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Insurance - Professional Pipe Services CCTV- 2017-07-27ACORo' CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY) ILSR L� gn/zolg 7/27/2017 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 poltcy(ies) must have ADDITIONAL INSURED provisions or be endorsed. H 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 LOGIQOD IiI511fEROC Eir0(CelS,LLC 0AUoaioe#0F15767 7255. rt $,351h8. LoB�90017 CONTACT NAME: AIHONEC No Ezl: FAX AIC No: E-MAIL INSURERS AFFORDING COVERAGE NAIC e 21 INSURERA: Tokio MarineSpecialtyInsurance Comm 23850 MED EXP (Anyone arson 10 ,000 INSURED �� C ` orp Corp. 1432958 dba Profeesiorlal Rpe SeNOes 23311 Madero S38318 treet INSURER B: Federal Insurance Company / 20281 INSURER C: Star Indemnit &Liabili Company INSURER 0, NlssionMejoCA92591 NSURER E B NS RERF LIABILITY ANY AUTO AUTOS ONLY AUTOSULED HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COVERAGES HSWHOOl CERTIFICATE NUMBER: 14858598 REVISION NUMBER: XXXXXXX 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. ILSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMBS A TXCOhMERCIALGENERALLABILITY CLAIMS-MADEOCCUR Y Y PPK1688659 8/1/2017 8/1/2018 EACH OCCURRENCE 1,000,000 PREMISES Ea occurrrence 100,000 MED EXP (Anyone arson 10 ,000 PERSONAL &ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC OTHER: GENERAL AGGREGATE $2000000 PRODUCTS-COMPIOPAGG$ 2,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO AUTOS ONLY AUTOSULED HIRED NON -OWNED AUTOS ONLY AUTOS ONLY N N 54309479 8/l/2017 8/1/2018 COMBINED SINGLE LIMIT Ea accident) $ 2,000,000 BODILY INJURY (Perperson) $ XX'X'X'XXX BODILY INJURY (Per accident $ XXXXXXX PROPERTY DAMAGE Peraccltlent $ Xx' X $XXXXXXX C X UMBRELLA LIAR I EXCESS UAB X I OCCUR CLAIMB-MADE N N 1000023850 8/1/2017 8/1/2018 EACH OCCURRENCE $ M000,000 00O 000 AGGREGATE $ 10,000,000 DED I I RETENTION $ $ XXXXXJ x ]3 WORIUERSCOMPENSATION AND EMPLOYERS' LIABILITY YIN MY PROPRIETONPARTNEIUEXECUTIVE ❑ OFFICERIMEMSER EXCLUDED' N (Manderory In Nat e res. d-orrod under DES CRIPTIONOFOPERATIONSI,elmv NIA Y 54309480 7/29/2017 8/1/2018 XsEArurE ER 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 / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional Insured(s) as per the attached endorsement or policy language. Waiver of subrogation applies as per the attached endorsements or policy language. See Additional Remarks Schedulc CCK I IH ICA I t KULUCK CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 58598 AUTHORIZED REPRESENTATIVE t 'SMITMYDISTPoCi9THSTI2�TNESACA92627 A 25 (2016/03) rDl9r88-201,`r-ACG4RD CORPORATION. All rights reserved rhe ACORD name and logo are registered marks of ACORD cVNI INUA IION ptNUKIF IION Oe OPERA NONsaOCATiONSIVENICLESIEXCLUSIONS ADDED BY ENOORSEMENTISPECIAL PROVISIONS (Use only if more space Is nquirea) 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. ACORD 25 (2016/03) Certificate Holder ID: 14858598 POLICY NUMBER: PPK1688659 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations As where required by written contract prior to loss All covered locations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, 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 2. 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. CG 2010 0413 Attachment Code : D532712 Master 1D: 1432958, Certificate ID: 14858598 B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply; This insurance does not apply to "bodily injury' or 'property damage" occurring after: 1. All work, Including materials, parts or equipment furnished in connection with such work, on the project (other than service. maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" cut of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. © ISO Properties, Inc., 2012 Page 1 of 2 C. 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 GG 2010 0413 Attachment Code: D532712 Master ID: 1432958, Certificate ID: 14858598 2. Available under the applicable Limits of Insurance shown in the Declarations; © ISO Properties, Inc., 2012 whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 POLICY NUMBER: PPK1688659 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/ COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization as required by written contract prior to loss. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 Attachment Code : D532715 Master ID: 1432958, Certificate ID: 14858598 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in Schedule. Schedule Where required by written contract in states where applicable. 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 7/29/2017 Policy No: 54309480 Endorsement No.001 Effective Date: Insured: HSW ProPipe, Inc. Insurance Federal Insurance Company Company WC 00 03 13 (Ed. 4-84) Attachment Code: D532852 Master ID: 1432958, Certificate ID: 14858598