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Insurance - Utility Systems Science and Software Inc. 2017-09-29AR H CERTIFICATE OF LIABILITY INSURANCE DATE/29/2D7"m) 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. 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 Garrett/Mosier/Griffith/Sistrunk Risk Management & Insurance Services 12 Truman Irvine, CA 92620 CONTACT NAME: Ashley Brewster PHONE 949-559-3377 aC No): 949-559-6703 E-MAILs: ashle b m s.com INSURER3 AFFORDING COVERAGE NAICk INSURERA: Admiral Insurance Company / 24656 www,'gmgs.com OB84519 INSURED Utility Systems Science and Software, Inc. dba Sewer Monitoring Traffic Services INSURER B: Continental Insurance Com an/ 35289 INSURERC: Insurance Company of the West 27647 INSURER D: 601 N. Parkcenter Drive, Suite 209 Santa Ana CA 92705 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 38131817 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 LTR TYPE OF INSURANCE.L= ADDLSUBR 2811L POLICY NUMBER POLICY EXP MWDDIYYYY LIMITS A COMMERCIAL GENERAL LIABILITY C000000021215 3/28/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR PREMSES EaEoccu ante $ 50,000 MED EXP (Any one person) $ 5,000 7 PERSONAL B ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GEN'L POLICY D PRO- ❑ JECT LOC PRODUCTS - COMP/OP AGO $ 2,000,000 OTHER: B AUTOMOBILE LIABILITY 6024061042 3/20/2017 -$ 3/20/2018 COMBINED MBIEa ED1SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ ✓ ANY AUTO OWNED ASCHEDULED AUTOS ONLY UTOS BODILY INJURY (Per acciaccident)$ PROPERTY DAMAGE $ Per accident ✓ HIREDNON-OWNED AUTOS ONLY ✓ AUTOS ONLY $ UMBRELLA LIAR H OCCUR EACHOCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANYPROPRIETOR/PARTNER/EXECUTIVE WSD500697806 10/1/2017 10/1/2018 ,/ STATUTE ETH E.L. EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUDED9 ❑ NIA E.L DISEASE - EA EMPLOYEE $ 1000,000 (Mandatory in NH) If yes, describe under DE SCRIPTION OF OPERATIONS below EL.DISEASE - POLICY LIMIT $ 1,000,000 A Professional Liability C000000021215 3/28/2017 3/28/2018 $1,000,000 Limit of Insurance Claims Made $5,000 Deductible Per Claim Retroactive Date: 03/28/2003 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached a more space is required) All operations of the named insured subject to the terms and conditions of the policies. As respects General Liability coverage, Costa Mesa Sanitary District, its directors, officials, officers, employees, agents and volunteers are added as Additional Insureds per CG20100413 and CG20370704 attached and this insurance is primary per AD06571203 attached. As respects Workers' Compensation coverage, a Waiver of Subrogation is hereby included per WC990634 attached. As respects General Liability coverage, 30 -day written notice of cancellation (10 days for non-payment of premium) applies per IL00171198 attached. Costa Mesa SanitaryDistrict SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 290 Paularino Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa CA 92626 AUTHORIZED REPRESENTATIVE Griff Griffith ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION- All rinhis resBrvo The ACORD name and logo are registered marks of ACORD 30131817 1 17-18 A/G/U/Ek0/WC I Ashley Brewster 19/29/2017 2:98:17 PM (PGT) I Page 1 of 8 Utility Systems Science and Software, Inc. dba Sewer Monitoring Traffic Services Policy Number: C000000021215 CG 20 10 04 13 Effective Date: 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) 2. If coverage provided to the additional insured is Or Organization(s) Locations Of Covered Operations Any person or organization that is an owner of real property All locations at which the Named Insured is performing or personal property on which you are performing ongoing ongoing operations. opera -tions, or a contractor on whose behalf you are contract or agreement to provide for such additional performing ongoing operations, but only if coverage as an insured. additional insured is required by a written contract or written agreement that is an "insured contract', and provided the "bodily injury" or "property damage" first occurs, or the "personal and adver-using injury" offense is first committed, subsequent to the execution of the contract or agreement 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 2. If coverage provided to the additional insured is as an additional insured the person(s) or organization(s) required by a contract or agreement, the insurance shown in the Schedule, but only with respect to liability afforded to such additional insured will not be for "bodily injury", "property damage" or "personal and broader than that which you are required by the advertising injury" caused, in whole or in part, by: contract or agreement to provide for such additional 1. Your acts or omissions; or insured. 2. The acts or omissions of those acting on your be- half; 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 CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page I of 2 ❑ 38131810 1 17-10 A/G/U/E&O/WC I Ashley Brewster 1 9/29/2017 2:90:17 PM (PDT) I Page 2 of 8 B. With respect to the insurance afforded to these addi- tional insureds, the following additional exclusions ap- ply: 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 pro- ject (other than service, maintenance or repairs) to be performed by or on behalf of the additional in- sured(s) at the location 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 con- tractor or subcontractor engaged in performing op- erations for a principal as a part of the same project. CG 20 10 04 13 C. With respect to the insurance afforded to these addi- tional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is re- quired by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of in- surance: 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 Lim- its of Insurance shown in the Declarations. C Insurance Services Office, Inc., 2012 38131817 117-18 A/G/U/E&O/WC I Ashley Brewster 19/29/2017 2:98:17 PM (POT) I Page 3 of 0 Page 2 of 2 ❑ Utility Systems Science and Software, Inc. dba Sewer Monitoring Traffic Services Policy Number: C000000021215 CG 20 37 04 13 Effective Date: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Or Or anization s Completed Operations Any person or organization that is an owner of real property All locations except locations where "your work" is or was or personal property for whom you work or have worked, or related to a job or project involving single-family dwellings, a contractor on whose behalf you work or have worked, but multi -family dwellings (other than rental apartments in an only if coverage as an additional insured extending to apartment building: (a) originally constructed and at all "bodily injury" or "property damage' included in the times used for such purpose, or (b) converted from a "products -completed operations hazard" is required by a commercial building), condominiums, townhomes, written contract or written agreement that is at.. "insured townhouses, time-share units, fractional -ownership units, contract" and provided that the "bodily injury" or "property cooperatives and/or any other structure or space used or damage' first occurs subsequent to the execution of the intended to be used as a residence. contract or agreement. 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 in- clude as an additionalinsured the person(s) or organi- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury' or "property damage" caused, in whole or in part, by "your work" at the lo- cation designated and described in the Schedule of this endorsement performed for that additional in- sured and included in the "products -completed opera- tions hazard". However: CG 20 37 04 13 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 addi- tional insured. © Insurance Services Office, Inc., 2012 38131917 1 17-18 A/G/U/EW/WC I Ashley Brewster 1 9/29/2017 2:48:17 PM (PDT) I Page 4 of B Page 1 of 2 ❑ B. With respect to the insurance afforded to these addi- tional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is re- quired by a contract or agreement, the most we will pay on behalf of the additional insured is the amount ofinsurance: 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. CG 20 37 04 13 © Insurance Services Office, Inc., 2011 Page 2 of 2 ❑ 38131817 1 17-10 A/G/U/ELO/WC I Ashley BeewaCaP 1 9/29/2017 2:48:17 PM (PDT) I Page 5 of 8 Utility Systems Science and Software, Inc. dba Sewer Monitoring Traffic Services 0000000021215 Policy Number: AD 06 57 12 03 Issued Date: 3/28/2017 - Effective Date: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARYAON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE ANY PERSON OR ORGANIZATION QUALIFYING AS AN INSURED UNDER THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS ENDORSEMENT FORM CG 20 10 07 04 ATTACHED TO THIS POLICY. It is agreed that Commercial General Liability Coverage 2) Who requires by specific written contract that this Form CG 00 01 Section IV paragraphs 4.b. and 4.c. do not insurance is to be primary and/or non-contributory apply with respect to other valid and collectible Commer +-, to other valid and collectible insurance available to cial General Liability insurance, whether primary or excess, _.. that person or organization. available to the person or organization shown in the Sched- ule and: This endorsement does not change the scope of coverage provided to the person or organization by any Additional 1) Who is an insured under an Additional Insured- Insured endorsement. Owners, Lessees or Contractors endorsement at- tached to this policy; and AD 06 57 12 03 All other terms and conditions remain unchanged. 38131817 1 17-18 A/G/U/E&O/WC I Ashley Brewster 19/29/201] 2:98:17 PM (PDT) I Page 6 of 8 Page I of 1 Utility Systems Science and Software, Inc. dba Sewer Monitoring Traffic Services COMMON POLICY CONDITIONS All Coverage Parts Included in this policy are subject to the following conditions. A- Cancellation 1. The first Named Insured shown in the Declara- tions may cancel this policy by mailing or deliv- ering to us advance written notice of cancella- tion. 2. We may cancel this policy by mailing or deliver- ing to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancel- lation if we cancel for nonpayment of pre- mium; or b. 30 days before the effective date of cancel- lation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last, mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy Is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be ef- fective even if we have not made or offered a refund. B. If notice Is mailed, proof of mailing will be suffi- cient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the Insurance afforded. The first Named Insured shown in the Declarations Is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C. Examination Of Your Books And Records We! may examine and audit your books and re- cords as they relate to this policy at any time dur- Ing the policy period and up to three years atter- wa rd. D. Inspections And Surveys 1. We have the right to: a. Make inspections and surveys at any time; IL 00 17 11 98 IL 00 17 11 98 b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any inspections, surveys, reports or recommendations and any such actions we do undertake relate only to in- surability and the premiums to be charged. We do not make safety inspections. We do not un- dertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes in- surance Inspections, surveys, reports or rec- ommendations. 4. Paragraph 2. of this condition does not apply to any inspections, suiveys, reports or recom- mendations we may make relative to certifica- tion, under state or municipal statutes, ordF nances or regulations, of boilers, pressure ves- sels or elevators. E. Premiums The first Named Insured shown in the Declara- tions: 1. Is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay - F. Transfer Of Your Rights And Duties Under'rbis Policy Your rights and duties under this policy may not be transferred without our written Consent except in the case of death of an individual named insured. If you die, your rights and duties will he transferred to your legal representative but only while acting within the scope of duties as your legal representa- tive. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. Copyright, insurance Services Office, Inc., 1998 38131819 1 17-18 A/G/U/E&O/WC I Ashley Brewster 19/29/2017 2;48:17 PM (PDT) I Page 7 of 8 Page 1 of 1 O WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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). The additional premium for this endorsement shall be otherwise due. Person or Organization ANY PERSON OR ORG FOR WHOM THIS WAIVER IS REQUIRED 3 % of the total California Workers' Compensation premium Job Description ALL CALIFORNIA OPERATIONS 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 Effective 10/1/2017 Policy No. WSD500697806 Endorsement No. Insured Utility Systems Science and Software, Inc. Premium $ INCL. Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. 8-00) NSURM 38131817 17-18 A/G/U1660/WC I Aahley Brewster 19/29/2017 2:48:19 PM (PDT) i Page 8 of 8