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Insurance - Municipal Underground Services Inc. - 2015-11-13MUNIUND-01 CDELATOR ACORN" CERTIFICATE OF LIABILITY INSURANCE D 111/312015 7 1 /1 312 01 5 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). PRODUCERCONTACT License # OD28764 Orion Risk Management Insurance Services, Inc.R,L C E NE D 7800 Quail Street, Suite 710 Newport Beach, CA 92660 NOV 1 C 205 ll NAME: Caesar De La Torre HO IAICNo E>n:(g49) 263-$850 FAX No: (949) 263-8860 E-MAIL ADDRESS: INSURER(S)AFFOROING COVERAGE NAICM Colony Insurance Company 39993 INSURED WJkMbINSURERA: INSURED u Municipal Underground Services, Inc. 28511 Breckenridge Drive Laguna Niguel, CA 92677 INSURERS: Employers Mutual CasualtyCompany 121415 INSURERC: INSURER D: INSURER E: INSURER F; COVERAGES CPRTIFICATF NIIMRFRI REVISION NUMBER: 2 COVERAGES 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 MAYBE 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 D /NSD MAID POLICY NUMBER POLICYEFF MMIDDIYYYY PM[DDADXP MM/DD/YYW LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXI OCCUR X 103GL000787605 1212912015 12129/2016 EACH OCCURRENCE S 1,000,00 PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY F_X] JECOT 1-1 LOC OTHER: GENERALAGGREGATE $ 2,000,00 PRODUCTS-COMP/OPAGG $ 2,000,00 $ B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS PAUTOS 4E43249 04118/2015 04/18/2016 BINED COM ccden SINGLE LIMIT $ 1,000,000 Ea t acciden BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Peraccident UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATIONPER AND EMPLOYERS'LIABILITYRRARTNER YIN ANYPROPRIETORIPARTNDED? CUTIVE ❑ OFFICERA(Mandatory In BERNH) EXCLUDED? (Mandatory In NH) It Dyes, RIF cI be under DESCRIPTION OF OPERATIONS below NIA OTER H. STATUTE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Certificate holder is included as additional insured per the terms of the attached General Liability Endorsement. rAvc u0I DER CANCFI I ATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District N THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 628 W. 19th St. Costa Mesa, CA 92627 V\ \0 AUTHORIZED REPRESENTATIVE lar-r..c ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD Municipal Underground Services, Inc. Policy Number 103 GL 0007876-05 December 29, 2015 to 2016 103 GL 0007876-05 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 or (Additional Insured): Location(s) of Covered Operations: All persons or organizations as required by written As designated in written contract with the Named contract with the Named Insured Insured 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 for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured 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) designated above. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability "Bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations at Work "Bodily injury" or "property damage' occurring after: 1. 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 U 156P-0310 Includes copyrighted material of ISO Properties, Inc., Page 1 of 2 with its permission. 103 GL 0007876-05 2. 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. Negligence of Additional Insured "Bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional insured(s). C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is amended and the following added: The insurance afforded by this Coverage Part for the additional insured shown in the Schedule is primary insurance and we will not seek contribution from any other insurance available to that additional insured. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U156P-0310 Includes copyrighted material of ISO Properties, Inc., Page 2 of 2 with its permission.