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Insurance - Municipal Underground Services, Inc 2018-04-17—�1 MUNIUND-01 TBELL .a►� CERTIFICATE OF LIABILITY INSURANCE DATEnM/2o e 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 13Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5), 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 endomement(s). PRODUCER License i OD28764 Acr Orion Risk Management insurance Services, Inc. PxoNE FAX 1800 Quail Street, Suite 110 Iluc, xo, Eal: (949) 263-8850 (aC, _1 (B49) 263-8860 Newport Beach, CA 92660DrslEss _.__ __ __ - - INSURERISIAFFORDING COVERAGE + me# IN_SuRERA Colony Insurance Compafry� 39993 INSURED wsmuetB Employers Mutual Casualty.Company Municipal Underground Services, Inc. :WRER e_. 28511 Breckenridge Drive :IxsuRERD: Laguna Niguel, CA 92677 1 -- i i INSURER E: I INSURER F: CnVFRAPFR r l=RTIFInATF NI IMRFR• RPVIBInN NI IMRFR- 'A 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 REOUIREM€NT, 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 ADDL SUINt POLICYEFF POLICYIXP - _... _ TYPE OF INSURANCE WAY POIICY NUMBER M IlM�T A CLGENELIABILITY X j OOMMERIARAL 1,000,000 C _ _ CLAIMSMADE [ X OCCUR X EACH OCCURRENCE $ I 103GL000787607 12/29/2017 1212912018 DAMAGETCRENTED $ 100,000 _ _ _ ',. _MED EXP(Aypm We..) S 51000 PERSONAL$ADV INJURY $ 1'000'0()0 GEN'L AGGREGATE APPLIES PER: i GENERALAGGREGATE $ 2'000'000 POLICY X PPR LOC PRODUCTS 2'000'000 JECr _ _COMP/OP AGO S I !OTHER' I S B AUTOMOBILE UAIML1TY COMBINED SINGLE LIMIT 1,000,000 (EaaWdan0 X ANY AUTO AE43249 04118/2018 04/18/2019 BODILY INJUI! 1Per�rson) S pU AUgT�O�S ONLY AUUTryOpSyyryLED II I BOOILYINJURY(PWac ant) $. AUTOS DAMAGE —_ ONLY :AUTOS ONLY (d2e� 9 $ I II s UMBRELLA me OCCUR i EACH OCCURRENCE S EXCESSUAB _.__. CLAIMS -MAGE _ AGGREGATE DED I I RETENTIONS 1 g WORKERS COMPENSATION 'AND EMPLOYERS? LIABILITYYIN I PER -0TH- STATUTE ER MpFY��PPRBOPREIETBBOEF�RR�IPARTNERIEXECImVE i � EXCLUDED? NIA EL EACHACCIDEW 5 IawndaUvyln NH) L ! :tt yyeS. aesaiDe lnOar DESCRIPTIONOFOPERATI N tel. EL DISEASE - EA EMPLOYEE E .� _ �' EL. DISEASE -POLICY LIMIT IIS DESCRIPTION OFOPE nONSILOCATIONS/VExx:LES(ACORD101,Adtli aWRenarb Wule,meybeathehW,e-4,paeela Wrt The Costa Mesa Sanitary District, it, elected and appointed officials, agents, officers, volunteers and emploeas are additional insureds subject to the terms of the attached General Liability endorsement. All operations: Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees listed as Additional Insured —Pursuant to attached endorsement Any other insurance maintained by the Costa Mesa Sanitary District shall be excess and non-contributing with the insurance provided by this policy. Said policy shall not terminate, nor shall it be canceled nor the coverage reduced, until thirty (30) days after written notice is given to thl District. CPRTIFICATF 41ni nPR CAMCFI i AnrYM ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa SanitaryDistrict THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 290 Paularino Avenue Costa Mesa, CA 92626 '•/nG/y AVTHORUED REPRESENTATIVE LGeL�'� v I _ ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 103 GL 0007876-07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - ONGOING & COMPLETED OPERATIONS PRIMARY & NON-CONTIBUTORY OTHER INSURANCE 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) And Description Of Operations All project owners or contractors!, as required by As required by written contract EXCEPT written contract with the named insured except any contract for Residential or Habitational any entity or contract involved with residential or Construction and/or any contract for a habitational construction Consolidated (Wrap Up) Insurance Program A. SECTION II — WHO IS AN INSURED is amended to include as additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to: 1. liability for "bodily injury" or "property damage" caused, in whole or in part, "your work" at the location designated and described in the SCHEDULE above performed for that additional insured and included in the "products -completed operations hazard". 2. liability for "bodily injury"; "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. your acts or omissions; or b. 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 is added to SECTION 111— 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 contractor 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. U462-0116 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2 with its permission. POLICY NUMBER: 103 GL 0007576-07 C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is amended and the following added: The insurance afforded to the additional insured designated in the SCHEDULE above is primary insurance and we will not seek contribution from any other insurance available to that additional insured under your policy provided that: 1. the additional insured designated in the SCHEDULE above 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. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U462-0116 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 2 with its permission.