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Insurance - 2018-05-30
A� o® CERTIFICATE OF LIABILITY INSURANCE DDiyyYY DATE D19 ) 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 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 Wood Gutmann & Bogart 15901 Red Hill Ave., Suite 100 Tustin CA 92780 CONTNAME ACT Jackie Murch _ PHONE 714-505-7000 FAX Not:714-573-1770 JA1Zjh ) a REs � 'murch & w bib.com INSURERS AFFORDING COVERAGE NAIC # Y INSURER A: Kinsale Insurance Company 01000649034 INSURED C&RDR-1 C & R Drains, Inc INSURER B: Westchester Surplus Lines —' 1525 W. Macarthur Blvd.#11 INSURER C: INSURER D: Costa Mesa CA 92626 INSURER E INSURER F: DAMAGE T RENTED PREMISES Ea occurrence $10DOOD COVERAGES CERTIFICATE NUMBER: 1280104062 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 ADDLU MM D POLICY NUMBER MMI�DYIYYYY EXP MEFF M DY /YYl'Y LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 01000649034 4/11/2018 4/11/2019 EACH OCCURRENCE $1,000,000 CLAIMS -MADE � OCCUR DAMAGE T RENTED PREMISES Ea occurrence $10DOOD MED EXP (My one person) $excluded PERSONAL &AOV INJURY $1000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 Pi JET F_� LOC PRODUCTS - COMP/OP AGG $2.000,000 S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Par person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Par accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATIONPER 0TH AND EMPLOYERS' LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Po lution Liability G71117200001 4/1112018 4/11/2019 Aggregate Limit $2,000000 Deductible $2500 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Certificate holder is named as additional insured per the attached endorsements as required by written contract and subject to the terms & conditions of the policy: GL Additional Insured per Form CG20120509 GL 30 -day Notice of Cancellation per Form ADF9027 0418 GL Waiver of Subrogation per Form CAS4008 0110 GL Primary & Non -Contributory per Form CAS5001 0717 _ CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District / 290 Paularino /( AUTHORIZED REPRESENTATIVE �� , Costa Mesa CA 92626 t 1Yn7//frylll/'f� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SCHEDULE ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100064903-0 05/24/2018 12:01AM at the Named insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: $0 1 $0 Policy Change Number: 1 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETEDOPERATIONS LIABILITY COVERAGE SCHEDULE Name and Address of Additional Insured Person(s) or Organization(s): Costa Mesa Sanitary District, 290 Paularino Avenue, Costa Mesa CA 92626 A. SECTION R- WHO IS AN INSURED is amended to include any person or organization shown in the above Schedule as an Additional Insured but only for the vicarious liability imposed on the Additional Insured provided that such liability is caused by the sole negligent conduct of the Named Insured and is proximately caused by "your work" or "your product" for the Additional Insured. B. The insurance provided to the Additional Insured under this endorsement is limited as follows: 1. The insurance provided to the Additional Insured shall be excess with respect to any other valid and collectible insurance available to the Additional Insured unless the written contract specifically requires that this insurance apply on a primary and non-contributory basis, in which case this insurance shall be primary and non-contributory. 2. In the event the written contract requires Limits of Insurance in excess of the Limits of Insurance provided by this policy, the Limits of Insurance provided by this polity shall apply and not the limits required by the written contract. This endorsement shall not increase the Limits of Insurance stated in the Declarations of this policy. 3. This insurance does not apply to "bodily injury" or "property damage" arising out of "your work or "your product" included in the "products -completed operations hazard" unless you are required to provide such insurance by written contract. If required, then insurance is provided only for "bodily injury" or "property damage" that occurs during the policy period arising out of "your work" or "your product". 4. Where there is no duty to defend the Named Insured, there is no duty to defend the Additional Insured. Where there is no duty to indemnify the Named Insured, there is no duty to indemnify the Additional Insured. 5. This insurance does not apply to "bodily injury" or "property damage" arising out of: a. The sole negligence of the Additional Insured or any employee of the Additional Insured; or b. Any obligation of the Additional Insured to indemnify another because of damages arising out of such injury or damage. C. Duties of the Additional Insured in the event of "occurrence", claim or "suit": 1. The Additional Insured must promptly give notice of an "occurrence", a claim which is made or a "suit", to any other insurer which has insurance for a loss to which this insurance may apply. CASS0010717 Page 1 of 2 2. The Additional Insured must promptly tender the defense of any claim made or "suit "to any other insurer which also issued insurance to the Additional Insured as a Named Insured or to which the Additional Insured may qualify as an Additional Insured for a loss to which this insurance may apply. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS50010717 Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100064903-0 05/24/2018 12:01AM at the Named Insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: $0 $0 Policy Change Number: 1 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State or Governmental Agency or Subdivision or Political Subdivision: Costa Mesa Sanitary District, 290 Paularino Avenue, Costa Mesa, CA 92626 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". ALL OTHER TERMS AND CONDITIONS OFTHE POLICY REMAIN UNCHANGED. CG 20 12 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY TERMINATION NOTICE TO THIRD PARTY Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100064903-0 05/24/2018 12:01AM at the Named Insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: $0 1 $o Policy Change Number: 1 This endorsement modifies insurance provided under the following: ALL COVERAGE FORMS The CANCELLATION section of the CONDITIONS section of this Policy are amended by adding the following: SCHEDULE Notice of Policy Termination To: Costa Mesa Sanitary District, 290 Paularino Avenue, Costa Mesa CA 92626 If we send notice of termination of this policy to the insured, we will also send written notification of such termination to the person or organization shown in the Schedule above at the address shown above. We will mail this notice in accordance with the Cancellation and Nonrenewal terms and conditions of this policy. If notice is mailed, proof of mailing will be sufficient proof of notice. No policy rights are conferred to the person or organization shown in the Schedule above. Failure to provide notice as described in this endorsement shall impose no obligation or liability of any kind upon the Company. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. ADF9027 0418 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHER TO US Attached To and Forming Part of Policy Effective Date of EndorsementNamed Insured 0100064903-0 05/24/2018 12:01AM at the Named Insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: $0 1 $0 Policy Change Number: 1 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE SCHEDULE Name of Person or Organization: Costa Mesa Sanitary District, 290 Paularino Avenue, Costa Mesa CA 92626 SECTION IV — CONDITIONS, 8. Transfer of Rights of Recovery against Others to Us is amended by the addition of the following: 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 work' done under a written contract with that person or organization wherein you have agreed to provide this waiver. This waiver applies only to the person or organization shown in the Schedule above and only to the extent of written agreement. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS4008 0110 Page 1 of 1 ,aCERTIFICATE OF LIABILITY INSURANCE E (MsUDOfYYYf DAT5/1712018 ) 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 Wood Gutmann & Bogart 15901 Red Hill Ave., Suite 100 Tustin CA 92780 CONTNAME ACT Jackie Murch PHONE FAX . 714-505-7000 IAIC, Nal. 714-573-1770 E-MAILmurch bib.com INSURER(S) AFFORDING COVERAGE NAIC# Y INSURER A: Kinsale Insurance Company 01000849034 INSURED C&RDRA C & R Drains, Inc 1525 W. Macarthur Blvd.#11 INSURER B: Westchester Surplus Lines INSURER C: Nationwide Mutual Ins Co INSURER D: Costa Mesa CA 92626 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 1242296849 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. LTR OF INSURANCE ADDLTYPE 1= AL POLICY NUMBER POLICY EFF POLICY VIYYXYV LIMITS A X COMMERCMLGENERAL LIABILITY Y Y 01000849034 4/1112018 4/112019 EACH OCCURRENCE $1.000,000 CLAIMS -MADE FKOCCUR- RENTED PREMISES Ea occunen a $100,000 MED EXP (Any we person) $ excluded PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERA -AGGREGATE $2,00.000 POLICY JEa r-1 LOC PRODUCTS-COMP/OPAGG $2,000,000 $ OTHER: C AUTOMOBILE LL481UTY ACPBA3XX8736687 4/112018 4/1112019 COMBINED SINGLE LIMIT $ e accident)X BODILY INJURY (Per person) $ ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Perexident) $ PROPERTY DAMAGE P ra c'd $ X NON.OWNED HIREDAUTOS X AUTOS A X UMBRELLA LIAB X OCCUR 0100084915-0 4/112018 4/112019 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN PER OTH- TUTE ER ANY PROPRIETORIPARTNEWEXECUNVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) #yea describe under DE SCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ B Pollution Liability G71117200001 4/112018 4/112019 Each condition 1000,000 General Aggregate 2000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, AddlUonal Remarks Schedule, may be attached H more space Is required) Certificate holder(s) is/are named as additional insured per the attached endorsements as required by written contract subject to the terms & conditions of the policy: GL Additional Insured - Ongoing Operations Form CG2010 0704 GL Additional Insured - Completed Operations Form CG2037 0704 GL Waiver of Subrogation Form CAS4002 0110 GL Per Project Aggregate Form CAS4005 0310 CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District 290 Paularino AUTHORIZED REPRESENTATIVE Costa Mesa CA 92626 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100064903-0 04/11/2018 12:01AM at the Named Insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: $0 1 $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): Location(s) of Covered Operations Blanket, as required by 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; 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. 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" 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. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS Attached To and Forming Part of Policy Effective Date of EndorsementNamed Insured 0100064903-0 04/11/2018 12:01AM at the Named Insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: $0 person or persons. "New residential construction" does not 1 $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s) Location and Description of Completed Operations Blanket, as required by written contract. EXCLUDES ALL NEW RESIDENTIAL CONSTRUCTION "Your work" does not include "new residential construction", which means any building or structure not previously occupied, and designed or intended for occupancy in whole or in part as a residence by any person or persons. "New residential construction" does not include apartments or apartment buildings or assisted living facilities. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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' or "property damage' caused, in whole or in part, by "your work" at the location desig- nated and described in the schedule of this endorse- ment performed for that additional insured and in- cluded in the "products -completed operations hazard". ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US -BLANKET Attached To and Forming Part of Policy Effective Date of Endorsement d Insured 0100064903-0 04/11/201812:01AM at the Named Insured FC&ReDrainslnc address shown on the Declarations Additional Premium: Return Premium: 1 $0 $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE SECTION IV — CONDITIONS, S. Transfer of Rights of Recovery against Others to Us is amended by the addition of the following: We waive any right of recovery we may have against persons or organizations because of payments we make for injury or damage arising out of "your work" done under a written contract with that person or organization wherein you have agreed to provide this waiver. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS4002 0110 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY LIMITATION - AMENDED AGGREGATE PER PROJECT OR LOCATION Attached To and Forming Port of Policy Effective Dote of Endorsement Named Insured 0100064903-0 04/11/2018 12:01AM at the Named Insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: $0 1 $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE SCHEDULE General Aggregate applies to EACH LOCATION in the amount of: Total ALL LOCATIONS Aggregate Limit: General Aggregate applies to EACH PROJECT in the amount of: $2,000,000 Total ALL PROJECTS Aggregate Limit: $5,000,000 SECTION III — LIMITS OF INSURANCE —2, is amended by the addition of the following: d. The General Aggregate Limit applies separately to each "project" of the Named Insured or to each "location" of the Named Insured as indicated in the Schedule above. Notwithstanding the application of the General Aggregate Limit to each "project" or each 'location" of the Named Insured, under no circumstances will we pay more than the TOTAL ALL LOCATIONS AGGREGATE LIMIT or the TOTAL ALL PROJECTS AGGREGATE LIMIT shown in the Schedule above for all claims arising out of all 'locations" or all "projects" as applicable under this policy. The following are added to the DEFINITIONS section of this policy: "Project" means all work done by you or on your behalf, away from premises owned or rented to you, to complete an individual bid or negotiated contract to provide services for a specified period of time. Multiple jobs, work orders, purchase orders, change orders or work done at multiple locations under one contract are not separate "projects" within the meaning of this coverage. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS4005 0310 Page 1 of 1