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Insurance - Hydrex 2017-01-25Ail �® CERTIFICATE OF LIABILITY INSURANCE page 1 of 1 01/25/2017 THIS CERTIFICATE IS ISSUED ASA 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subjectto 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 CONTMANS�ACT Willie of Tennessee, Inc.PHONE c/o 26 Century Blvd. P.O. Box 305191 FAX 877-945-7378 414-443-0128 E-MAIL certificates@willis.com Nashville, IN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Old Republic Insurance Company 24147-002 MWZY308589 INSURED INSURERS: ACE Property and Casualty Insurance Comps 20699-001 B.D.D. Pest Control, Inc. 3073 Long Beach Blvd. INSURERC: New Hampshire Insurance Company r 23841-001 INSURERD: National union Fire Ins Cc of Pittsburgh 19445-002 Long Beach, CA 90807 INSURERE: INSURER F: COVFRACFS CERTIFICATE NUMBER: 25175790 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. INSR ITSTYPEOFINSURANCE DDL SUB POLICYNUMBER POLICY EFF usebrinnonCOU POLICYEXP LIMITS AX Attn: COMMERCUIL GENERAL LIABILITY y _. – MWZY308589 1/1/2017 1/1/2018 EACH OCCURRENCE $ 2,000,000 Mesa, CA 92626 C pgNWAQE ✓ItEkfISeS pa T-nce) 5 2,000,000 CLAIMS-MADEX OCCUR X MED EXP (Any one person) $ 10,000 Pesticide/Herbicide X verage PERSONAL B ADV INJURY $ 2,000,000 GE NT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY [�] PECT RO- ElLOCPRODUCTS-COMP/OP J AGO $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY y MWTB308588 1/1/2017 1/1/2018 COMBINED(Ee SINGLE LIMIT accident) $ 3,000,000 BODILY I NJURY(Per person) $ X ANY AUTO X OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY 8001 LY I NJURV(Per accident) $ PROPER DAMAGE (Perawden0 $ B X UMBRELLALIAB X OCCUR XOOG27927683002 1/1/2017 1/1/2018 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAR CLAIMS -MADE DED I X RETENTION$ 50,000 $ C WORKERS COMPENSATIONWC 014649491 1/1/2017 1/1/2018 X AND EMPLOYERS' LIABILITY ANY PROPRIEfOWPARTNEWEXECUTIVE[/] OFFICEWMEMBER EXCLUDED? ifMandator,m NH) yes, describe under DESCRIPTION OF OPERATIONS below NIA E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE -POLICY LIMIT $ 2,000,000 D Excess Workers Comp XWC 6583120 1/1/2017 1/l/2018 E.L.Each Accident $2,000,000 Limit WC Cover is Statutory E.L.Disease-Ea Emp $2,000,000 Limit E.L.Disease-Pol.Li $2,000,000 Limit DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) H.D.D. Pest Control Inc. dba Hydrex Pest Control Company of California, 3073 Long Beach Blvd., Long Beach, CA 90807. The Costa Mesa Sanitary District, It's elected and appointed officials, agents, officers, volunteers and employees are included as Additional Insured as respects to General Liability, Auto Liability and Property, but solely in regards to work being performed by or on behalf of the Named Insured as required by Written contract. CERTIFICATE HOLDER CANCELLATION Coll:5022877 Tp1:2104513 Cart:26IT5790 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 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 Costa Mesa Sanitary District / /I/ Attn: De}�ana Bojarski - _. – B. PnlaAve. ✓\/�/ Cos Costa Mesa, CA 92626 C Coll:5022877 Tp1:2104513 Cart:26IT5790 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ADDITIONAL COVERAGE SCHEDULE COVERAGE LIMITS POLICY TYPE: Contractors Pollution $10,000,000 Each Occurrence CARRIER: Allied World Assurance Company (USA) $10,000,000 Policy Limit POLICY TERM: 01/01/2017 — 01/01/2018 POLICY NUMBER: 03062978 POLICY TYPE: Pest Control Professional Liability $2,000,000 Each Claim CARRIER: Old Republic Insurance Company $2,000,000 Aggregate POLICY TERM: 01/01/2017 — 01/01/2018 POLICY NUMBER: MWZY308589 Real & Personal Property, Stock, B&M, and POLICY TYPE: Commercial Property Improvements & Betterments $100,000,000 US CARRIER: AXIS Insurance Company Operations POLICY TERM: 01/01/2017 — 01/01/2018 Equipment Included POLICY NUMBER: MAB75723217 $2,000,000 Business Interruption Rollins, Inc. Policy Term: 11112017 to 1/1/2018 Workers' Compensation and Employers Liability Policies Policy Number Work Comp/EL WC014649490 New Hampshire Ins. Co. - covers state of ME Work Comp/EL WC014649491 New Hampshire Ins. Co. - covers states of AL, A R, C O, C T, D E, H I, I A, I D, I N , KS , LA,MD,MI,MN,MO,MS, MT,N E, NH,NM,NV,OK,OR,SC,SD,TN,TX, W V Work Comp/EL WC014649492 American Home Assurance Company - covers state of CA Work Comp/EL WC014649493 New Hampshire Ins. Co. - covers states of MA and WI - This policy also provides Stop Gap coverage for ND,WA,WY Work Camp/EL WC014649494 New Hampshire Ins. Co. -covers states of NJ & PA Work Camp/EL WC014649495 New Hampshire Ins. Co. -covers state of IL, KY, NC, NY, UT & VT Work Comp/EL WC014649496 New Hampshire Ins. Co. -covers state of AZ & VA Excess Work XWC6583120 National Union Fire Insurance Comp/EL Company of Pittsburgh, PA and coverage applies to the qualified self insured states: OH & GA Excess Work XWC6583121 National Union Fire Insurance Comp/EL Company of Pittsburgh, PA and coverage applies to the qualified self insured stats: FL Statutory $2,000,000 Bodily Injury by Accident - Each Accident/$2,000,000 Each Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease Statutory $2,000,000 Bodily Injury by Accident Each Accident/$2,000,000 Each Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease Statutory $2,000,000 Bodily Injury by Accident - Each Accidentl$2,000,000 Each Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease Statutory $2,000,000 Bodily Injury by Accident - Each Accidentl$2,000,000 Each Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease Statutory $2,000,000 Bodily Injury by Accident - Each Accident/$2,0O 0,000 Each Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease Statutory $2,000,000 Bodily Injury by Accident - Each Accident/$2,000,000 Each Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease Statutory $2,000,000 Bodily Injury by Accident - Each Accident/$2,000,000Each Employee Bodily Injury by Disease/$2;000,000 Policy Limit Bodily Injury by Disease Statutory $2,000,000 Bodily Injury by Accident - Each Accident/$2,000,000 Each Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease Statutory $2,000,000 Bodily Injury by Accident - Each Accidentl$2,000,000 Each Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease