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Insurance - Southern California Fleet Services Inc. - 01-21-2020A� ©� CERTIFICATE OF LIABILITY INSURANCE DAT01M21 �YY'�> 01/21iZ020 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 carter rights to the certificate holder in lieu of such endorsements . PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 CONTACT NAME: CLIENT CONTACT CENTER (A/ PHONE No, El : 888-333-4949 FAX No): 507-446-4664 ADDRESS: CLIENTCONTACTCENTER FEDINS.COM OWATONNA, MN 55060 INSURERS) AFFORDING COVERAGE NAIC # DAMAGE TO RENTED $100 0� PREMISES Ea occurrence INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 I INSURED 336-585-5 INSURER B: SOUTHERN CALIFORNIA FLEET SERVICES INC 34211 PACIFIC COAST HWY UNIT 104 INSURER C: INSURER D: DANA POINT, CA 92629-3859 INSURER E: GN'L AGGREGATE LIMIT APPLIES PER: POLICY ECT LOC ;�_`�OTHER:[:] INSURER F: COVERAGES CERTIFICATE NUMBER: 303 REVISION NUMBER: 0 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•I TYPE OF INSURANCE LTR ADDLINSR INSR SUER WVD POLICY NUMBER POLICY EFF MMfDDIYYYY POLICY EXP MMIDDIYYYY OMITS X I COMMERCIAL GENERAL LIABILITYEACH CLAIMS -MADE ❑X OCCUR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COSTA MESA, CA 92626-3314 OCCURRENCE $1,000,000 DAMAGE TO RENTED $100 0� PREMISES Ea occurrence — MED EXP (Any one person) EXCLUDED I Y N 9823225 03/01!2020 03!0112021 A PERSONAL &ADV INJURY $1,000,000 GN'L AGGREGATE LIMIT APPLIES PER: POLICY ECT LOC ;�_`�OTHER:[:] GENERAL AGGREGATE $2,000,000 PRODUCTS - COMPIOP AGG $2,000,000 AUTOMOBILE LIABILITY X ANY AUTO COMBINED SINGLE LIMIT Ea accident, $1,000,000 BODILY INJURY (Per person) A 1 OWNED AUTOS ONLY ^ AUTOSULED N N 9823225 03/01/2020 03/01/2021 BODILY INJURY (Per accident) NON -OWNED i HIRED AUTOS ONLY AUTOS ONLY —i PROPERTY DAMAGE Per accident X ;UMBRELLA LIAR X OCCUR A T EXCESS LIAB CLAIMS -MADE N N 9823226 03/0112020 03/01/2021 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N OTH- PER STATUTE ER E.L. EACH ACCIDENT ANY PRO PRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ._ N I A — E.L. DISEASE - EA EMPLOYEE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT i i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more spate is required) SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION 336-585-5 3030 COSTA MESA SANITARY DISTRICT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 290 PAULARINO AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COSTA MESA, CA 92626-3314 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - 4, © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ACORV AGENCY CUSTOMER ID: 336-585-5 LOC #: FA 111 I Lei►� _ ► ►1_�►► ■ Page 1 of 1 AGENCY NAMEDINSURED FEDERATED MUTUAL INSURANCE COMPANY SOUTHERN CALIFORNIA FLEET SERVICES INC 34211 PACIFIC COAST HWY UNIT 104 DANA POINT, CA 92629-3859 POLICY NUMBER SEE CERTIFICATE ## 303.0 CARRIER NAIC CODE SEE CERTIFICATE ## 303.0 EFFECTIVE DATE: SEE CERTIFICATE ## 303.0 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE ADDITIONAL INSURED INCLUDES: COSTA MESA SANITARY DISTRICT, THEIR ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS AND EMPLOYEES THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ON GENERAL LIABILITY SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES, OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION ENDORSEMENT. INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. FOR REASONS OTHER THAN NON-PAYMENT OF PREMIUM, 30 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Additional Insured Copy POLICY NUMBER: 9823225 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: X018AI A1:1 7*]/_\WC14,111:4 I_1411 J=1:AI SCHEDULE Name Of Additional Insured Person(s) Or Organizations: Location(s) Of Covered Operations COSTA MESA SANITARY DISTRICT See IL -F-40-0003 290 PAULARINO AVE COSTA MESA CA 92626 nformation 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. SOUTHERN CALIFORNIA FLEET SERVICES INC 34211 PACIFIC COAST HWY UNIT 104 DANA POINT CA 92629 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. © Insurance Services Office, Inc., 2012 Page 1 of 2 CG 20 10 04 13 Policy Number: 9823225 Transaction Effective Date: 03-01-2020 Additional Insured Copy 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 Policy Number: 9823225 Transaction Effective Date: 03-01-2020 Additional Insured Copy EXTENSION ENDORSEMENT Extension - CG 20 10 - COSTA MESA SANITARY DISTRICT ANY COVERAGE PROVIDED BY THIS ENDORSEMENT APPLIES ONLY WITH RESPECT TO NAMED INSURED'S SERVICE AND REPAIR OF CERTIFICATE HOLDER'S VEHICLES. ADDITIONAL INSUREDS ALSO INCLUDE: COSTA MESA SANITARY DISTRICT, THEIR ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS AND EMPLOYEES IL -F-40-0003 (05-10) Policy Number: 9823225 Transaction Effective Date: 03-01-2020 COMMERCIAL GENERAL LIABILITY CG 20 01 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 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 (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. © Insurance Services Office, Inc., 2012 Page 1 of 1 CG 20 0104 13 Policy Number: 9823225 Transaction Effective Date: 03-01-2020 POLICY NUMBER: 9823225 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS,•' • •' SCHEDULED PERSON •' ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizations: Location(s) Of Covered Operations COSTA MESA SANITARY DISTRICT See IL -F-40-0003 290 PAULARINO AVE This insurance does not apply to "bodily injury" or COSTA MESA CA 92626 "property damage" occurring after: nformation 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", This insurance does not apply to "bodily injury" or "property damage" or "personal and advertising "property damage" occurring after: injury" caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its insured only applies to the extent permitted by intended use by any person or organization law; and other than another contractor or subcontractor engaged in performing operations for a 2. If coverage provided to the additional insured principal as a part of the same project. 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. SOUTHERN CALIFORNIA FLEET SERVICES INC 34211 PACIFIC COAST HWY UNIT 104 DANA POINT CA 92629 © Insurance Services Office, Inc., 2012 Page 1 of 2 CG 20 10 04 13 Policy Number: 9823225 Transaction Effective Date: 03-01-2020 C. With respect to the insurance afforded to these additional insureds, the following is added to Section 111 - 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 Policy Number: 9823225 Transaction Effective Date: 03-01-2020 EXTENSION ENDORSEMENT Extension - CG 20 10 - COSTA MESA SANITARY DISTRICT ANY COVERAGE PROVIDED BY THIS ENDORSEMENT APPLIES ONLY WITH RESPECT TO NAMED INSURED'S SERVICE AND REPAIR OF CERTIFICATE HOLDER'S VEHICLES. ADDITIONAL INSUREDS ALSO INCLUDE: COSTA MESA SANITARY DISTRICT, THEIR ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS AND EMPLOYEES IL -F-40-0003 (05-10) Policy Number: 9823225 Transaction Effective Date: 03-01-2020