Loading...
Insurance - Environmental Engineering & Contracting 2016-10-28ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD Y) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 1 10/28/2016 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 Garrett/Mosier/Griffith/Sistrunk Risk Management & Insurance Services 12 Truman Irvine, CA 92620 CONTACTAShIe Brewster PHONEFA% AIC No Ext: 949-559-3377 BAC. No: 949-559-6703 ADDRESS: ashleybOgmqs.com INSURERS AFFORDING COVERAGE NAICM GLP2006942-14 www.gmgSUWm 0884519 INSURER A: Great Divide Insurance Company/ 25224 INSURED EEC Environmental INSURER B: Peerless Insurance Company/ 24198 CLAIMS -MADE M OCCUR dba Enviromental Engineering Contracting Inc., One City Boulevard West, Suite 1800 Orange CA 92868 INSURER C: INSURER D: INSURER E: INSURER F: DAMAGE TO RENTEff_ PREMISES Ea occurrencel $ 109,000 COVERAGES CERTIFICATE NUMBER: 32610748 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMFD 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 TYPE OF INSURANCE ADDLSUBR INSO MID POLICYNUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYNNYI LIMITS COMMERCIAL GENERALLIABILITY GLP2006942-14 10/31/2016 10/31/2017 EACHOCCURRENCE $ 5,000,000 CLAIMS -MADE M OCCUR DAMAGE TO RENTEff_ PREMISES Ea occurrencel $ 109,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 5,000,000 POLICY0 JE'' LOC PRODUCTS-COMPIOPAGG $ 5,000,000 $ OTHER: B AUTOMOBILE LIABILITY CBP8977390 10/31/2016 10/31/2017 COMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY (Par person) $ ✓ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOSHIRED BODILY INJURY (Per accident) $ ✓ _ AUTOS ONLY ✓ AUTOS ONLY PROPERTY acciden DAMAGE $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNER/EXECUTIVE YIN WCA2008815-13 5/24/2016 5/24/2017,/ STATUTE OR'- E. L. EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCWDED9 NIA E . DISEASE- EA EMPLOYEE $ 1,000,00 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below EL.DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) As respects General Liability coverage, Costa Mesa Sanitary District, its directors, officials, officers, employees, agents and volunteers are added as Additional Insureds and this insurance is primary per ENV2154AO906 attached. As respects Workers' Compensation coverage, a Waiver of Subrogation is hereby included per WC040306 attached. As respects General Liability coverage, 30 -day written notice of cancellation (10 days for non-payment of premium) applies per IL00171198 attached. Costa Mesa Sanitary D 628 W. 19th Street Costa Mesa CA 92627 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. All Hi hfe rascnrvnd ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 32610748 1 16-17 G/A/UMB/POLL/E60/pC I Ashley Brewster 1 10/28/2016 3:19:03 PM (PM) I Page 1 of 4 GLP2006942-14 EEC Environmental ENDORSEMENT This endorsement forms a part of the policy to which it is attached. Please read it carefully. ADDITIONAL INSURED - BLANKET - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Who is An Insured (Section 11) is amended to Include as an insured any person(s) or organizations, for whom you are performing operations under a written contract or agreement, which is in effect prior to the performance of your work which is the subject of such written contract or agreement, that such person(s) or organization(s) be added as an additional insured on your policy, 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 the acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured; or 2. Your work performed for such person(s) or organizations(s) and included in the products -completed operations hazard, only when required by the written contract or written agreement. With respect to damages caused by your work, as described above, the coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above, but only when required by written contract or agreement. 912006 by Berkley Specialty Underwriting Managers LLC, an affiliate of Nautilus Insurance Company and Great Divide Insurance Company. All rights reserved. m 1985-2006 by Insurance Services Office, Inc., material used by permission. ENV 2154 A 09 06 Page 1 of 1 32610718 1 16-17 G/A/VMB/POLL/ECV/WC I Ashley Bnewsfe 1 10/20/2016 3:19:03 . IPOTI 1 Page 2 of 4 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 04 84 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0.00% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization As required by written contract 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 5/24/2016 Insured EEC Environmental Insurance Company: Great Divide Insurance Company Policy No. WCA2008815-13 Countersigned by Endorsement No. WC 04 03 06 04 84 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers Compensation Insurance Forms Manual 2001. 32610498 1 16-11 G/A/UMB/P0LL/E60/WC I Ashley Brewster 1 10/28/2016 3:19:03 PM (PDT) I Page 3 of 4 Premium Page 1 of 1 EEC Environmental dba Enviromental Engineering Contracting Inc., COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Declara- tions may cancel this policy by mailing or deliv- ering to us advance written notice of cancella- tion. 2. We may cancel this policy by mailing or deliver- ing to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancel- lation if we cancel for nonpayment of pre- mium; or b. 30 days before the effective date of cancel- lation if we cancel for anyother reason. 3. We will mall or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy Is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. It the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be ef- fective even if we have not made or offered a refund. 8. If notice is mailed, proof of mailing will be suffi- cient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the Insurance afforded. The first Named insured shown in the Declarations Is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement Issued by us and made a part of this policy. C. Examination Of Your Books And Records We may examine and audit your books and re- cords as they relate to this policy at any time dur- ing the policy period and up to three years after- ward. D. Inspections And Surveys 1. We have the right to: a. Make inspections and surveys at any time; IL 0017 1198 b. Give you reports on the conditions we find; and C. Recommend changes. 2. We are not obligated to make any Inspections, surveys, reports or recommendations and any such actions we do undertake relate only to in- surability and the premiums to be charged. We do not make safety inspections. We do not un- dertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2, of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes in- surance Inspections, surveys, reports or rec- ommendations. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recom- mendations we may make relative to certifica- tion, under state or municipal statutes, ordi- nances or regulations, of boilers, pressure ves- sels or elevators. E. Premiums The first Named Insured shown in the Declara- tions: 1. is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay. F. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named insured. if you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representa- tive. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 32610/48 1 16-19 G/A/PlIB/POLL/ Ed0/WC I Ashley B- ­t.. 1 10/20/2016 3:19:03 PM IPMI I Page 4 of 4 Page t of 1 O