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Insurance- Robotic Sewer Solutions Inc. 2018-11-20ACCCR�li CERTIFICATE OF LIABILITY INSURANCE lltw� DATE(MM/oDmYY) 1 11/20/2018 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 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 Bolton & Companyy 3475 E. Foothill Blvd., Suite 100 Pasadena, CA 91107 CONTACT NAME: A/CNNo Ext): 626 799-7000 ! aC No): 626 583-2117 EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: James River Insurance Company/ 12203 www.boltonco.com 0008309 INSURED Robotic Sewer Solutions, Inc. 1111 Foothill Boulevard, Suite B INSURER B: StarStone Specialty Insurance Com an ! 44776 INSURER C: State Com ensation Insurance Fund INSURER D: La Canada, CA 91011 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 45486596 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 LTR ADDL SUER POLICY NUMBER MM/DDY EFF MM DPOLD1YYY Y EX137 LIMITS A ✓ COMMERCIAL GENERAL LIABILITY ✓ 000506278 11/22/2018 11/22/2019 EACH OCCURRENCE I $1,000,000 '— � � �` F CLAIMS -MADE 'D OCCUR ,DAMAGE TO RENTED ' PREMISES (Ea occurrence)� $ 50,000 Y/ Per Project Aggregate I MED EXP (Any one person I $1,000 '/ !Capped at $5,000,000 j PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: j GENERAL AGGREGATE $ 2,000,000 RO POLICY PJECT LOC PRODUCTS - COMP/OP AGG 1 $ 2,000,000 1$i OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED — PROPERTY DAMAGE $ I AUTOS ONLY AUTOS ONLY j (Per accident) i$ B UMBRELLALIAB�/ OCCUR 87446H185AL1 11/22/2018 11/22/2019 EACH(OCCURRENCE 4$4,000,000 y/ EXCESS LIAB iICLAIMS-MADE AGGREGATE $ 4,000,000 DED ✓ RETENTION $O $ C WORKERS COMPENSATION 11980264 11/22/2018 11/22/2019 �/ ; STATUTE ; EORH AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVEE.L. -1 EACH ACCIDENT $$1,000,000 OFFICER/MEMBEREXCLUDED? FY (Mandatory in NH) N/A E.L. DISEASE - EA EMPLOYEE $$1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $$1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GL Additional Insured applies per form CG20100704 & CG20370704 attached, only if required by written contract/agreement. GL Primary wording applies per AP5031 US (04-10) attached. Re: #314 Grade 5 Repairs Phase 7. Additional Insured(s): Costa Mesa Sanitary District, its directors, officials, officers, employees, agents, and volunteers. The Certificate of Insurance is subject to policy terms, conditions, limitations and exclusions. rr-PTIPIr_ATF I4nI ni:R CANCELLATION v#314 Grade 5 Repairs Phase 7 Costa Mesa Sanitary District 290 Paularino Avenuet� Costa Mesa, CA 92626 — J'( 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 i David Kuo U 9988-2015 ACURD CUKrUKA1 IUN. An rignis reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 45486596 1 ROBOSEW-01 1 18-19 GL, XS & WC, 18-19 1 Nancy Cadwallader 1 11/20/2018 10:45:19 AM (PST) ( Page 1 of 4 POLICY NUMBER: 000506278 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR This endorsement modifies insurance provided under the following: SCHEDULE Name of Additional Insured Person(s) or Organ izations : Locations(s) of Covered Operations Where Required By Written Contract Or Agreement All Projects Of The Named Insured 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) desig- nated above. CG 20 10 07 04 B. With respect to the insurance afforded to these additional insureds, the following additional exclu- ions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, pads or equip- ment 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 in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. © ISO Properties, Inc., 2004 45486596 1 ROBOSEW-01 1 18-19 GL, XS & WC, 18-19 1 Nancy Cadwallader 1 11/20/2018 10:45:19 AM (PST) I Page 2 of 4 Page 1 of 1 POLICY NUMBER: 000506278 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organ izations : Locations and Description of Covered Operations Where Required By Written Contract Or Agreement All Projects Of The Named Insured 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 dam- age" caused, in whole or in part, by "your work' at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products -completed operations hazard." CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 45486596 1 ROBOSEW-01 1 18-19 GL, XS & WC, 18-19 1 Nancy Cadwallader 1 11/20/2018 10:45:19 AM (PST) I Page 3 of 4 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS Name Of Additional Insured Person(s) Or Orcianization(s): Where Required By Written Contract or Agreement If no entry appears above, this endorsement applies to all Additional Insureds covered under this policy. Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance apply on a primary and noncontributory basis,. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP5031 US 04-10 Page 1 of 1 45486596 1 ROBOSEW-01 1 18-19 GL, XS & WC, 18-19 1 Nancy Cadwallader 1 11/20/2018 10:45:19 AM (PST) I Page 4 of 4