Loading...
Insurance - Professional Pipe Services 2017-07-27ACOR& CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD/YYYY) `� 8/1/2018 1 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(tes) 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 endomemenl(s). PRODUCER LOCIdal IRELrEfiCS ElfiI(gn;LLC CALjcerlce#0F15767 725 S F Street, 35th fl. Lcs=esCA90017 21 CONTACT PHONE AIC No, Ert: AIC No: E-MAIL ADDRESS: INSURERISI AFFORDING COVERAGE NAIC INSURERA: Tokio Marine Specialty Insurance Company 23850 INSURED I MbM SoUth LC Colp. 1432958 SVV BOC FW WIsonvilleOR97070 INSURER B: Federal Insurance Company 20281 INSURERC: Stan lndemnl &Liabili Company 38318 INSURER D: 8/1/2017 SU ER : COVERAGES HSWH001 CERTIFICATE NUMBER: 14861928 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. INSR LT TYPE OF INSURANCE ADDL INSD SUBR I POLICY NUMBER POLICY EFF ID POLICY EXP MWD LIMBS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y Y PPK1688659 8/1/2017 8/1/2018 EACH OCCURRENCE 1,000,000 PREMISETO Esoccurrenre 100,000 MED EXP An one man)e10,000 PERSONAL& ADV INJURY $ 1000 000 GENT AGGREGATE LIMIT APPLIES PER: =1:1 JEOT E] LOC GENERAL AGGREGATE $2000000 PRODUCTS AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY X ANY AUTO AUTOS ONLY AUTOSULED NON -OWNED AUTOS ONLY AUTOS ONLY n N N 54309479 8/1/2017 811;2018 COMBINED LIMIT $2000000 BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident $ =Y=HIRED PROPERTYDAMAGE Perauiden [ $ XXXXXXX $XXXXXXX C UMBRELLALIAB X EXCESS LIMB X I OCCUR CUU.'N ADE N N 1000023850 8/1/2017 8/1/2018 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DEO I I RETENTION $ I $ XxXXXXX B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN AN OFFlCERIME BER"CLUDEOi C�I� N❑ IMantlatorylnflu If ye%de dnbe under DESCRIPTION OF OPEMTIONS below NIA 1' 54309480 7/29/2017 8/1/2018 X STATUTE ER E.L. EACH ACLIOENi $ 1,000,000 E.L. DISEASE - EA EMPLOYEE Is 1,000,000 E.L. DISEASE- POLICY LIMIT I a 1,000.000 DESCRIPTION OF OPERATIONS / LOCATIONS I 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 Schedule CCK I IFIGA 1 t KULUhK GANGLLLAIIUN See AttactimentS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 4861926 AUTHORIZED REPRESENTATIVE The Costa Nbsa taryOistrid 628 W. 19th S11Ed Costa Masa 0492627 ACORD 25 (2016/03) ©1 88-201 C D CORPORATION. All rights reserved rhe ACORD name and logo are registered marks of ACORD The City of Costa Mesa, The Costa Mesa Sanitary District and its elected and appointed boards, officers, agents, volunteers, and employees are additional insureds on the 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: 14861928 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 11 - 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 20 10 04 13 Attachment Code: D532712 Master ID: 1432958, Certificate ID: 14861928 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 CG 20 10 04 13 Attachment Code : D532712 Master ID: 1432958, Certificate ID: 14861928 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 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: 14861928 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: 14861928