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Insurance - Jimni Systems, Inc. 2016-04-11JIMNSYS-01 SHENDERSON '44 R� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODO V) 4/11/2016 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 License # OD79613 Bowermaster & Associates Insurance Agency, Inc. 10805 Holder Street, Suite 350 Cypress, CA 90630 CONTACT NAME: PHONE (714) 733-6200 ac No 714 252-8253 AIC No EM: ( ) E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAICN A INSURER A: Admiral Insurance Company X INSURED INSURERS: American Fire & Casualty Company 24066 INSURER C: Praetorian Insurance Company/ Jimni Systems, Inc. INSURER D; 11161 Jeffrey Rd Irvine, CA 92602 INSURER RE: 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 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. IN$R LTR TYPE OF INSURANCE IN D BR WVD POLICY NUMBER POLICYEFF MMIDONYYY POLICYEXP MM/DOIYYTY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MAGE 1 OCCUR X FEIECC2133401 04101/2016 04/01/2017 EACH OCCURRENCE $ 1,000,006 PREMISES Ea occurrence $ 50,000 MED EXP (My one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY[ X ] J'ECOT [:] LOC GENERALAGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 1,000,000 B X ANVAUTO BAA56443207 04/01/2016 04101/2017 BODILY INJURY (Per person) $ AOWNED SCHEDULED AUTOS IUO BODILY INJURY (Per accident) $ NON -OWNED HIRED AUrOS AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,006 A X EXCESS LIAR CLAIMS -MADE FEIEXS2133501 04/0112016 0410112017 AGGREGATE $ 21000,000 DED I I RETENTIONS $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? F—] NIA EQB0102429 04101/2016 0410112017 X PER TH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 (Mandatory in NN) e es, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: All Operations Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees are listed as Additional Insured – Pursuant to attached endorsement CG2010 0413 and CG2037 0704. Any other insurance maintained by the Costa Mesa Sanitary District shall be excess and non-contributing with the Insurance provided by this policy per form ECC548 0712. CERTIFICATE HOLDER CANCELLATION ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District {{/I / 628 W. 19th Street �y)/)`, f 0 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa, CA 92627 VV �( AUTHOR(IIZZZEE/{D.�REPRESENTATIVE . C v . � ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Jimni Systems. Inc. Endorsement Number: 21 ADMIRAL �.... Additional Insured - Owners, Lessees or Contractors - Scheduled Person or Organization This endorsement, effective 4/1/2016 attaches to and forms apart of Policy Number FEI-ECC-21334-01. This endorsement changes the Policy. Please read it carefully. In consideration of an additional premium of $Applied, 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 Any person(s) or organization(s) whom the Named Insured Those project locations where this agrees, in a written contract, to name as an additional insured. endorsement is required by contract However, this status exists only for the project specified in that contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11- 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) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: CG 20 10 04 13 0 ISO Properties, Inc. Jimni Systems. Inc. Endorsement Number: 21 .aoaaeni �,,.... This insurance does not apply to "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 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 other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 0413 0 ISO Properties, Inc. Jimni Systems, Inc. Endorsement Number: 22 ADMIRAL W`,".:7" Additional Insured — Owners, Lessees or Contractors — Completed Operations This endorsement, effective 4/1/2016 attaches to and forms apart of Policy Number FEI-ECC-21334-01. This endorsement changes the Policy. Please read it carefully. In consideration of an additional premium of SApplied, this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persou(s) Or Organization(s): Location And Description Of Completed Operations Any person(s) or organization(s) whom the Named Insured Those project locations where this agrees, in a written contract, to name as an additional insured endorsement is required by contract. However, this status exists only for the project specified in that contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Jimni Systems, Inc. + Endorsement Number: 13 ADMIRAL a°:T.F` Automatic Primary and Non -Contributory Insurance Endorsement Designated Work Or Project(s) This endorsement, effective 4/1/2016 attaches to and forms apart of Policy Number FEI-ECC-21334-01. This endorsement changes the Policy. Please read it carefully. SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to provide Primary and/or Non-contributory status of this insurance. However, this status exists only for the project specified in that contract. In consideration of an additional premium of $Annlied and notwithstanding anything contained in this policy to the contrary, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third parties in respect to work performed by you under any written contractual agreement with such third party. It is further agreed that any other insurance which the person(s) or organization(s) named in the schedule may have is excess and non- contributory to this insurance. ECC -548-0712