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Insurance-Hoffman Southwest Corp. - 2016-07-13(HOFFM63) ACORO® CERTIFICATE OF LIABILITY INSURANCE iko� DATE(MM/DD YYYY) OF INSURANCE 7/13/2016 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(les) must have ADDITIONAL INSURED provisions or 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 The Graham Com y an CONTACT NAME: Joe Holden PHONE 215-701-5225 A No: 215-933-3988 AM NQ Ext)E-MAIL The Graham Building One Penn Square West 25th Floor Philadelphia, PA 19102 DRESS: Holden Unit rahamco.com INSURERS AFFORDING COVERAGE NAIC# O RENTED✓ Ea occurence $ 100,000 INSURERA: First Mercury Insurance Company 10657 WWw.grahamco.com INSURED DSOUthwest Corp. Hoffmandba Professional Pipe Services INSURER B: Zurich American Insurance Company 16535 INSURER C: Endurance Risk Solutions Assurance Co. 43630 INSURER D: 23311 Madero Street Mission Viejo CA 92691 INSURER E: INSURER F COVERAriES CFRTIFICATF NIIMRFR• gORR0191 RFVISION NIIMRFR• 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 LTR OF INSURANCE ADDLTYPE JUM SUD POLICYNUMBER MMIDDY/YErn POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR WACGL000006591301 7/13/2016 8/1/2017 $ 1,000,000 O RENTED✓ Ea occurence $ 100,000 Any one person) $ 10,000 B AOV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY jEa � LOC OTHER: ftOCCURRENCEURRENCE GGREGATE $ 2,000,000 -COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE r/ LIABILITY ANY AUTO OWNED SCHEDULEp AUTOS ONLY AUTOS HIRED NON-OWNEDPROPERTY AUTOS ONLY AUTOS ONLY BAP017954301 7/13/2016 8/1/2017 SINGLE LIMITE. $ 2000000 BODILY INJURY (Per person) $ BODILY INJURY (Per acdden) t $ DAMAGE $ Per ao9d G r/ UMBRELLALIAB EXCESS LIAB OCCUR CLAIMS -MADE XSC30000143100 7/13/2016 8/1/2017 EACH OCCURRENCE $ 10000000 AGGREGATE $ 10,000,000 DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTNEWEXECUTIVE OFFICER/MEMBEREXCLUDEDF (Mandatory In NH) tire , describe under DCRIPTION OF OPERATIONS below NIA WC 017954501 7/13/2016 7/29/2017 r/ SPER TATUTE ETH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) See Additional Remarks Schedule COSTA MESA SANITARY DISTRICT SCOTT CARROLL 628 WEST 19TH STREET COSTA MESA CA 92627-9 ��/, 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 ,/��a William A. Graham IV ©1988.2015 ACORD CORPORATION. All riahts reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 30889351 1 MSMOLD-01 1 16/17 GL All XS WC I Holden unit 1 7/13/2016 10:19:51 AM (ROT) I Page 1 of 3 AGENCY CUSTOMER ID: HSWHOLD-01 LOC #: ACCOR ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED The Graham Company Hoffman Professional Pipe Services 23311 Madero Street Mission Viejo CA 92691 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) HOLDER: COSTA MESA SANITARY DISTRICT SCOTT CARROLL ADDRESS: 628 WEST 19TH STREET COSTA MESA CA 92627 RE: CLOSED CIRCUIT TELEVISING (CCTV) SERVICES - RFP 02-15 COSTA MESA SANITARY DISTRICT, its directors, officials, officers, employees, agents, and volunteers are additional insureds on the above General Liability policy if required by written contract. Coverage provided to the additional insureds shall apply on a Primary / Non -Contributory Basis on the above General Liability policy if required by written contract. Prior to loss, and if required by written contract, Waiver of Subrogation is provided on Workers Compensation Policy for work performed under contract if permissible by state law. Should any of the above described policies be cancelled before the expiration date thereof, The Graham Company will endeavor to mail 30 days written notice to the certificate holder, but failure to do so shall impose no obligation or liability of any kind upon The Graham Company, its agents or representatives. ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD 30889351 1 HSWMLO-01 1 16/17 GL AO %S WC I Holden Unit 1 7/13/2016 10;19:51 AM (EDT) I Page 2 of 3 All rights reserved. ADDENDUM 30889351 1 HSWH06 -01 116/17 GL AU %5 We I Holden Unit 1 7/13/2016 10:19:51 AM (EDT) I Page 3 of 3