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Insurance - Golden Bell Products, Inc. 2019-09-30ter--�-^C) ti� �® i,. " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 09/30/2019 THIS CER�IFICATE 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 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 Van Beurden Ins. Serv, Inc. - Kingsburg PO Box 67 CONTACT Jeanette Heinrichs PHONE FAX A/C No Ext: (559) 897-2975 A/C No: (559) 897-4070 E-MAIL ADDRESS: � +T Kingsburg CA 93631 R1`iCE r ED INSURERS AFFORDING COVERAGE NAIC # A: Evanston Insurance Company 35378 OCT 0 7 2019INSURER INSURED (714) 630-3861 Golden Bell Products, Inc. INSURER B: CLAIMS -MADE � OCCUR INSURER C: INSURER D: P.O. Box 366 Cbft Mesa Sanitary mstriCt INSURER E: Atwood CA 92811 INSURER F: COVERAGES CERTIFICATE NUMBER: Cert ID 35010 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. I✓0711WITHSTANDING 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR MKLV5ENV101933 10 25 2019 / / 10 25 2020 / / DAMAGE ( RENTED PREMISESS Ea occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 X Incid. Prof . Services X $10,000 SIR PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- ❑ LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED AUTOS NON -OWNED AUTOS $ A UMBRELLA LIAB X OCCUR MKLV5EFX100468 10/25/2019 10/25/2020 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 X EXCESS LIAB CLAIMS -MADE DED I X RETENTION $ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Cont. Pollution Liab. MKLV5ENV101933 10/25/2019 10/25/2020$25,000 SIR $ 11000,000 A Environ. Impairment Liab. MKLV5ENV101933 10/25/2019 10/25/2020$25,000 SIR $ 1,000,000 DESCRIPTION OF OPERATIONS f LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Manhole spraying for roaches at various city locations. It is agreed that the Costa Mesa Sanitary District, its elected and appointed officials, officers, agents, and employees are named as additional insureds as respects to General Liability per attached additional insured form only when required by written contract. CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD n^ , „-P 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 'jam Q) Costa Mesa Sanitary District �/.�1 -t ACCORDANCE WITH THE POLICY PROVISIONS. 290 Paularino Avenue AUTHORIZED REPRESENTATIVE Costa Mesa CA 92626' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD n^ , „-P 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: MKLV5ENV101933 MARKEr EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. Section II — Who is An Insured is amended to include as an additional insured any person(s) or organization(s) to whom the insured agrees to provide additional insured status on a primary and non-contributory basis in a written contract, provided such written contract is signed by both parties and executed prior to the commencement of operations, 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. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. 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", "property damage", or "personal and advertising injury" occurring after: 1. All work on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured at the location of the covered operations, including materials, parts or equipment furnished in connection with such work, 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. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: 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 will not increase the applicable Limits Of Insurance shown in the Declarations. MEGL 1543 05 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2 with its permission. D. With respect to the- coverage provided by this endorsement, the following is added to Paragraph 4. Other Insurance under Section IV — Commercial General Liability Conditions: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to any person(s) or organization(s) qualifying as an additional insured by this endorsement 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. All other terms and conditions remain unchanged. MEGL 1543 05 16 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 2 with its permission. I POLICY NUMBER: MKLV5ENV101933 COMMERCIAL GENERAL LIABILITY CG 20 37 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As required by written contract signed by both parties N/A and executed prior to commencement of operations. 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. C Insurance Services Office, Inc., 2012 Page 1 of 1 CG 20 37 04 13 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: MKLV5ENV101933 MARKED EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE -POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Person Or Organization: Any person(s) or organization(s) with whom the Named Insured agrees, in a written contract executed prior to the "occurrence", to waive rights of recovery The following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV — Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization shown in the Schedule of this endorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. MEGL 0241-01 05 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. ENVIRONMENTAL ' POLICY NUMBER: MKLV5ENV101933 MARKEr EVA NSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT' CAREFULLY. AUTOMATIC PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following, where indicated by an "X" In the checkbox below: ®COMMERCIAL GENERAL LIABILITY COVERAGE FORM CONTRACTOR'S POLLUTION LIABILITY COVERAGE FORM [� OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM SCHEDULE Person Or Organization: Any additional Insured with whom you agree in a written contract signed by both parties and executed prior to the commencement of operations to provide Primary and Non -Contributory status under this insurance. With respect to the coverage provided by this endorsement, the following is added tb the Other Insurance condition of the Coverage Form(s) indicated above: Primary And Non -Contributory This Insurance is primary to, and will not seek contribution from, any other insurance available to the Person Or Organization shown in the Schedule of this endorsement. However, this does not apply to any "claim", "suit" or "pollution condition" resulting from the sole negligence of the Person Or Organization shown In the Schedule of this endorsement. All other terms and conditions remain unchanged. MEE12274 05 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 'I with Its permission.