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Insurance - Vortex Industries, Inc. 2018-06-21,d►� �® CERTIFICATE OF LIABILITY INSURANCE DATE/ZV2018YI 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(tes) 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 Arthur J. Gallagher & Co. Insurance Brokers of CA Inc. LIC #0726293 18201 Von Karmen Ave Suite 200 CONTACT Arthur J. Gallagher &Com ant/ PxoxE FAX 949-349-9800 c : 949-349-9962 -MAIL EADDRESS INSURERS AFFORDING COVERAGE NAIC# Irvine CA 92612 INSURER A: Old Republic Insurance Company 24147 MWLY30779918 INSURED VORTIND-01 VORTEX INDUSTRIES, INC. VORTEX COLORADO_, INC. INSURER B; nsuRERc: INSURER D: 20 Odyssey Irvine CA 92618 INSURER E: NSURER F : COVERAGES CERTIFICATE NUMBER: 1848752504 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. ILTR TYPE OF INSURANCE i D B POLICYNUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIALGENERALUABIDTY Y MWLY30779918 7/12018 7/112019 EACH OCCURRENCE $looe 00 CLAIMS -MADE I—xi OCCUR DAMAGE TO RENTED PREMISES Ea occu.nm $100,000 MED EXP Anyoneperson) $5,000 PERSONAL&ADV INJURY $1,000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2.00D.000 X POLICY JECT � LOC PRODUCTS -COMP/OPAGG $2.000,000 I UMmate Gen A $10,ODO,000 OTHER A AUTOMOBILE LIABILITY Y MWTB3078D018 7112018 7112019 COMBINED SINGLE LIMIT $1aco'coo a accident BODILY INJURY (Per Person) $ X ANY AUTO IAUTOS OWNED SCHEDOULED AUTOS ONLY UTS A BODILY INJURY (Per acdtlent) $ X HIRED X NON-0WNEO ONLY AUTOS ONLY PROPERTY DAMAGE $ Par aocident Comp/Coll Ded $250/$500 UMBRELLAIJ B OCCUR EACHOCCURRENCE $ AGGREGATE $ EXCESS LMB CLAIMS -MADE DED I I RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN Y MWC30T79818 7112018 7112019 X I STATUTE ETH E.L. EACH ACCIDENT $1,000,000 ANYPROPRIETOWPARTNEWEXECUTIVE OFFICER/MEMSEREXCLUDED7 ❑ NIA E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory In NH) Nes, , describe under SCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OFOPERATIONS/LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached it more apace is required) Certificate holder is included as additional insured/primary non-contributory on the general liability policy, per the attached forms CG20100413, CG20370413 and CG20010413. Certificate holder is included as additional insured/primary non-contributory on the general liability policy, per the attached forms CG20100413, CG20370413 and CG20010413. Waiver of subrogation applies to the certificate holder on the workers compensation, per the attached form WC040306. RE: Work performed by the named insured as required per written contract with respects to Costa Mesa Sanitary District. Certificate Holder(s) Continued: Costa Mesa Sanitary District, its directors, officials, officers, employees, agents and volunteers. CERTIFICATE HOLDER CANCELLATION /I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE _jam/Try✓, �y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District COI 290 Paularino Avenue Costa Mesa CA 92626 Costa Mesa CA 92626 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: MWC30779818 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) 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 otherwise due on such remuneration. PERSON OR ORGANIZATION AS REQUIRED PER CONTRACT SPECIFICATIONS TO THE EXTENT ALLOWABLE BY LAW % of the California workers' compensation premium SCHEDULE JOB DESCRIPTION ON FILE WITH COMPANY ©1998 by the Workers' Cornpensation Insurance Rating Bureau of California. All fights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual © 1999. INSURED GD Y POLICYNUMBER: MWZY30779918 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 PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations All persons or organizations as required by written contract The locations as specified in the written contracts or or agreement agreements 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 organizations) 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. B. With respect to the insurance afforded to these additional insureds, the follow ng 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 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 MWZY30779918 Vortex Industries, Inc. 07/01/2018-07/01/2019 -. _ : u urldiyL:ZiZ�LE:3 COMMERCIAL AUTO CA 20 481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE 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 this endorsement. This endorsement Identifies person(s) or organization(s) who are'lnsureds" 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. Namedlasured: Vortex Industries, Inc., Vortex Colorado, Inc. Endorsement Effective Data: SCHEDULE Name Of Person(s) or Organization(s): All persons or organizations where required by written contract or agreement Ibis 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 D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 0 Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY #: MWZY30779918 COMMERCIAL GENERAL LIABILITY CG 20 010413 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies 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 from 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 (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. CG 20 0104 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: MWZY30779918 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations All persons or organizations as required by written contract or The locations as specified in the written contracts or agreements 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 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 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 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: 2. 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, 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 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. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 MVVZY30779918 Vortex tndusoies, Inc. 07/01/2018 - 07/01/2019 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 2010 0413 MWZY30779918 Vortex industries, Inc. 07/01/2018-07/01/2019