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Insurance - Tecta America 2018-02-27ACORO' CERTIFICATE OF LIABILITY INSURANCEDATE(MWDDNYYY) `� 3/31/2019 1 2/27/2018 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 LoCkton IrISLEtanCe Brokers LLC 725$. Ft}JBfUB .�f, 3'5111 F1' CO3Ljoanse#0F15767 LOS ACA SM17 (213) 6ffiaffi CONTACT NAME: EaRcElEAIC No, Ext): A/C, No): E-MAIL ADDRESS INSURERISE, AFFORDING COVERAGE INSURERA: Starr Indemnity&Liabili Company 38318 f INSURED Tecta Anle(ICa Sadt1ern CdifOnYa, Inc.INSURER 1378672 1217 East Vd kdlarn AMerlue Santa Aria CA92705 B: American Guarantee and Liab. Ins. CD. 26247 INSURER C: INSURER D: 3/31/2018 INSURER F COVERAGES TECAM22 CERTIFICATE NUMBER: 15152998 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 LM TYPE OF INSURANCE ADDL S SUER POLICY NUMBER POUCYEFF PO ICYEXP LIMITS A X COMMERCUIL GENERAL LM EL" CLAIMS -MADE OCCUR Y Y 1000025369181 3/31/2018 3/31/2019 EACH OCCURRENCE 2,000,000 DAMAGE TO RENTED 2,000,000 PREMISES Ea occurrence MED EXP An oneperson) 10,000 PERSONAL 8 ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: }{ POLICYF—]PEO 71 LOC OTHER: GENERALAGGREGATE $ 4,000,000 PRODUCTS -COMP/OPAGGs4000000 $ A AUTOMOBILE LIABILITY X ANY AUTO AUTOS ONLY SCHEDULED AUTOS ONLY AUTOS ONLDY Y Y SISIPCA08289418 3/31/2018 3/31/2019 COMBINED ISINGLE LIMIT $ 2,000,000 BODILY INJURY (Per person) $ Y'X'X'Y')( X BODILY INJURY (Per accident $ )CXXXXXX PerOaecden�AMAGE $ XXXXXXX $ xxXxxxx $ UMBRELLA LMB X EXCESS LIAII X OCCUR CLAIMS -MADE N N SXS-9242436-06 3/31/2018 3/31/2019 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED RETENTION$ $ XXXXXXX A A A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER,EXECUTNE ❑ OFPICERIMEMBER EXCLUDED? N IMandstantaNH) DESCRIPTION OF OPERATIONSbelav N / A Y WC 100 0001352 AOS WC 1000001662 AOS WC 100 0002637 FL& A) WC 100000263$ WI) 3/31/2018 3/31/2018 3/31/2018 3/31/2018 3/31/2019 3/31/2019 3/31/2019 3/31/2019 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 EL.DISEASE- EAEMPLOYEE 1,000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be allached if more space is required) RE: Roofing services provided under under agreement dated 1-25-18 for CMSD Headquaners, Costa Mesa Sanitary District, 290 Paularino Avenue, Costa Mesa, CA 92626. DISTRICT, its directors, officials, officers, employees, agents and volunteers with respect to the work performed by or on behalf of CONTRACTOR are Additional Insured(s) as per the attached endorsement or 9olicy language. Insurance provided m respect is primary and non-contributory as per the attached endorsements or policy language. Waiver of subrogation applies as per the attached endorsements or policy language. RECEIVED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MAR 2 3 2018 ACCORDANCE WITH THE POLICY PROVISIONS. 15152998 AUTHORIZED REPRESENTATIVE Coda mesa Sanitary Dismot Costa Mesa Sanitary District Attn: David Griffin Crstarvti?sacA92626 n •; r I plpffKII[if 133 o711'R1*.&][ 11to2-TeieNeI"163.1 lel[TtVlei al_t 111TIM. The ACORD name and logo are registered marks of ACORD Attachment Code: D530070 Certificate ID : 15152998 POLICY NUMBER: 1000025369181 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 Or anization s Locations Of Covered Operations Where required by a written contract Where required by a written contract 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, C. 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: 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 However: 2. That portion of "your work" cut of which the injury or damage arises has been put to its 1. The insurance afforded to such additional insured intended use by any person or organization only applies to the extent permitted by law; and other than another contractor or subcontractor engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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 © ISO Properties, Inc., 2012 Page 1 of 2 D. With respect to the insurance afforded to these 2. Available under the applicable Limits of Attachment Code : D530070 Certificate ID : 15152998 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 © ISO Properties, Inc., 2012 Page 2 of 2 Attachment Code: D495199 Certificate ID: 15152998 Starr Indemnity & Liability Company Dallas, TX 1-866-519-2522 Primary and Non -Contributory Condition Policy #: 1000025369181 Effective Date: 3/31/2018 Named Insured: TECTA AMERICA CORP. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. SECTION IV — CONDITIONS, condition 4. Other Insurance is amended as follows: 1. The following is added to paragraph 4.a. of the Other Insurance condition: This insurance is primary insurance as respects our coverage to the additional insured, where the written contract or written agreement requires that this insurance be primary and non-contributory. In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured is a Named Insured. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Signed for STARR INDEMNITY & LIABILITY COMPANY OG 107 (04/11) Page 1 of 1 Copyright © C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. POLICY NUMBER: 1000025369181 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 to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 Attachment Code : D494730 Certificate ID : 15152998 © Insurance Services Office, Inc., 2008 Page 1 of 1 Attachment Code: D530170 Certificate ID : 15152998 POLICY NUMBER: SISIPCA08289418 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modified insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Tecta America Corp. Endorsement Effective Date: 3/31/2018 SCHEDULE Name Of Person(s) Or Organization(s): WHERE REQUIRED BY WRITTEN CONTRACT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph 13.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 Starr Indemnity & Liability Company Dallas, TX 1-866-519-2522 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INSURANCE PRIMARY AS TO CERTAIN ADDITIONAL INSUREDS Policy Number: SISIPCA08289418 Effective Date: 3/31/2018 Named Insured: Tecta America Corp. This policy is amended as follows: BUSINESS AUTO COVERAGE FORM Section IV- Business Auto Conditions, B., General Conditions, 5., Other Insurance, c., is amended by the addition of the following sentence: The insurance afforded under this policy to an additional insured will apply as primary insurance for such additional insured where so required under an agreement executed prior to the date of accident. We will not ask any insurer that has issued other insurance to such additional insured to contribute to the settlement of loss arising out of such accident. All other terms and conditions remain unchanged. SICA 1017(02/12) Page 1 of t Copyright © C. V. Starr & Company and Starr Surplus Lines Insurance Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. Attachment Code: D501440 Certificate ID: 15152998 Attachment Code : D530063 Certificate ID : 15152998 POLICY NUMBER: SISIPCA08289418 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Tecta America Corp. Endorsement Effective Date: 3/31/2018 Name(s) Of Person(s) Or Organization(s): Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurence of loss. com The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident' or the "loss" under a contract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 Attachment Code: D495200 Certificate ID : 15152998 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 the Schedule. SCHEDULE Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. 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: 3/31/2018 Endorsement No. Insured: Tecta America Corp. Premium WC 00 03 13 Copyright 1983 National Council on Compensation Insurance. Page I of I (Ed. 4-84)