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Insurance - C & R Drains 2019-09-09� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 9/9/2019 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 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 Wood Gutmann & Bogart insurance Brokers 15901 Red Hili Ave., Suite 100 Insurance License #0679263 CONCT NAME Melissa Ignelis PHONE 'FAX !� 714 : 714-450-1669 A/C. No : -573-1770 A DRESS: mignelis@wgbib.com Tustin CA 92780 ECEJtVED iNSURER(S) AFFORDING COVEROE NAIC # INSURER A: Kinsale insurance Company PERSONAL & ADV INJURY $1,000,000 INSURED SEP 1 ,� 0 �9 C8 Rt7R 1 C & R ©rains, Inc 1525 W. Macarthur Blvd.#11 INSURER B: Westchester Surplus Lines 1✓% INSURER c : Insurance Company of the West 27847 INSURER D: INSURER E: Costa Mesa CA 92626 Costa Mesa Sanitary District INSURER F OTHER: COVERAGES CERTIFICATE NUMBER: 1723538205 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. LIMITSSHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR : AUDL suai ___ _ EFi 1 Pouch EXP LTR = TYPE OF INSURANCE INSD WVD ; POLICY NUMBER MM/DD/YYYY MM/DDIYYYY LIMITS A X ' COMMERCIAL GENERAL LIABILITY Y Y i 01000849031 4/11/2019 4111/2020 EACH OCCURRENCE I $1,000,000 CLAIMS•MADEX: OCCUR _I?FiEMISES {S_ op r ?Cr9nco _. $100_000 MED EXP (Any one person) $ excluded i PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 00 A 2.000 0 _. . �._ ,_ .. PRO- POLICY JECT ; LOG . PRODUCTS - COMPIOP AGG $ 2,000000 iE$ OTHER: AUTOMOBILE LIABILITY a COMBINED SINGLE LIMIT $ ANY AUTOBODILY ___.. INJURY (Per person) $ ALL OWNED SCHEDULED ; AUTOS ;AUTOS t BODILY INJURY (Per accident) t $ NON -OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS 4 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS MADE ; AGGREGATE $ _. i DED '. ; RETENTION $ 1$ C WORKERS COMPENSATION E W5[05050 x1100 9/10/2019 9/10/2020 ,�( PER ETRH STATUTE F AND EMPLOYERS' LIABILITY Y / N _ ANY PROPRIETORiPARTNEWEXECUTIVE E.L. EACH ACCIDENT $1,000,000 N 1 A OFFICER/MEMBER EXCLUDED? El (Mandatory In NH) E.L. DISEASE EA EMPLOYEE- $1,000.000 — ifyes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT f $1,000,000 B Pollubon Liability x 671117200002 4/11/2019 4111/2020 Each Poliubon Condit $1,000,000 General Aggregate $2,000.000 i i Deductible $2,500 DESCRIPTION OF OPERATIONS / LOCATIONS t VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is named as additional insured per the attached endorsements as required by written contract and subject to the terms & conditions of the policy: GL Additional Insured - Primary and Nan- Contributory per Form CG20120509 & CAS50010717 GL 30 -day Notice of Cancellation per Form ADF90270418 GL Waiver of Subrogation per Form CAS4008 0110 See Attached... CANCELLA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ot ACCORDANCE WITH THE POLICY PROVISIONS. Carta Mesa Sanitary DistriG 290 Paularino lye)l Costa Mesa CA 92626 AUTHORIZED REPRESENTATIVE k Q 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 2* of 8 170 AGENCY CUSTOMER ID: C&RDR-1 LOC #: F.Al NJ 1 Page 1 of 1 AGENCY Wood Gutmann & Bogart Insurance Brokers NAMED INSURED C & R Drains, Inc 1525 W. Macarthur Blvd.#11 Costa Mesa CA 92626 POLICY NUMBER CARRIER MAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 2255 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE HOLDER' VESTING. DISTRICT, its directors, officials, officers, employees, agents, and volunteers ACORD 101 (2008/01) 0 2008 ACORD CORPORATION. All rights reserved. The ACORD name and Ingo are registered marks of ACORD 3' of 8 170 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY TERMINATION NOTICE TO THIRD PARTY Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100064903-1 04/11/2019 12:01AM at the Named Insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: $0 1 $0 This endorsement modifies insurance provided under the following: ALL COVERAGE FORMS The CANCELLATION section of the CONDITIONS section of this Policy are amended by adding the following: SCHEDULE Notice of Policy Termination To: Costa Mesa Sanitary District 290 Paularino Avenue, Costa Mesa, CA 92626 If we send notice of termination of this policy to the insured, we will also send written notification of such termination to the person or organization shown in the Schedule above at the address shown above. We will mail this notice in accordance with the Cancellation and Nonrenewal terms and conditions of this policy. If notice is mailed, proof of mailing will be sufficient proof of notice. No policy rights are conferred to the person or organization shown in the Schedule above. Failure to provide notice as described in this endorsement shall impose no obligation or liability of any kind upon the Company. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. ADF9027 0418 Page 1 of 1 4* of 8 170 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Attached To and Forming Port of Policy Effective Date of Endorsement Named Insured 0100064903-1 04/11/2019 12:01AM at the Named Insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State or Governmental Agency or Subdivision or Political Subdivision: Costa Mesa Sanitary District 29OPmu|arinoAvenue, Costa Mesa, CA 92626 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section |1—Who Is An Insured isamended toinclude asan 2. This insurance does not apply to: insured any state or governmental agency or subdivision a "Bodily injury", "property damage" or "personal or political subdivision shown in the Schedule, subject and to advertising injury" arising out of operations the foUowinQprovisions: performed for the federal state or 1. This insurance applies only with respect to operations municipality; or performed byyou oronyour behalf for which the state b, "Bodily injury" or "property damage" included or governmental agency or subdivision or political within the "products -completed operations subdivision has issued apermit orauthorization. hazard". ALL OTHER TERMS AND CONDITIONS OFTHE POLICY REMAIN UNCHANGED. CG 20 12 05 09 @ Insurance Services Office, Inc., 2008 Page I of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ 0[CAREFULLY. —Attached To and Forming Port of Policy Effective Date of Endorsement Named Insured 0100064903-1 04/11/2019 12:01AM at the Named Insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS UABILITY COVERAGE pig�0��� Name and Address of Additional Insured Person(s) or Organization(s): Costa Mesa Sanitary District 290 Paularino Avenue, Costa Mesa, CA 92626 A. SECTION 11- WHO IS AN INSURED is amended to include any person or organization shown in the above Schedule as an Additional Insured but only for the vicarious liability imposed on the Additional Insured provided that such liability is caused by the sole negligent conduct of the Named Insured and is proximately caused by "your work" or "your product" for the Additional Insured. B. The insurance provided to the Additional Insured under this endorsement is limited as follows: 1.The insurance provided to the Additional Insured shall be excess with respect to any other valid and collectible insurance available tothe Additional insured unless the written contract specifically requires that this insurance apply on a primary and non-contributory basis, in which case this insurance shall be primary and non -contributory. Z. In the event the written contract requires Limits of Insurance in excess of the Limits of Insurance provided by this policy, the Limits of Insurance provided by this policy shall apply and not the limits required by the written contract. This endorsement shall not increase the Limits of Insurance stated in the Declarations of this policy. 3. TNsinsurancedoesnotapp|yto"bodUy|mUuryrur"propertydamage"arisingoutof"yourworkor"yourproduct" included in the "products -completed operations hazard" unless you are required toprovide such insurance by written contract. If required, then insurance is provided only for "bodily injury" or "property damage" that occurs during the policy period arising out of "Your work" or "Your product". 4. Where there is no duty to defend the Named Insured, there is no duty todefend the Additional Insured. Where there isnnduty toindemnify the Named insured, there isnoduty toindemnify the Additional Insured. 5. This insuranoedpesnotappk/to"bmdi|y|n]ury"or"propertydamage"ahsin8outot a. The sole negligence of the Additional Insured or any employee of the Additional Insured; or b. Any obligation ofthe Additional Insured toindemnify another because ofdamages arising out ofsuch injury or damage. C. Duties ofthe Additional Insured inthe event of"occunence" claim nr^suh": 1 The Additional Insured must promptly give notice of an "occurrence", a claim which is made or a "'suit", to any other insurer which has insurance for a loss to which this insurance may apply. CAS500107I7 0,01RE 2. The Additional Insured must promptly tender the defense of any claim made or "suit "toany other insurer which also issued insurance to the Additional Insured as a Named Insured or to which the Additional Insured may qualify as an Additional Insured for a loss to which this insurance may apply. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS50010717 Page 2 of 2 rofo 170 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100064903-1 04/11/2019 12:01AM at the Named Insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: $0 1 $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE SCHEDULE Name of Person or Organization: Costa Mesa Sanitary District 290 Paularino Avenue, Costa Mesa, CA 92626 SECTION IV — CONDITIONS, 8. Transfer of Rights of Recovery against Others to Us is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of "your work" done under a written contract with that person or organization wherein you have agreed to provide this waiver. This waiver applies only to the person or organization shown in the Schedule above and only to the extent of written agreement. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS4008 0110 Page 1 of 1 s• of 8 170