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Insurance - Municipal Underground Services 2016-12-21MUNIUND-01 COELATOR ,4coRv CERTIFICATE OF LIABILITY INSURANCE �� DATE 12121120/6 YI 12121/2016 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 License # OD28764 CONTACT Caesar De La Torre Orion Risk Management Insurance Services, Inc. 1800 Quail Street, Suite 110 Newport Beach, CA 92660 PHONE rax (AIC, No, Ext): (949) 431-2007 A/C, No): ADDRESS: cdelatorre@orionrisk.com INSURERS AFFORDING COVERAGE NAIC # DAMAGE TO RENTED $ 100,000 INSURERA:Colony Insurance Com an ✓ 39993 INSURED INSURER B: Employers Mutual Casualty Company an 21415 INSURER C: Municipal Underground Services, Inc. INSURER D: 28511 Breckenridge Drive Laguna Niguel, CA 92677 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER. 2 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. INSRTYPE OF INSURANCE ADDL INSD SUBR MD POLICY NUMBER POLICY EFF 12129/2016 POLICY EXPLTR 1212912017 _ LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X 103GL000787606 EACH OCCURRENCE $ 1+000,006 DAMAGE TO RENTED $ 100,000 MED EXP An one arson g 6,000 PERSONAL INJURY $ 1'000'000 GENT AGGREGATE URM IT APPLI ES PER: POLICY � %ef LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS EE ATOS ONLY AUTOWONIY 4E43249 04/1812016 0411812017 COMBINEDSINGLE LIMIT 1,000,000 Ea accident $ BODILY INJURY Pet erson $ BODILY INJURY Per accident $ Per aoclRdent AMAGE $ UMBRELLA LIAB EXCESS LUG OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ WORKER5 COMPENSATION EMPLOYERS' LIABILITY YIN OFFICEWMEIETOERPARTNER/E ECUTIVE ❑ (Mandatoryln NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA STATUTE ER E.L. EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCMPTIONOFOPEMnON$ILOCAnONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is mqulmd) The Costa Mesa Sanitary District, it's elected and appointed officials, agents, officers, volunteers and employees are additional insureds subjectto the terms of the attached General Liability endorsement All operations: Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees listed as Additional Insured — Pursuant to attached endorsement Any other insurance maintained by the Costa Mesa Sanitary District shall be excess and non-contributing with the insurance provided by this policy. Said policy shall not terminate, nor shall it be canceled nor the coverage reduced, until thirty (30) days after written notice is given to the District. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa SanitaryDistrict THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 628 W. 19th Street Costa Mesa, CA 92627 q�� ACCORDANCE WITH THE POLICY PROVISIONS. 7� AUTHORIZEDREPRESENTATWE �s� I6Au ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 103 GL 0007876-06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - ONGOING & COMPLETED OPERATIONS - PRIMARY & NON-CONTIBUTORY OTHERINSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) And Description Of Operations All project owners or contractors as required by As required by written contract EXCEPT written contract with the named insured except any contract for Residential or Habitational any entity or contract involved with residential or Construction and/or any contract for a habitational construction Consolidated (Wrap Up) Insurance Program A. SECTION II — WHO IS AN INSURED is amended to include as additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to: 1. liability for "bodily injury" or "property damage" caused, in whole or in part, "your work' at the location designated and described in the SCHEDULE above performed for that additional insured and included in the "products -completed operations hazard". 2. liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. your acts or omissions; or b. 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 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. U462-0116 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2 with its permission. 103 GL 0007876-06 C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is amended and the following added: The insurance afforded to the additional insured designated in the SCHEDULE above is primary insurance and we will not seek contribution from any other insurance available to that additional insured under your policy provided that: 1. the additional insured designated in the SCHEDULE above is a Named Insured under such other insurance; and 2. you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U462-0116 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 2 with its permission.