Insurance - SOS Services, Inc. 2019-08-20AC"R" CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
08/20/2019
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
CONTACT
NAME: Jolene Waugh
PHC N Ext): ONE 9492638850 FAX No
Orion Risk Management Insurance Services, An Alera Group Insurance Agenc
E-MAIL ADDRESS: jwaugh@orionrisk.com
License Number # OM70471
INSURERS AFFORDING COVERAGE NAIC #
1800 QUAIL ST STE 110
INSURERA: XL INSURANCE AMERICA INC. 24554
NEWPORT BEACH CA 92660-2340
INSURED
INSURER B: INSURANCE COMPANY OF THE WEST 27847
INSURER C :
INSURER D :
SOS Services, Inc.
INSURER E:
12888 WESTERN AVE
1 INSURER F:
GARDEN GROVE CA 92841-4034
COVERAGES CERTIFICATE NUMBER: 7CDOCC 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.
INSRPOLICY
LTR
TYPE OF INSURANCE
IVSD
WVD SUER
POLICY NUMBER
EFF
MM DD/YYYY
POLICY EXP
MM DD/YYYY
LIMITS
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
CLAIMS -MADE ® OCCUR
DAMAGE TO RENTED $ 500,000
PREMISES Ea occurrence
MED EXP (Any one person) $ 10,000
PERSONAL & ADV INJURY $ 1,000,000
A
X
NPC100134200
08/19/2019
08/19/2020
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $ 2,000,000
X POLICY PRO- a LOC
JECT
PRODUCTS - COMP/OP AGG $ 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT $
Ea accident 1,000,000
BODILY INJURY (Per person) $
X
ANY AUTO
A
OWNED SCHEDULED AUTOS ONLY AUTOS
NBA100134400
08/19/2019
08/19/2020
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
Per accident
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
IrUMBRELLA
LIAB
OCCUR
EACH OCCURRENCE $
AGGREGATE $
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N
OFFICER/MEMBER EXCLUDED? ❑Y
(Mandatory in NH)
N / A
WSD504575500
01/01/2019
01/01/2020
PER STATUTE OERH
E.L. EACH ACCIDENT $ 1,000,000
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)
Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees are included as additional insured subject to the
terms of the attached General Liability endorsement. Any other insurance maintained by Costa Mesa Sanitary District shall be excess and non-contributing
with the insurance provided by this policy per the terms of the enclosed General Liability endorsement. 30 days notice of cancellation except 10 day notice for
non payment of premium.
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ERTIFICATE HOLDER CANCELLATION
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 District `
290 PAULARINO AVE AUTHORIZED REPRESENTATIVE
COSTA MESA, CA 92626-3314,;,�.�
RD 25 (2016/03)
O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ASSURED CERTIFICATES, LLC
2129 INDIA ST.
SAN DIEGO CA 92101
006484 6484 1 MB 0.428
T19 P1 *****AUTO**MIXED AADC 601
COSTA MESA SANITARY DISTR
290 PAULARINO AVE
COSTA MESA CA 92626-3314
ASSURED CERTIFICATES
2159 INDIA ST SAN DIEGO CA A.
assuredcertificates.com
Issuance Date: August 2019
AUG 2 7 2019
Costa Mesi,. Sii0im-, Wstrict,
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Support: support@ assuredcertificates.com 1858-239-0248
RVA"O.
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Certificate Number: 7CDOCC
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POLICY NUMBER: meC100I34200
COMMERCIAL GENERAL LIABILITY
CG 20 37 04 13
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
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s)
Location And Description Of Completed Operations
Blanket as required by written contract
Blanket as required by written contract
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section 11 Who Is An Insured is amended to
include as an additional insured theperson(s) or
organization(s) shown in the Schedule, but only
with respect to Uob1|hv for "bodily injury" or
"property damage" caused, inwhole or'n part,]bv
"your work" at the location designated and
described in the Schedule of this endorsement
performed hor that additional insured and
included in the "products -completed operations
1. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
B. With respect to the insurance afforded to theme
additional ineuredo, the following is added to
Section III - Limits Of Insurance:
K coverage provided to the additional insured is
required by e contract or agreement, the most we
will pay on behalf of the additional insured is the
amount ofinsurance:
1. Required bvthe contract oragreement; or
2. /\vai|ob|a under the applicable Limits of
Insurance shown |nthe Declarations;
whichever 1aless.
This endorsement shall not increase the applicable
Limits of Insurance shown in the Declarations.
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 vvh|oh you are
required by the contract or agreement to
provide for such additional insured.
CG 20 37 0413 @|nouronceServices Office, |no..2O12
Page I of 1
POLICY NUMBER: NeCIUOz342oO
CG 20 10 04 A
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
6:1639Q411100�
Name.Of Additional Insured Person(s)
Or 0[ganization(s)
Location(s) Of Covered Operations
Blanket as required by written contract
Blanket as required by written contract
Information reguired to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section 81 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 Uab1|�yfor "bodi| injury", "pro rt
damage" or "personal and advertising injury"
caused, |nwhole or|n pad. by:
1. Your acts oromissions; or
2. The acts or omissions ofthose acting on your
behalf'
'
in the performance of your ongoing operations for
the additional insured(s) at the location(s)
designated above.
1- The insurance afforded to such additional
insured only applies tothe extent permitted by
law; and
2. |fcoverage providedtoiheadditiona]inauredka
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that vvh|oh you are
required by the contract or agreement to
provide for such additional insured.
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B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance doeanot "bod||vinjury" or
"property oocu ' after
1. All work, including materials, parts or
equipment furnished in connection with such
vvorh, on the project (other than aen/iue,
maintenance orrepairs) 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 uoopart ofthe same project.
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�2010 0413 @|naurancaServicOffice,
C. With respect to the insurance afforded to these
additional |naureda, the following is added to
Section UII- Limits Of Insurance:
If coverage provided to the additional insured is
required byacontract or agreement,the most me
will pay on behalf of the additional insured is the
amount ofinsurance:
1. Required bvthe contract oragreement; or
Nt
2. Available under the applicable Urnko of
Insurance shown |nthe Declarations;
whichever is less.
This endorsement aho]| not increase the
applicable Limits of Insurance shown in the
Declarations.
Z 9
Page 2 of 2 @|nsurance Services Office, |nc.'2012 CG 2010 0413
OMMERCIAL GENERAL LIABILITY
CG 20 0104 13
A
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A 10 %M
This endorsement modifies insurance provided under the following:
-.101 Pill" 16MV191 kh W 01:3 9:4 CUS] W:I ZMAI I W 0 LM q FWAI -.]I I I VK49101TA
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
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(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.
Z 9 CG 20 0104 13 @ Insurance Services Office, Inc., 2012 Page 1 of 1