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Insurance - South County Air, Inc. - 2017-09-26 DATE(MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 09/26/2017 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 policy(ies)must 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 CONTACT NAME: Automatic Data Processing Insurance Agency,Inc. PHONE Eat): FAX No): 1 Adp Boulevard ADDRIESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: NorGUARD Insurance Company 31470 INSURED INSURER B: SOUTH COUNTY AIR INC. INSURER C: 1300 AVENIDA VISTA HERMOSA STE 100 San Clemente,CA 92673 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 750728 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO $ CLAIMS-MADE OCCUR PREMISES EaEN1Eoccu ence ) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO LOC PRODUCTS-COMP/OP AGG $ JECT _ OTHER: AUTOMOBILE LIABIUTY - COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATIONX PER OTH- AND EMPLOYERS'LIABILITY Y I N • STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? Y N/A N SOWC707186 10/21/2016 10/21/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa Sanitary District ACCORDANCE WITH THE POLICY PROVISIONS. 290 Paularino Avenue Costa Mesa,CA 92626 (91f1 AUTHORIZED REPRESENTATIVE A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Policy Number: Date Entered: 9/19/2017 ACORU® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 9/19/2017 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 policy(ies)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 CONTACT McFarland Insurance Agency NAME: 30110 Crown Valley Parkway, Ste 205 PHONE .No. E:t): (949)388-2424 (A/C No); (949)388-1101 ADDRESS: marcene@mcfarlandins.com Laguna Niguel, CA 92677 INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Security National Insurance Company/ 33120 INSURED South County Air Conditioning and Heating, Inc•INSURERB:Wesco Insurance Company/ 25011 Jim and Lisa Kopp INSURER C: 26 Via Lucerna INSURER D: San Clemente, CA 92673 INSURERE: • INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD AND POLICY NUMBER (MMIDDIYYYY) (MM/DDIYYYY) LIMITS XCOMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE OCCUR X X PREMISES(Ea occurrence) $ 100,000 NA105222104 03/18/2017 03/18/2018 MED EXP(Anyone person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X jE 7 LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED '.09/11/2017 09/11/2018 BODILY INJURY Per accident) $ B § AUTOS ONLY AUTOS WPP1582737 • HIRED NON-OWNED I PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY (Per accident)• $ UMBRELLA(IAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEO RETENTION$ _ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S • l I I � DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) District its directors, offcials, officers, employees, agents and volunteers shall be covered as additional insureds with respect to the work or operations performed by or on behalf of the consultant, including materials, parts, or equipment furnished in connection with such work and insurance shall be primary insurance as respects District, its directors, officails, officers, employees, agents and volunteers or if the excess shall stand in an unbroken chain of coverage excess of the consultants scheduled underlying coverage. CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District 290 Paularino Avenue SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa, CA 92626 ��j' ACCORDANCE WITH THE POLICY PROVISIONS. II AUTHORIZED REPRESENTATIVE 7/1(C, 3"0,10,k_ • ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software. www.FormsBoss.com; Impressive Publishing800-208-1977 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSUREDS - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Policy Number: NA105222104 Endorsement Effective: 3/18/2017 12:01 a.m. Named Insured Countersigned y: 4 SOUTH COUNTY AIR CONDITIONING AND HEATING INC,DBA: SOUTH COUNTY AIR CONDITIONING AND HEATING INC SCHEDULE Any poerson ooP o°rgamza ons a't the named insured is obligated by virtue of a written contract or agreement to provide insurance such as is afforded by this policy. Location: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II—Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions 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 site of the covered operations has been completed; or (2) That portion of"your work"out 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. C. The words"you"and "your"refer to the Named Insured shown in the Declarations. D. "Your work" means work or operations performed by you or on your behalf; and materials, parts or equipment furnished in connection with such work or operations. Primary Wording If required by written contract or agreement: Such insurance as is afforded by this policy shall be primary insurance, and any insurance or self-insurance maintained by the above additional insured(s)shall be excess of the insurance afforded to the named insured and shall not contribute to it. Waiver of Subrogation If required by written contract or agreement: We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of "your work" done under a contract with that person or organization. 49-0108 07 11 May Include Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 1 Used with permission Progressive RDT1 8/25/2017 7:36: 15 PM PAGE 2/003 Fax Server Progressive PROGRESS/UE� PO Box 94903 COMMERCIAL Cleveland,OH 44101 1-800-444-4487 Policy number: 02397622-3 Underwritten by: Progressive Express Ins August 25,2017 Page 1 of 2 Certificate of Insurance Certificate Holder Additional Insured COSTA MESA SANITARY DISTRICT 290 PAULARINO AVE COSTA MESA,CA 92626 Insured Agent SOUTH COUNTY AIR CONDIT USAA INS AGCY INC AND HEATING INC 9800 FRDRCKSBRG HSVCW 26 VIA LUCENA SAN ANTONIO,TX 78288 SAN CLEMENTE,CA 92673 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s)indicated. This Certificate is issued for information purposes only, It confers no rights upon the certificate holder and does not change,alter,modify,or extend the coverages afforded by the policies listed below. The coverages afforded by the policieslisled below are subject to all the terms,exclusions,limitations,endorsements, and conditions of these policies. Policy Effective Date: Sep 11,2016 Policy Expiration Date: Sep 11,2017 Insurance coverage(s) Limits Bodily Injury/Property Damage $1,000,000 Combined Single Limit Uninsured/Underinsured Motorist $1,000,000 Combined Single Limit Description of LocationNehicles/Special Items Scheduled autos only 2004 FORD F250 1FTNX20P54EB41097 Medical Payments $5,000 Roadside Assistance Selected 2001 FORD F250 3FTNX20L31MA86927 Medical Payments $5,000 Comprehensive $1,000 Ded Collision $1,000 Ded Rental Reimbursement $30 Per Day($900 Max) Roadside Assistance Selected 2013 NON OWNED TRAILER N/A 2016 FORD F250 1FT7W2B66GEA82548 Medical Payments $5,000 Comprehensive $1,000 Ded Collision $1,000 Ded Contin Progressive RDT1 8/25/2017 7:36: 15 PM PAGE 3/003 Fax Server Policy number: 02397622-3 Page 2 of 2 Rental Reimbursement $30 Per Day($900 Max) Roadside Assistance Selected Certificate number 23717A10622 Please be advised that additional insureds and loss payees will be notified in the event of a mid-term cancellation. Form524100/02) ill PROGRESSIVE PROGRESS/YE PO BOX 94739 COMMERCIAL CLEVELAND,OH 44101 Policy number: 02397622-3 Underwritten by: Progressive Express Ins Insured: COSTA MESA SANITARY SOUTH COUNTY AIR CONDIT 290 PAULARINO A COSTA MESA,CA 92626 August 26,2017 Policy Period:Sep 11,2016-Sep 11,2017 Mailing Address Progressive Express Ins PO Box 94739 Additional insured endorsement Cleveland,OH 44101 1-800-444-4487 Name of Person or Organization For customer service,24 hours a day, COSTA MESA SANITARY 7 days a week 290 PAULARINO A COSTA MESA,CA 92626 The person or organization named above is an insured with respect to such liability coverage as is afforded by the policy,but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page. Limit of Liability Bodily Injury Not applicable Property Damage Not applicable Combined Liability $1,000,000 each accident All other terms,limits and provisions of this policy remain unchanged. This endorsement applies to Policy Number:02397622-3 Issued to(Name of Insured):SOUTH COUNTY AIR CONDIT AND HEATING INC Effective date of endorsement:08/25/2017 Policy expiration date: 09/11/2017 Form 1198(01/04) Security National Insurance Company - Company Profile - Best's Credit Rating Center Page 1 of 3 A.M. Best Rating Services Security National Insurance Company u A.M.Best#:002522 NAIC#:19879 FEIN#:756020448 Mailing Address View Additional Address Information gmeYl ~ P.O.Box 650771 Dallas,TX 75265-0771 United States Assigned to insurance companies that have,in our opinion,an excellent ability Web:www.amtrustgroup.com to meet their ongoing insurance Phone:800-777-2249 obligations. Fax:214-360-8097 View additional news,reports and products for this company. Based on A.M.Best's analysis,051002-AmTrust Financial Services,Inc is the AMB Ultimate Parent and identifies the topmost entity of the corporate structure.View a list of operating insurance entities in this structure. Best's Credit Ratings Financial Strength Rating View Definition Rating: A(Excellent) Affiliation Code: g(Group) Financial Size Category: XV($2 Billion or greater) Outlook: Negative Action: Affirmed Effective Date: February 27,2017 Initial Rating Date: June 30, 1927 i F Long-Term Issuer Credit Rating View Definition Long-Term: a Outlook: Negative Action: Affirmed Effective Date: February 27,2017 Initial Rating Date: April 28,2006 u Denotes Under Review Best's Rating Best's Credit Rating Analyst Rating Issued by:A.M.Best Rating Services,Inc. Director:Jennifer Marshall,CPCU,ARM Senior Director:Michael J. Lagomarsino,CFA,FRM Disclosure Information View A.M.Best's Rating Disclosure Form Ste' A.M. Best Revises Outlooks to Negative and Affirms Credit Ratings of AmTrust Financial Services,Inc.and Its Subsidiaries v February 27,2017 Rating History A.M.Best has provided ratings&analysis on this company since 1927. http://www3.ambest.com/ratings/entities/CompanyProfile.aspx?ambnum=2522&URatingl... 8/30/2017 Company Profile Page 1 of 2 CALIFORNIA DEPARTMENT OF INSURANCE COMPANY PROFILE Company Profile Company Search Company Information Company Search Results SECURITY NATIONAL INSURANCE COMPANY Company 800 SUPERIOR AVENUE Information CLEVELAND, OH 44114-2613 Old Company 800-777-2249 Names Agent for Service Old Company Names Effective Date Reference Information SECURITY NAT'L F INS CO 12/20/1954 NAIC Group List Lines of Business Agent For Service Workers' KARISSA LOWRY Compensation 2710 GATEWAY OAKS DRIVE Complaint and SUITE 150N Request for SACRAMENTO CA 95833 Action/Appeals Contact Information Financial Statements Reference Information PDF's Annual Statements NAIC #: 19879 Quarterly Statements California Company ID #: 0857-3 Company Complaint Date Authorized in California: 09/27/1943 Company Performance& License Status: UNLIMITED-NORMAL Comparison Data Company Company Type: Property&Casualty Enforcement Action State of Domicile: DELAWARE Composite Complaints Studies Additional Info back to top Find A Company Representative In NAIC Group List Your Area View Financial Disclaimer NAIC Group #: 2538 AmTrust NGH Grp Lines Of Business The company is authorized to transact business within these lines of insurance. For an explanation of any of these terms, please refer to the glossary. AUTOMOBILE BURGLARY COMMON CARRIER LIABILITY FIRE LIABILITY MARINE MISCELLANEOUS PLATE GLASS SPRINKLER SURETY TEAM AND VEHICLE WORKERS'COMPENSATION Il https://interactive.web.insurance.ca.gov/companyprofile/companyprofile?event=companyP... 8/30/2017