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Insurance - Hydrex of California - 2019-02-15Page 1 of 2 '46'�`'b0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 02/15/2019 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 Willis Insurance Services of Georgia, Inc. Five Concourse Corporate Center, 18th Floor Atlanta, GA 30328 CONTACT Willis Towers Watson Certificate Center NAME: PHONE 1-877-945-7378 FAX 1-888-467-2378 A/C No Ext: A/C No: E-MAIL certificates@willis . com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B: ACE Property & Casualty Insurance Company 20699 B.D,D. Pest Control, Inc. 3073 Long Beach Blvd. INSURER C: New Hampshire Insurance Company 23841 INSURER D: National Union Fire Insurance Company of P 19445 Long Beach, CA 90807 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: W10124922 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. LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM DDYIYYYY POLICY EXP - MM DD/YYYY LIMITS X , COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 2,000,000 $ u DAMAGE TO RENTED 2 000 000 CLAIMS -MADE OCCUR( PREMISES Ea occurrence $ , , A X Pesticide/Herbicide Coverage MED EXP (Any one person)$ 10,000 Y i MWZY 312034-19 01/01/2019 01/01/2020 PERSONAL &ADV INJURY $ 2,000,000 X Pest Control Professional GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY � JECOT- X LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 3,000,000 j Ea accident X ANY AUTO ( BODILY INJURY (Per person) $ A X OWNEDSCHEDULED AUTOS ONLY AUTOS Y MWTB 312033-19 01/01/2019 01/01/2020 BODILY INJURY (Per accident) $ X HIREDX NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY I Per accident $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS -MADE XOO G27927683 004 01/01/2019 01/01/2020 AGGREGATE $ 5,000,000 DED I X I RETENTION $ 50, 000 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER C ANYPROPRIETOR/PARTNER/EXECUTIVE No N/AI E.L. EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH)E.L. WC 046912728 01/01/2019 01/01/2020 DISEASE - EA EMPLOYEE $ 2 , 000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 2,000,000 D Excess Workers Comp XWC 5565579' 01/01/2019 01/01/2020 E.L. Each Accident $2,000,000 E.L. Disease -EA Emp $2,000,000 E.L. Disease- Pol Li $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) This Voids and Replaces Previously Issued Certificate Dated 02/14/2019 WITH ID: W10122322. Branch# 45010 Branch Name: BDD PC DBA Hydrex of California Re: All operations. CERTIFICATE HOLDER CANCELLATION ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 17540678 BATCH: 1072486 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary DistrictL. r ,1 AUTHORIZED REPRESENTATIVE 290 Paularino Avenue Costa Mesa, CA 92626 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 17540678 BATCH: 1072486 AGENCY CUSTOMER ID: LOC #: AcvRoADDITIONAL REMARKS SCHEDULE L._... -- Page 2 of 2 AGENCY NAMED INSURED Willis Insurance Services of Georgia, Inc. B.D.D. Pest Control, Inc.3073 Long Beach Blvd. Long Beach, CA 90807 USA POLICY NUMBER See Page 1 CARRIER NAIC CODE See Page 1 See Page 1EFFECTIVE DATE: See Page 1 AUUII IVNAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Division: Pacific. Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers and employees are included as Additional Insureds as respects to General Liability and Auto Liability, as required by written contract. General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional Insureds as required by written contract. AcvRD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 17540678 BATCH: 1072486 CERT: W10124922 Rollins, Inc. Policy Term: 1/1/2019 to 1/1/2020 Workers' Compensation and Employers Liability Policies Coverage Policy Number Carrier WC Coverage EL Limits Work Comp/EL WC046912728 New Hampshire Ins. Co. - covers states of Statutory $2,000,000 Bodily Injury by Accident - AL,AR,CO,CT,DE,HI,IA,ID,IN,KS,LA,MD, Each Accident/$2,000,000 Each ME,MI,MN,MO,MS,MT,NE,NH,NM,NV,NY, Employee Bodily Injury by OK,OR,RI,SC,SD,TN,TX,WV Disease/$2,000,000 Policy Limit Bodily Injury by Disease Work Comp/EL WC046912725 American Home Assurance Company - Statutory $2,000,000 Bodily Injury by Accident - covers state of CA Each Accident/$2,000,000 Each Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease Work Comp/EL WC046912726 New Hampshire Ins. Co. - covers states of Statutory $2,000,000 Bodily Injury by Accident - MA and WI - This policy also provides Each Accident/$2,000,000 Each Stop Gap coverage for WA, WY Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease Work Comp/EL WC046912727 New Hampshire Ins. Co. - covers state of Statutory $2,000,000 Bodily Injuryby Accident - AZ,IL,KY,NC,NJ,PA,UT,VA,VT Each Accident/$2,000,000 Each Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease Excess Work XWC5565579 National Union Fire Insurance Company of Statutory $2,000,000 Bodily Injury by Accident - Comp/EL Pittsburgh, PA and coverage applies to Each Accident/$2,000,000 Each the qualified self insured states: GA & OH Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease Excess Work XWC5565580 National Union Fire Insurance Company of Statutory $2,000,000 Bodily Injury by Accident - Comp/EL Pittsburgh, PA and coverage applies to Each Accident/$2,000,000 Each the qualifed self insured state of FL Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease NOTICE TO OTHERS ENDORSEMENT — SCHEDULE NOTICE BY INSURED'S REPRESENTATIVE Nan ed insumd Endorsement Number Rolfirm, inc. I Pollcy Symbol Poir-Y Number PoRcy Period Elf-m-hve Date of Endomemew X00 G27927683 004 1/1 /2019 - 1/1/2020 lRm°d By Name of 1nSU--U-_e Cumpany) ACE Property and Casualty Insurapoe Company THIS ENDORSEMENT CHANGES THE PDLICY, PLEASE READ IT CAREFULLY. A. If we cancel this F'oficy prior to its expiration date tty notice to you or the fM Named insured for any reason other than nonpayment of premium, me will endeavor, as sat out in this aridorsearnent, to send wrifter, no-fice of canceliabori, to the persons or organizations fisted in the schedule that you or your repres; wing your rrenta epsefive to sand sucharfl-ative, create or mats (the "Saheduie') by allowing notice to such persons or organizations. This nofice will be in addffion to our notice to you or the f rs., Named Insured, and any other party i#hom we are required to notffy by statute and in a=ordarim With the czncefiabon provisions of the Policy. a. The notice referenced in this endorsementt as provided by your repressentative is intended only to t� a courtasy notficaton to the person(s) or organizabon(s) named in the Schedule in the event of, a pending cancellation oj' coverage. We have no legal obfigation of any ldnd to any such person(sj, or organization(s). The failure to provide adva=e nalffication of c;anc-eliabon to the parson(s) or orgAnt bon s) shown in the Sdreduie will impale no obligation or fiabffit,, of any kind upon us, our ants or representatives, well not extend any Floiicy cancellaiion, :ate and will not negaie any cancellation of the Policy, C. We are not responsible for verifying any i4orr-nation in any Schedule, nor are we responsible for any inc3ri e�-,,t information that you or your representative may use - D. We vAll only be responsible for sending such notice to your representative., and your representative will in tum sand the notice to the persons or organtzabons fisted in the Scheduie at least 30 Sys Prior to the cancefiation date applicabie to the Pohl -ay. You wil'i cooperate with us in proving 1,5"e—Schadule, or in causing your represantative to provide the Stn5dlUie. E. This endorsement does not apply in the event that you cancel the kPolicy. All other terms and conditions of this Policy remain undhanged. Authorized Representative ALL -32686 (011'l 1) Flaoe IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS This endorsement modifies the notice of cancellation of insurance provided hereunder by adding the following: A. In the event this policy is cancelled for any permissible reason, other than for nonpayment of premium, we shall endeavor to provide advance written notice of cancellation to certificate holders set out in the schedule on file with the Company, after notifying the first Named Insured of such cancellation. Notice of cancellation to certificate holders may be made by any commercially reasonable means, including mail, electronic mail, facsimile transmission or courier service. B. This advance written notification of a cancellation of coverage is intended as a courtesy only. Our failure to provide such advance written notification will not extend the policy cancellation date, nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. PIL 029 10 10 POLICY NUMBER: MWTB 312033-19 Rollins, Inc. POLICY PERIOD: 01/01/2019-01/01/2020 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 where required by written contract All where required by written contract 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) 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 additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or 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 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. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 MWZY 312034-19 Rollins, Inc. 0110112019 - 0110112020 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 applicable Limits of Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 MWZY312034-19 Rollins, Inc. 0110112019 - 0110112020 shall not increase the Insurance shown in the CG 20 10 0413 POLICY NUMBER: 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations All where required by written contract All where required by written contract 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 "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 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 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 MWZY 312034-19 Rollins, Inc. 0110112019 - 0110112020 POLICY NUMBER: MWZY 312034-19 PIL 029 10 10 POLICY PERIOD: 01/01/2019-01/01/2020 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS This endorsement modifies the notice of cancellation of insurance provided hereunder by adding the following: A. In the event this policy is cancelled for any permissible reason, other than for nonpayment of premium, we shall endeavor to provide advance written notice of cancellation to certificate holders set out in the schedule on file with the Company, after notifying the first Named Insured of such cancellation. Notice of cancellation to certificate holders may be made by any commercially reasonable means, including mail, electronic mail, facsimile transmission or courier service. B. This advance written notification of a cancellation of coverage is intended as a courtesy only. Our failure to provide such advance written notification will not extend the policy cancellation date, nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. Rollins, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following " attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM forms a part of Policy No. WC 046912725 Issued to: Rollins Inc. By: American Home Assurance Company LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL TO ENTITIES OTHER THAN THE NAMED INSURED (WORKERS' COMPENSATION ONLY) This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 1. the cancellation effective date is prior to this policy's expiration date; 2. the Named Insured or, if applicable, any other employers named in Item 1 of the Information Page is under an existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the "Certificate Holder(s)") and the Named Insured has provided to the Insurer, either directly or through its broker of record, the email address of a contact at each such entity; and 3. the Insurer received this information after the Named Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Insurer, the Insurer will provide advice of cancellation (the "Advice") via e-mail to each such Certificate Holders within 30 days after the Named Insured provides such information to the Insurer; provided, however, that if a specific number of days is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable after the Named Insured provides such information to the Insurer. Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following definitions apply to this endorsement: 1. Named Insured means the insured first named employer in Item 1 of the Information Page of this policy. 2. Insurer means the insurance company shown in the header on the Information Page of this policy. All other terms, conditions and exclusions shall remain the same. AUTHORIZED REPRESENTATIVE WC 99 00 56 (Ed. 04/11) POLICY NUMBER: MWZY 312034-19 POLICY PERIOD: 01/01/2019-01/01/2020 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • • • 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 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 Rollins, Inc. IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Name of Person(s) or Organization(s): All persons or organizations where required by written contract. With respect to COVERED AUTOS LIABILITY COVERAGE, Who Is An Insured is changed with the addition of the following: Each person or organization shown in the Schedule for whom you are doing work is an "insured". But only for "bodily injury" or "property damage" that results from the ownership, maintenance or use of a covered "auto" by: 1. You; 2. an "employee" of yours; or 3. anyone who drives a covered "auto" with your permission or with the permission of one of your "employees". However, the insurance afforded to the person or organization shown in the Schedule shall not exceed the scope of coverage and/or limits of this policy. Not withstanding the foregoing sentence, in no event shall the insurance provided by this policy exceed the scope of coverage and/or limits required by the contract or agreement. PCA 001 10 13 Rollins, Inc. POLICY NUMBER: MWTB 312033.19 POLICY PERIOD:01/01/2019 -01/01/2020