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Insurance-C & R Drains - 2016-09-23A� b?o CERTIFICATE OF LIABILITY INSURANCE an'7T �`Z3r2016m 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 POIJCIES 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 re4uire an endorsement. A statement on this certificate does not confer rights to the certificate homer In lieu of such endorsement(s). PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 CONTACT N ME: CLIENT CONTACT CENTER PHONE No Ext): B88-333-4949 Fac xo 507-046-0664 ADDRESS: CLIENTCONTACTCENTER FEDINS.COM OWATONNA, MN 55060 INSURER(S) AFFORDING COVERAGE NAIL# 09/10/2016 INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 EACH OCCURRENCE $1,000,000 INSURED 310-410-6 INSURER B: C & R DRAINS INC, RONCO PLUMBING INC INSURER C: 1525 W MACARTHUR BLVD #11 COSTA MESA, CA 92626 INSURER D: INSURER F. GENERAL AGGREGATE $2,000,000 NSURER F: COVERAGES CERTIFICATE NUMBER: 78 REVISION NUMBER: 3 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 TYPE OF INSURANCE DL ME SUER VIVD POLICY NUMBER POLICY EFF POLIICDY EXP IMMID LIMITS —UL A COMMERCIAL GENERAL LIABILITY CLAIMS -MAGE ❑X OCCUR BUSINESS OWNER'S LIABILITY Y Y 0696048 09/10/2016 09/10/2017 EACH OCCURRENCE $1,000,000 X DAMAGE ( RENTED $100,000 DAMAPREMIGES Ea ENTERsocurrnce MED EXP lAny one person) GEN'L X PERSONAL S ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: PRO - POLICY JECT � LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGO $2,000,000 A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON-0WNED AUTOS N N 0696049 09/10/2016 09/10/2017 COMBINED SINGLE LIMIT $1,000,000 IS. accident BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE e a A X UMBRELLA LIAB LI EXCAB X OCCUR-MAD Cz0C:E N N 0696050 09/10/2016 09/10/2017 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DESS ED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) It yes, Ees.Nbe under DESCRIPTION OF OPERATIONS below NIA OTH PER STATUTE ER E.L EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AMcM1 ACORD 101, Addidunal Remarks Schedule, i1 more space is required) SEE ATTACHED PAGE 310410-6 COSTA MESA SANITARY DISTRICT 628 W 19TH ST COSTA MESA, CA 92627-2716 al��/�( 783 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1RRR-'JIHS ACCPF) CCIPPOPATIr1N all rinMe r e.4 ACORD 25 (2014101) The ACO RD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 310-4' LOC #: ACCW?" ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED FEDERATED MUTUAL INSURANCE COMPANY C & R DRAINS INC, RONCO PLUMBING INC 1525 W MACARTHUR BLVD #11 COSTA MESA, CA 92626 POLICY NUMBER SEE CERTIFICATE # 78.3 CARRIER NAC CODE SEE CERTIFICATE # 78.3 EFFECTIVE DATE: SEE CERTIFICATE # 78.3 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE COSTA MESA SANITARY DISTRICT, THEIR ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS, AND EMPLOYEES LISTED AS ADDITIONAL INSURED INSURANCE PROVIDED BY THE BUSINESSOWNERS LIABILITY IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. BUSINESSOWNERS LIABILITY CONTAINS A WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER SUBJECT TO THE CONDITIONS OF THE BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY ENDORSEMENT. FOR REASONS OTHER THAN NON-PAYMENT OF PREMIUM, 30 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE -HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. COMMERCIAL UMBRELLA FOLLOWS FORM ACCORDING TO THE TERMS, CONDITIONS, AND ENDORSEMENTS FOUND IN THE COMMERCIAL UMBRELLA POLICY. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD FED.COPY FEDERATED INSURANCE COMPANIES THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTHORIZATIONSADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR This endorsement modifies insurance provided underthe following: BUSiNESSOWNERS LIABILITY COVERAGE FORM SCHEDULE State Or Governmental Agency or Subdivision or Political Subdivision: COSTA MESA SANITARY DISTRICT 628 W 19TH ST COSTA MESA CA 92627 The following is added to Paragraph C. Who Is An Insured: 4. Any state or governmental agency ar subdivision or political subdivision shown in the Schedule is also an insured, subject to the following provisions: a. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. Insured: C & R DRAINS INC 1525 W MACARTHUR BLVD #11 COSTA MESA CA 92626 b. This insurance does not apply io: (1) "Bodily injury, "property damage", or "personal and advertising injury" arising out of operations periornad for the state or municipality; or (2) "Bodily injury" or "property damage" included within the "products-compleied operations hazard". Place of Issue: FEDERATED MUTUAL INSURANCE COMPANY Home Office 121 East Park Square Owatonna, MN 55060 (507) 455-5200 Includes copyrighted material of Insurance Services Office. Inc., with its permission. BP -F-254 (08-11) Policy Number: 0696048 Transaction Effective Date: 09-22 2016 .4� CERTIFICATE OF LIABILITY INSURANCE g/DATU�61DDNYYVI 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 Wigmore Insurance Agency, Inc. 2970 Harbor Blvd. #215 License #0811959 CONTACT Ken NOden, CPCU PHONE FAX .714-979-6543 aD No.714-549-2943 E'lea'L . commercial@wigmoreins.com INSURERS AFFORDING COVERAGE NAICN Costa Mesa CA 92626 INSURERA:Falls Lake Fire & Cas. Co EACH OCCURRENCE $ INSURED INSURER 8: INSURER C: C & R Drains, Inc. Ronco Plumbing, Inc. 1525 W. MacArthur Blvd. #11 INSURER D: INSURER E: Costa Mesa CA 92626 _ NSURERF: COVERAGES CERTIFICATE NUMBER: 480017152 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. ILTR TYPE OF INSURANCE ADDLSUBR INSD WVD POLICY NUMBER MM/DDYEFF MMM POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCURDAMAGE EACH OCCURRENCE $ I ORENTED PREMISES Ea occurrence $ MED EXP (Any one parson) $ PERSONAL &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROECT - [::] LOC OTHER. GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO AUT04SMJE0 AUTOEDULED HIRED AUTOS NON -OWNED AUTOS Eaaccitlenl $ BODILY INJURY (Per person) $ BODILY INJURY Per accident) $ PR $ - Per accident UMBRELLA LIAB EXCESS LIPS OCCUR CLAIMS -MADE 1 EACH OCCURRENCE $ AGGREGATE $ DED RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑N/A IM OFFICEREMBER EXCLUDED9 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below y TRD 9/10/2016 9/10/2017 X PER OTH- STATUTE ER E L. EACH ACCIDENT $11000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 E . DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks, Schedule, may be attached if more space is required) WORKERS COMPENSATION INCLUDES BLANKET WAIVER OF SUBROGATION. Lea:ulaLea$a COSTA MESA SANITARY DISTRICT 628 W 19TH ST COSTA MESA CA 92627 ACORD 25 (2014/01) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD reserved.