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Insurance - Tunnelworks Services, Inc 2018-06-18TUNNE-1 OP .4COR0 OF LIABILITY INSURANCE DATE Y)CERTIFICATE 06/18/2018 THIS CERTIFICATE IS ISSUED AS AMATTER 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 909-941-9080 CNONrnCT Philip E Hakopian Cornerstone Commercial & Personal Insurance Services PHONE 909-941-9080 F'ix 909-941-9050 AIC, No, Ezt : pIC, No : E-MAIL phil cornerstoneinsurance.org 9340 Baseline Road, Ste 103 Rancho Cucamonga, CA 91701 Philip E Hakopian INSURERS) AFFORDING COVERAGE NAIC 9 INSURER A: Colony Insurance Company INSURED Tunnelworks Services, Inc INSURERS: State Compensation Ins Fund / Willie / Jeff 12213 Philadelphia Street INSURER C: INSURER 0 Whittier, CA 90601 INBURER E0 DAMAGE TO RENTEDrrS 100,000 10124/2018 PREMISES 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 CLAIMS -MADE FX OCCUR 103GL0006910-03 10/24/2017 DAMAGE TO RENTEDrrS 100,000 10124/2018 PREMISES 5'000 MED EXP (Any oneperson) 1,000'000 PERSONAL &ADV INJURY 21000.000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE X F—] LOC 2'000'000 POLICY JECT PRODUCTS - COMP/OP AEG OTHER' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY Per erson OWNED SCHEDULED _ AUTOS ONLY AUTOS BODILY INJURY Peraccitlent HIRED NON -AWNED PROPERTY DAMAGE Peraccitlent AUTOS ONLY AUTOS ONLY UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTIONS B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITYSTATUT YIN 9099073-18 05/09/2018 F 05/09/2019 1,000,000 ANY PROPRIETORIPARTNERIEXECUTIVE � Mandatory in NHS EXCLUDED? NIA EL EACH ACCIpENT 1,000,000 I E. L. DISEASE - EA EMPLOYEE 5 If as under 1,000,000 DESCRIPTION OF OPERATIONS below RIPTIOe E.L. DISEASE -POLICY LIMIT A Pollution CSP307294 07/21/2017 07/21/2018 Pollution 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be allachad if more space is required) RE:#314 Grade 5 Repairs Phase 10 Costa Mesa Sanitary District, its agents, representatives, employees, or insureds to the subcontractors shall be covered as additional with respect work or operations performed by or on behalf of the CONTRACTOR, including materials, parts, or equipment CFRTIFICATE HOLDER CANCELLATION COSTAME 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 PaularinoAvenue `iQfl�i Costa Mesa, CA 92626 /I p AUTHORIZED REPRESENTATIVE 1� ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 103 GL 0006910-03 ENDT. #002 EFF: 06I13f2018 POLICY NUMBER: 103 GL 0006910-03 COMMERCIAL GENERAL LIABILITY CG 20 12 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS 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 Ave. Costa Mesa, CA 92626 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 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. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. 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. 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". 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. CG 20 12 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 TUNNSER-01 TLYLES '4� CERTIFICATE OF LIABILITY INSURANCE EIIII 005124120ATE 18 05124/2018 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 suchendorsement(s). PRODUCER License # OG19762 NAopMEACT Janice Ray Momentous Insurance Brokerage Inc 5990 Sepulveda Blvd., #550 Van Nuys, CA 91411 PHONE FAX INC, No, Ext): (818) 574-0888 )arc, No):(818) 933-2287 JWss.janice.Ty@mmlbi.com INSURERS AFFORDING COVERAGE NAIC N INSURER A: California Automobile Insurance Company/ 38342 PREMISES EeaNaT.un $ INSURED INSURER B: INSURER C: TunnelWOrks Services Inc. INSURER D: 13502-H Whittier Blvd, Ste 165 Whittier, CA 90605 INSURER E INSURER F: AUTOMOBILE COVERAGES CERTIFICATE NUMBER: RFVISIr1N NIIMRFR- 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 CONTRACTOR OTHER DOCUMENT WITH RESPECTTO 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 ADDLSUBR INSD POLICY NUMBER POLICY EFF p POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑OCCUR EACH OCCURRENCE $ PREMISES EeaNaT.un $ MED EXP An one rson $ PERSONALS ADVINJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY L_] PEeT [7] LOC OTHER' GENERAL AGGREGATE $ PRODUCTS-COMP/OPAGG $ $ A AUTOMOBILE LIABILITY ANY AUTO AAURTEO�S ONLY AUTOSWULNED AUTOS ONLY NOT1 ONEV BA040000019527 1211212017 1211212018 COMBINEDISINGLE LIMIT $ 1,000,006 (Ea gmilluX BODILY INJURY Perperson) $ BRODILY INPar accident $ PerOeCcltlenl AMAGE $ 8 UMBRELLA LIAR EXCESSLIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION ANDEMPLOYERS, LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE [—]E.L. FFICERNEMBER EXCLUDED' PMan tlstory In NH) If yes, tles0be untler DESCRIPTION OF OPERATIONSbelow N/A IPER OTH- ISTATUTE ER EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may W attached if more space is required) Evidence of Insurance Costa Mesa Sanitary District 290 Paularino Ave Costa Mesa, CA 92626 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD