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Insurance - Vortex Industries 2019-06-21Ac"R" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) �,,...� 6/21/2019 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(les) 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 CONTACT NAME: Arthur J. Gallagher & Company Arthur J. Gallagher & Co. g PHONE I FAX Insurance Brokers of CA Inc. LIC #0726293 A/C No Ext): 949-349-9800 FAX No): 949-349-9962 A DRIESS: 18201 Von Karman Ave Suite 200 Irvine CA 92612 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Old Re ubli-,Insurance Com an 24147 INSURED VORTIND-01 INSURER B: VORTEX INDUSTRIES, INC. — -- --- VORTEX COLORADO, INC. INSURER C 20 Odyssey INSURER D: Irvine CA 92618 _ INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 934684573 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 ADDLISUBR, POLICY EFF POLICY EXP LTR D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X j COMMERCIAL GENERAL LIABILITY Y MWZY30779919 ! 7/1/2019 7/1/2020 i EACHOCCURRENCE $1,000,000 — CLAIMS -MADE �X OCCUR PA�REM DAMAGE O(Ea occur encs_ $ 100,000 — —— ;MED EXP (Any one person) j $ 5,000 PERSONAL & ADV INJURY It $ 1,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER: !,1 GENERAL AGGREGATE i $ 2,000,000 X )�( PRO- — — --- X 1 POLICY li JECT ! LOC PRODUCTS - COMP/OP AGG 1$ 2,000,000 OTHER:'Ultimate Gen Agg $10,000,000 A ;AUTOMOBILE LIABILITY YMWTB30780019 7/1/2019 7/1/2020 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO i ;BODILY INJURY (Per person)$ OWNED r SCHEDULED AUTOS ONLYf AUTOS i BODILY INJURY (Per accident) $ r X !! HIRED NON -OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY i ! (Per accident) $_ _ Comp/Coll Ded j $ 250/$500 UMBRELLA LIAB OCCUR CLAIMS-MADEj' j EACH OCCURRENCE $ !EXCESS LIAB � ! I —� AGGREGATE $ DED RETENTION $ ! j �_- – � $ ----- A 1 WORKERS COMPENSATION Y j MWC30779819 7/1/2019 7/1/2020 X PER OTRH- AND EMPLOYERS' LIABILITY STATUTE ANYPROPRIETOR/PARTNER/EXECUTIVE Y / NEACH ACCIDENT $ 0 OFFICER/MEMBER EXCLUDED? �N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE! $ 1,000,000 If yes, describe under — --- DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 j i DESCRIPTION OF OPERATIONS t LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD a 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 119� 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 a POLICY NUMBER: MWZY30779919 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES 0 CONTRACTORS - SCHEDULED PERSON OR ORGANIZ4TIQU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 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 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 2014 0413 Q Insurance Services Office, Inc., 2012 Page 1 of 2 MWZY30779918 Vortex fndusides, Inc. 07/01/2018 - 07/01/2019 C. With respect to the insurance afforded to these additional insureds, the following is added to SectionIQ—KJnnits Of Insurance: If coverage provided tothe additional insured is required by m contract or agreement, the most we will pay on behalf ofthe additional insured is the amount ofinsurance: i. Required bythe contract oragreement; or 2. Available under the applicable Limits of Insurance shown |nthe Declarations; whichever ialess. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 o 2 @\nounanoeServices Office, |mz,2U12 CG 20100413 mvvZY30779e18 vortex Industries, Inc. 07/01m018 07m1x2019 POLICY #: MWZY30779919 COMMERCIAL GENERAL LIABILITY CO 20 0104 13 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 PROWCTSICOMPLETEL) OPERATIONS LIABILI'fY COVERAGE PART The following Is added to the Other Insurance Condition and %Ipersedes 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 010413 @ Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: MWZY30779919 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 Or anization 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 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 0413 O Insurance Services Office, Inc., 2012 Page 1 of 1 MWZY30779919 Vortex industries, Inc. 07/01/2019-07/01/2020 POLICY NUMBER: MWC30779819 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 Linder 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 Q 1998 by the Workers! Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual @ 1999. INSURED COPY