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Insurance - Golden Bell Products, Inc.2018-10-18AC'"R'" CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY) k,�/ 10/18/2018 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(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 CONTACT Jeanette Heinrichs Van Beurden Ins. Serv, Inc. - Kingsburg PHONE FAX PO Box 67 AIC No Ext: (559) 897-2975 AIC No: (559) 897-4070 E-MAIL Kingsburg CA 93631 ADDRESS: CLAIMS -MADE X OCCUR INSURERS AFFORDING COVERAGE NAIC # INSURERA:Evanston Insurance Company/,' 35378 10/25/2018 INSURED (714) 630-3861 INSURER B Golden Bell Products, Inc. X CPL INSURER C: INSURER D: P.O. Box 366 INSURER E: Atwood CA 92811 INSURER F: PERSONAL &ADV INJURY $ 1,000,000 COVERAGES CERTIFICATE NUMBER: Cert ID 31691 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, T HE 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR MKLV5ENV101253 10/25/2018 10/25/2019 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 X CPL X 10,000 SIR PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY FI PRO- JECT FILOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ A UMBRELLA LIAB X OCCUR MKLV5EFX100304 10/25/2018 10/25/2019 EACH OCCURRENCE $ 2,000,000 X AGGREGATE $ 2,000,000 EXCESS LIAR CLAIMS -MADE DED I X I RETENTION $ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? H N / A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Cont. Pollution Liab. MKLV5ENV101253 10/25/2018 10/25/2019$25,000 SIR $ 1,000,000 A Environ. Impairment Liab. MKLV5ENV101253 10/25/2018 10/25/2019$25,000 SIR $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Manhole spraying for roaches at various city locations. It is agreed that the Costa Mesa Sanitary District, its elected and appointed officials, officers, agents, and employees are named as additional insureds as respects to General Liability per attached additional insured form only when required by written contract. CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD n--- 1 „-F n 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 Paularino Avenue -9 AUTHORIZED REPRESENTATIVE l► v (, Costa Mesa CA 926261 �% ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD n--- 1 „-F n CERTIFICATE COVERAGES OVERFLOW DATE(MM/DD/YYYY) ADDL INSR 10/18/2018 PRODUCER INSURED Van Beurden Ins. Serv, Inc. - Kingsburg Golden Bell Products, Inc. PO Box 67 Incid.Prof.Services Liab. P.O. Box 366 Kingsburg CA 93631 10/25/2018 10/25/2019 Atwood CA 92811 CONTACT NAME: PHONE (A/C, No, Ext): PHONE (A/C, No, Ext): Jeanette Heinrichs (559) 897-2975 (714) 630-3861 ADDITIONAL COVERAGES CERTIFICATE NUMBER: Cert ID 31691 REVISION NUMBER: INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A Incid.Prof.Services Liab. MKLV5ENV101253 10/25/2018 10/25/2019 $ 1,000,000 Certificate Coverages Overflow (11/2010) Pblicy Number: MKLV5ENV101253 COMMERCIAL GENERAL LIABILITY ..MARKED EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY: PLEASE READ IT CAREFULLY. OWNERS,BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. Section 11'_ Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) to whom the insured agrees to provide additional insured status on a primary and non-contributory basis in a written contract; provided such written contract is signed by both parties and executed prior to the commencement of operations, 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. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. 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 additional exclusions apply: This insurance- does not apply to "bodily injury", "property damage", or "personal and advertising injury" occurring after: 1. All work on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured at the location of the covered operations, including materials, parts or equipment furnished in connection with such work, 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. C.. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: 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 will not increase the applicable Limits Of Insurance shown in the Declarations. MEGL 1543 05.16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2 with its permission. D. With respect to the coverage provided by this endorsement, the following is added to Paragraph 4. Other Insurance under Section IV — Commercial General Liability Conditions: Primary And Noncontributory Insurance This .insurance .is .primary to and will not seek contribution from any other insurance available to any person(s) or organiiation(s) qualifying as an additional insured by this endorsement provided that: (II The additional insured is a Named Insured under such other insurance; and (2), You have agrees( 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 remain unchanged. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2of2 POLICY NUMBER: MKLv5ENv101253 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS' ENDORSEMENT CHANGES THE POLICY. PLEASEREAD IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES* OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s Location And Description Of Completed Operations Any persons or organization(s) to whom the' Not Applicable insured agrees to provide Additional Insured status in a -written contract signed by both parties and executed prior to the commencement of operations 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" or ''property damage" caused, in whole or in part, by It 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. CG .20.37 04.13 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 contractor 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. © Insurance Services Office, Inc., 2012 Page 1' of 1 Policy Number: MKT,V5ENV101253, COMMERCIAL GENERAL LIABILITY POLICY NUMBER: MKLV5ENV100373 MARKED EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: .COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Person Or Organization: Any person(s), or organization(s) with whom the Named Insured agrees, in a written contract executed prior to the "occurrence", to waive rights of recovery. Additional Premium: $ Included The following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV — Commercial General Liability Conditions: We waive any .right of recovery we may have against any person or organization shown in the Schedule of this endorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. 'MEGL'0241-01 0516 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission.