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Insurance - ServiceMaster Advanced Restoration 2020-04-21ACC>R" CERTIFICATE OF LIABILITY INSURANCE ATE D 4/21/2020 ) 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 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 TACT NAME: PHONE No Ext): ( 661) 266-9390 aic, No): (661)266-9391 Driscoll & Driscoll Insurance Agency, Inc. E-MAIL Certs@DriscollandDriscoll.com ADDRESS: 41235 11th St West, Suite A INSURER(S) AFFORDING COVERAGE NAIC # Palmdale CA 93551 INSURER A:GuideOne National Insurance Company/ INSURED INSURER B : State Compensation Insurance Fund Bailey Enterprises, LLC, INSURER C: INSURER D: DBA: ServiceMaster Advanced Restoration INSURER E: 23230 Del Lago Drive INSURER F: Laguna Hills CA 92653 COVERAGES CERTIFICATE NUMBER:CL19102910007 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 SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑X OCCUR DAMAGE TO RENTED 50,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 X ENV562002097-00 10/26/2019 10/26/2020 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: X POLICY 1 PRO- ❑ LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANYAUTO ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A X EXCESS LIAB rl CLAIMS -MADE DED RETENTION $ N/A $ ENV562002098-00 10/26/2019 10/26/2020 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N X PER OTH- STATUTE ER EACH ACCIDENT $ 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICER/MEMBER EXCLUDED? E (Mandatory in NH) N / A 9146369-2019 11/6/2019 11/6/2020 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Contr Pollution Liability ENV562002097-00 10/26/2019 10/26/2020 Per Occ/Agg 1 M / 2 M Professinal Liability ENV562002097-00 10/26/2019 10/26/2020 Claims Made 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Blanket Primary & Non -Contributory wording applies to the General liability Policy per form # GO 0216 - 4YP 10 17. Additional Insured applies to the General Liability Policy per form # CG 20 12 07 98; In favor of: Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees. 10 Day Notice of cancellation for Non -Payment & 30 day Notice of cancellation for all other per form # GO 0223 - 2YE 10-17. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014101) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 290 Paularino Avenue Costa MEsa, CA 92626 �� ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ross Driscoll, Sr/DM ACORD 25 (2014101) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy # ENV562002097-00 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EARLIER NOTICE OF POLICY CANCELLATION OR MATERIAL CHANGE This endorsement modifies insurance under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART PROFESSIONAL LIABILITY COVERAGE PART TRANSPORTATION POLLUTION LIABILITY COVERAGE PART WASTE FACILITIES POLLUTION LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART EXCESS LIABILITY COVERAGE PART Number of Days Advance Notice:30days (except 10 days for non-payment of premium) In the event of a material change to this Policy or cancellation prior to the expiration date on the Declarations page, the Company will mail prior written notice to the following: The Costa Mesa Sanitary District 290 Paularino Ave., Costa Mesa, California 92626 All Other Terms and Conditions Remain Unchanged. GO 0223 - 2YE 10-17 Includes Copyrighted Material of Insurance Services Office, Inc. with Page 1 of 1 its permission POLICY NUMBER: ENV562002097-00 COMMERCIAL GENERAL LIABILITY CG 20 12 07 98 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR POLITICAL SUBDIVISIONS - PERMITS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Political Subdivision: The Costa Mesa Sanitary District, its elected and appointed officials, agents, officers, volunteers and employees. (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section 11 — Who Is An Insured is amended to include as an insured any state or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit. 2. This insurance does not apply to: a. "Bodily injury," "property damage" or "personal and advertising injury" arising out of operations performed for the state or municipality; or b. "Bodily injury" or "property damage" included within the "products - completed operations hazard". CG 20 12 07 98 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1 POLICY NUMBER: ENV5G2OO2O97-00 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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 Any person or organization for whom you are performing In respect to any location where the named insured is operations when you and such person or organization have performing "your work". agreed in writing in a contract or agreement, effected prior to the date your operations for that person or organization commenced, that such person or organization be added as an additional insured on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section U - Who Is An Insured is amended to include as an additional insured the person(s) or organization(o) shown in the Suhedule, 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 oromissions, or 2. The acts oromissions oythose acting onyour behalf, - in the ehalf,- inthe performance of your ongoing operations for �the additional insured(s) at the location(s) designated B. VVith respect to the insurance afforded to these additional insureda, the following additional exclu- sions apply - This insurance does not apply to "bodily injury" or "property damage" occurring after* 1. All work, including materials, parts or equ|p- mentyum}ohed inconnection with such wmM( on the project (other than aem|ce, 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 ordamage arises has been put toits in- tended use by any person or organization other than another contractor orsubcontractor engaged in performing operations for o principal aempart ofthe same project. CG 20 100O4 @ ISO Properties, |nc,2004. Page lofI I af] I LIVA112 LeNTA I 0000-pat"I COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IKKKO] 0 k I ZT11" ID] This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Any person or organization for whom you are In respect to any location where the named insured is performing operations when you and such person or performing "your work". organization have agreed in writing in a contract or agreement, effected prior to the date your operations for that person or organization commenced, that such person or organization be added as an additional insured on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section 11 - 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". CG 20 37 07 04 C ISO Properties, Inc., 2004 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifie's insurance provided underthe following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRIMARY/NON-CONTRIBUTORY — If required by written contract or agreement, effected prior to the date your operations for that person or organization commenced and named below, such insurance as is afforded by this policy to any additional insureds underthis policy shall be primary insurance, and any insurance or self-insurance maintained by such additional insured(s) shall not contribute to the insurance afforded to the named insured. All other terms and conditions remain unchanged. Any person or organization that is: An owner of real or personal property on which you are performing operations, but only at the specific written request by that person or organization to you, and only if: a. That request is made prior tothe date your operations forthat person or organization commenced: and b. ACertificate of Insurance evidencing that request has been issued by your authorized insurance agent or broker, or 2. A contractor on whose behalf you are performing operations, but only at the specific written request by that person or organization to you, and only if: a. That request is made priortothe date your operations for that person or organization commenced; and b. ACertificate of Insurance evidencing that request has been issued by your authorized insurance agent or broker. GO 0216 - 4YP 10-17 Includes Copyrighted Material of Insurance Services Office, Page I oft Inc. with its permission THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY OVERAGE PART SCHEDULE Name of Person or organization: Any person or organization that is: 1. An owner of real or personal property on which you are performing operations, but only at the specific written request by that person or organization to you, and only if: a. That request is made priorto the date your operations forthat person or organization commenced; and b. A Certificate of Insurance evidencing that request has been issued by your authorized insurance agent or broker; or 2. A contractor on whose behalf you are performing operations, but only at the specific written request by that person or organization to you, and only if: a. That request is made prior to the date your operations for that person or organization commenced; and b. A Certificate of Insurance evidencing that request has been issued by your authorized insurance agent or broker. WAIVER OF SUBROGATION — If required by written contract or agreement, we waive any right of recovery we may have against any entity that is an additional insured shown in the Schedule above per the terms of this endorsement because of payments we make for injury or damage arising out of "your work" performed undera contract with that person or organization. All other terms and conditions remain unchanged. GO 0218-4YA 10-17 Includes Copyrighted Material of Insurance Services Office, Inc. Page 1 of 1 with its permission