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Insurance - Municipal Maintenance Equipment Inc. 2019-06-15acorza CERTIFICATE OF LIABILITY INSURANCE ��.• DAT5/2019 D/YYYY} 06/15/2019 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 CONSTIT&E 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 If SUBROGATION IS WAIVED, to the terms t A endorsed. subject and conditions off e policy, certain policies may require an endorsement. statement on this certificate does not confer nghts to the certificate holder in lieu of such endorsement(s). PRODUCER Brian Eldund CONTACT NAME: Sentry Customer Service PHONE FAX A/C No Ext): 800-473-6879 AIC No: 800-514-7191 EMAIL X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [fl OCCUR GEN'LAGGREGATE LIMIT APPLIES PER: POLICY � PRO ❑ LOC X JECT OTHER: X ADDRESS: businessproducts direct@sentry.com INSURER(S) AFFORDING COVERAGE NAIC # 12/15/2018 INSURER A: Sentry Select Insurance Company 21180 EACH OCCURRENCE $ 500,000 INSURED INSURER B: Municipal Maintenance Equipment Inc 4634 Mayhew Rd INSURER C INSURER D: Sacramento, CA 95827-9700 A INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 938354 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 LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF M/DD POLICY EXP M/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [fl OCCUR GEN'LAGGREGATE LIMIT APPLIES PER: POLICY � PRO ❑ LOC X JECT OTHER: X 4967776004 12/15/2018 12/15/2019 EACH OCCURRENCE $ 500,000 DAMAGE TO RENTED $ 100,000 PREMISES a occurrence MED EXP (Any one persari) $ 5,000 PERSONAL & ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,500,000 PRODUCTS - COMP/OP AGG $ 1,500,000 $ A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 4967776005 12/15/2018 12/15/2019 COMBINED SINGLE LIMIT $ 500,000 a accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident $ $ A X UMBRELLA LIAR X EXCESS LIAB X OCCUR CLAIMS -MADE 4967776006 12/15/2018 12/15/2019 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 9,000,000 DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Refer to attached CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 290 Paularino Ave Costa Mesa, CA 92626-3314 /� w THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) 4967776 Sentry Select Insurance Company 1 00001 0000008827 19166 0 N Page 1 of 2 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 06/15/2019 85Be65DD-D549-4749-AF73-039752530668 0027020044350637285292626331490 �.-•� AGENCY CUSTOMER ID: =0=3697 ACC>R" LOC #: 46 - - ADDITIONAL REMARKS SCHEDULE AGENCY NAMEDINSURED Brian Eklund Municipal Maintenance Equipment Inc POLICY NUMBER 4967776004 CARRIER NAIC CODE Sentry Select Insurance Company 21180 EFFECTIVE DATE: 12!15/2018 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance General Liability Page 2 of 2 COSTA MESA SANITARY DISTRICT, THEIR ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS, AND EMPLOYEES AS ADDITIONAL INSURED- PERSUANTTO ATTACHED ENDORSEMENT.ANY OTHER INSURANCE MAINTAINED BY THE COSTA MESA SANITARY DISTRICT SHALL BE EXCESS & NON-CONTRIBUTORING WITH THE INSURANCE PROVIDED BY THIS POLICY. UMBRELLA IS EXCESS OVER GENERAL LIABILITY AND AUTO LIABILITY POLICIES. ACORD 101 (2008/01) 0 2008 ACORD CORPORATION. All rights reserved. 4967776 The ACORD name and logo are registered marks of ACORD U6/15/2D19 Sentry Select Insurance Company POLICY NUMBER: 4967776004 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) Location(s) Of Covered Operations Costa Mesa Sanitary District All Locations Description: ALL JOBS 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. Change effective 06/13/2019 CG 20 10 04 13 4967776 Sentry Select Insurance Company 00001 0000008828 19166 0 N 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. O Insurance Services Office, Inc., 2012 5B2ED34C-CD31-4202-9302-4045823CFOD1 0027020044350637277392626331490 Pagel of 2 06/15/2019 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 shall not increase the applicable Limits of Insurance shown in the Declarations. Change effective 06/13/2019 Page 2 of 2 Q Insurance Services Office, Inc., 2012 CG 2010 0413 4967776 Sentry Select Insurance Company 06/15/2619