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Insurance - EBS General Engineering 2017-10-03ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE10/03/2003/20IYYYY) 17 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(les) 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 LIC #OE28842 1-949-756-4100 CONTACT Kathryn Lopez Invensure Insurance Brokers, Inc. PHONE,969-756-4123 F'ix 969-756-4199 ac xo: E4AIL ADDRESS- klopez@inV6.S.re.Dnm 17991 Cowan _ __ _ INBURERISI AFFORDINGCOVERAGE NAICS TB2-Z91-454286-017 INSURERA: LIBERTY NOT FIRE INS CO 23035 Irvine, CA 92614 INSURED INSURER B: FIRST LIBERTY INS G IiP 33588 EBS General Engineering, Inc. INSURER C: LIBERTY INS CORP 42404 INSURER D: 1320 E. Sixth St. #100 INSURER E : INSURERF: Corona, CA 92879 rKa7a:7-TH:&�ii4 A iIa18YA1:1: !J:14 1 • INATIMU7,rD1l,I:T�;� 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. INGR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF HP POLICY EXP MMIDDIY/YY LIMITS A XCOMMERCM1lGENERALL1A81LITY TB2-Z91-454286-017 09/28/17 09/28/18 EACHOCCURRENCE $ 1,000,000 CLAIMS -MADE 1XI OCCUR DAMAGE TO RENTED PREMISES IFa owrnnnw $ 100,000 MEDEXP(Anyone Person) $ 5,000 X $2,500 Deductible PERSONAL S ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERA -AGGREGATE $ 2,000,000 POLICY [X] jEG'T 1:1 LOC PRODUCTS - OOMPIOP AGG $ 2,000,000 $ -- OTHER: B AUTOMOBILELUBIL" AS6-Z91-454286-027 09/28/17 09/28/18 COMBINED SINGLE LIMIT Ea amidenl E 1,000,000 BODILY INJURY (Per Person) $ X ANY AUTO OWNED SCHTOB AUTOSONLY AUEOULEO BODILY INJURY (Pe eccltlent) $ PROPERTYDAMAGE Per amidenl f X HIRED X NON OWNED AUTOS ONLY AUTOS ONLY C X UMBREUALIAB X OCCUR TH7-Z91-454206-047 09/20/17 09/28/18 EACH OCCURRENCE g 4,000,000 AGGREGATE f 4.000,000 EXCESS LIAR CLAIMS MADE f DEO I X I RETENTION$ 10,000 A AND EMPLOYERS' AND EMPLOYER ELIABILITY LIABILITY ANYPROPRIETOWPARTNERIEXECUTIVE y OFFICERIMEMBEREXCLUDEDT NIA X NC2-Z91-454286-037 09/28/17 09/28/18 X STATUTE ERH E. L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEEI — -"—'-- f 1,000,000 (MandatorylnNH) If yes. d.wnee antler DESCRIPTION OF OPERATIONS DN. E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AUdlUonal Remade SCAadulo, may W mU.I ni it mon specs Ia mqulrod) --Additional insured form CG2037 04 13 a CG2010 04 13 4 blanket NC waiver of subrogation # WC040306 4/84 are attached. Primary wording CG 20 01 04 13 applies per attached. ••Costa Mesa Sanitary District, its directors, officials, officers, employees, agents and volunteers are additional insureds. Project: Sewer Manhole Surface Repair Program - Phase II ; Project # 311 EBS Job #15110 Mesa Sanitary District 628 M. 19th St. Mesa, CA 92627 ACORD 25 (2015103) klopez 51067588 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORMEDREPRESENTATIVE USA 1 '6Y v i"^ ®1988.2015 ACORD CORPO The ACORD name and logo are registered marks of ACORD All rights reserved. C O M rsa�..en�x¢ WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2.0% of the California workers' compensation premium otherwise due on such remuneration. Schedule Additional premium is a percent of the California Manual Workers Compensation premium. Subject to a minimum premium charge of $ 250 Person or Organization Job Description Where required by contract or written Any agreement prior to loss and allowed by law. Issued by Co 2 - Liberty Mutual Fire Insurance Company For attachment to Policy No. WC2-Z91-454286-037 Effective Date 09/28/2017 Premium $ Issued to EBS General Engineering Inc. WC O4 03 06 Ed. 04/1984 0] w 0 pll.'. POLICY NUMBER: TB2-Z91454286-017 COMMERCIAL GENERAL LIABILITY CG 2010 0413 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 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; or 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. 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: CG 2010 0413 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" 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. 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 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. © ISO Properties, Inc., 2012 Page 1 of 2 0 w 0 v�11". ,wz SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations All Persons or organizations with whom you have All locations as required by written contract or entered into a written contract or agreement, prior to agreement entered into prior to an 'occurrence" an "occurrence" or offense, to provide additional or offense. insured status. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 2010 0413 © Insurance Services Office, Inc., 2012 Page 2 of 2 vsxr�wm�.¢ POLICY NUMBER: TB2-Z91-454286-017 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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) Or Or anization s Location And Description Of Completed Operations All Persons or organizations with whom you have All locations as required by written contract or entered into a written contract or agreement, prior agreement entered into prior to an 'occurrence" or to an 'occurrence" or offense, to provide additional offense. insured status 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" or "property damage" caused, in whole or in part, by .your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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 37 0413 B. 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 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. C Insurance Services Office, Inc., 2012 Page 1 of 1 t. vsuux,>nwz Policy No. TB2-Z91-454286-017 COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement moaifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution frcm any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance, and CG 20 0104 13 (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. © Insurance Services Office, Inc., 2012 Page 1 of 1