $1,000,000 Professional Liability Aggregate $1,000,000 SIR $250,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Permit technician counter services. General Liability policy excludes claims arising out of the performance of professional services. Independent Contractors are included as respects t0 General Liability. Costa Mesa Sanitary District, its directors, officials, officers, employees, agents, and volunteers are included as additional insured as respects to General Liability; Primary and Non -Contributing coverage applies to GL; Waiver Of Subrogation or Rights applies to Workers' Compensation policy only as required by a written signed contract prior to any loss occurring in accordance with GL, AL and WC policy provisions. (ANAHEIM). 4 CERTIFICATE HOLDER CANCELLATION V ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) 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 ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District AUTHORIZED REPRESENTATIVE Attn: District Clerk 628 West 19th Street Costa Mesa CA 92627 USA f tJr��-x �n L 1 y �f Pim ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Policy Number: 5088210281 CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. The WHO IS AN INSURED section is amended to add as an Insured any person or organization whom the Named Insured is required by written contract to add as an additional insured on this coverage part, including any such person or organization, if any, specifically set forth on the Schedule attachment to this endorsement. However, such person or organization is an Insured only with respect to such person or organization's liability for: A. unless paragraph B. below applies, 1. bodily injury, property damage, or personal and advertising injury caused in whole or in part by the acts or omissions by or on behalf of the Named Insured and in the performance of such Named Insured's ongoing operations as specified in such written contract; or 2. bodily injury or property damage caused in whole or in part by your work and included in the products - completed operations hazard, and only if a. the written contract requires the Named Insured to provide the additional insured such coverage; and b. this coverage part provides such coverage. B. bodily injury, property damage, or personal and advertising injury arising out of your work described in such written contract, but only if: 1. this coverage part provides coverage for bodily injury or property damage included within the products completed operations hazard; and 2. the written contract specifically requires the Named Insured to provide additional insured coverage under the 11-85 or 10-01 edition of CG2010 or the 10-01 edition of CG2037. II. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. III. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: N A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. IV. Notwithstanding anything to the contrary in the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance, this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or any other basis. However, if this insurance is required by written Policy Number: 5088210281 CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement contract to be primary and non-contributory, this insurance will be primary and non-contributory relative solely to insurance on which the additional insured is a named insured. V. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. except as provided in,Paragraph IV. of this endorsgment, agree.to make available; any,4ther insurance the additional insured has for any loss covered under this coverage part; 3. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 4. tender the defense and indemnity of any claim to any other insurer or self insurer whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph (4) does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires the Named Insured to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. G -19160-B CNA (Ed. 11/97) Policy Number: 6022647422 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS This endorsement changes the policy to which it is attached. It is agreed that Part One Workers' Compensation Insurance G. Recovery From Others and Part Two Employers' Liability Insurance H. Recovery From Others are amended by adding the following: We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) PREMIUM CHARGE - The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is G -19160-B Page 1 of 1 (Ed. 11/97) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION ON WHOSE BEHALF YOU ARE REQUIRED TO OBTAIN THIS WAIVER OF OUR RIGHT TO RECOVER FROM UNDER A WRITTEN CONTRACT OR AGREEMENT. This endorsement 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 11/09/2015 Policy No. 6020541572 Endorsement No. N/A Insured Willdan Group, Inc. Premium$ N/A Insurance company The Continental Insurance Company Countersigned by WC 00 03 13 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance. CNA C 1 (Ed.d. 02/ 02/13) NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS It is understood and agreed that: If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificate holders at least 30 days in advance of the date cancellation is effective. If notice is mailed, then proof of mailing to the last known mailing address of the Certificate holder on file with the Agent of Record will be sufficient to prove notice. Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon us or the Agent of Record. CC68021A (Ed. 02/13) Policy No: 5088210281 Page 1 of 1 Endorsement No: N/A Effective Date: 11/09/2015 Insured Name: Copyright CNA All Rights Reserved. CNA CC680 1 A (Ed. 02/13) NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS It is understood and agreed that: If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificate holders at least 30 days in advance of the date cancellation is effective. If notice is mailed, then proof of mailing to the last known mailing address of the Certificate holder on file with the Agent of Record will be sufficient to prove notice. Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon us or the Agent of Record. CC68021A (Ed. 02/13) Policy No: 6020541586 Page 1 of 1 Endorsement No: N/A Effective Date: 11/09/2015 Insured Name: copyright CNA All Rights Reserved. CNA C 1 (Ed.d. 02/ 02/13) NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS It is understood and agreed that: If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificate holders at least 30 days in advance of the date cancellation is effective. If notice is mailed, then proof of mailing to the last known mailing address of the Certificate holder on file with the Agent of Record will be sufficient to prove notice. Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon us or the Agent of Record. CC68021 A (Ed. 02/13) Policy No: 6020541572 Page 1 of 1 Endorsement No: N/A Effective Date: 11/09/2015 Insured Name: copyright CNA All Rights Reserved. CNA C 1 (Ed.d. 02/ 02/13) NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS It is understood and agreed that: If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificate holders at least 30 days in advance of the date cancellation is effective. If notice is mailed, then proof of mailing to the last known mailing address of the Certificate holder on file with the Agent of Record will be sufficient to prove notice. Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon us or the Agent of Record. CC68021A (Ed. 02/13) Policy No: 6022647422 Page 1 of 1 Endorsement No: N/A Effective Date: 11/09/2015 Insured Name: Copyright CNA All Rights Reserved. CNA CC680 1 A (Ed. 02/13) NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS It is understood and agreed that: If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificate holders at least 30 days in advance of the date cancellation is effective. If notice is mailed, then proof of mailing to the last known mailing address of the Certificate holder on file with the Agent of Record will be sufficient to prove notice. Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon us or the Agent of Record. CC68021A (Ed. 02/13) Page 1 of 1 Policy No: 6020541619 Endorsement No: N/A Effective Date: 11/09/2015 Insured Name: Copyright CNA All Rights Reserved.