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Insurance - C & R Drains Inc. - 2020-04-20 (2)
aCC)RL> CERTIFICATE OF LIABILITY INSURANCE OATE(MM/DDIYYYY) �- 4/20/2020 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)CO". PRODUCER NAME c Melissa Ignelis Wood Gutmann & Bogart Insurance Brokers PHONE 714.450.1669c No)- 714-573-1770 15901 Red Hill Ave., Suite 100 RECEIVED insurance License #0679263 ADDRESS:_ mignelis a-wgbib_._com Tustin CA 92780 INSURER(S) AFFORDING COVERAGE NAIC APR 2 8 2020 IC & R cASRnR-i INSURERA: Kinsale Insurance Company INSURER : Westchester S & rams. B Westeurplus Lines inc INSURER Mesa Sanitary District _ . .__ _... _ 1525 W. Macarthur Blvd.#11 INSURER c :Insurance Company of the West✓_ _ 27_847 Costa Mesa CA 92626 INSURER D : INSURER E INSURER F : COVERAGES CERTIFICATE NUMRER* 9n1Rnda9R3 RFVISION Nf1MR1=R- 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 ADDL•SUSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMiDDNYYY MM1DD:'YYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y O1 G00549032 411 10020 411 112021 EACH OCCURRENCE $ 1.000 000 X DAMAGE TO RENTED CLAIMS MADE OCCUR PREMISES (Ea orarrronre, } $ 100 0_r MED EXP tAry one person) $ excIL ded PERSONAL & ADV INJURY $ 1 wo DGu GEN'L AGGREGATE LIMI T APPLIES PER. GENERAL AGGREGATE $ 2 000 000 POLICY JEC LOC JEC PRODUCTS COMP:OPAGG S2. OLD OG0 . . . OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ tEa accident) ANY AIITG BODILY INJURY ?Per person' $ ALL OWNED SCHEDULED AUTOS AUTOS - - - -- - BODILY INJURY {Per accidmrti _ S NON OWNED PROPERTY DAPlAGE S HIRED AUTOS ^ AL11OS LPer acradenti UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE S DED RETENTION 5 $ C WORKERS COMPENSATION w5D5050C I00 9/1012319 9110/2020 X PER OTH STATt)7E ER AND EMPLOYERS' LIABILITY y i N ___ _ _., AJNY PROPRIETOP•PARTNER: EXECUTIVE E L. EACH ACCIDENT g 1.000 0°20 OFFICER. -MEMBER EXCLUDED? N , A (Mandatory In NH) E L. DISEASE EA EMPLOYEE $1 ow oo0 11 yes. desonbe under —.—_ _ ._ _ _ _ _ . ._ ._ : __ -__.. __ _. DESCRIPTION OF OPERATIONS below E.L. DISEASE . POLICY LIMIT ' $ 1 00o Quo B Dollubor Liability C71117200002 4/11/2020 4111r2021 Each nollubor Condrt 51 000 000 General Aggregate 52.000 000 Deducbble 52 50`.' DESCRIPTION OF OPERATIONS r LOCATIONS r VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it 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 Non- Contributory per Form CG20120509 & CAS50010717 GL 30-day Notice of Cancellation per Form ADF90270418 GL Waiver of Subrogation per Form CAS4008 0110 I See Attached... I CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District tit'�� j 290 Pauiarino //vimwro Costa Mesa CA 92626 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014,ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 2' of 8 17; CORD AGENCY CUSTOMER ID: C&RDR-1 LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Wood Gutmann & Bogart Insurance Brokers C & R Drains, Inc 1525 W Macarthur Blvd.#11 POLICY NUMBER Costa Mesa CA 92626 CARRIER NAIC CODE EFFECTIVE DATE! ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 — FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE HOLDER VESTING: DISTRICT, its directors. officials, officers, employees. agents, and volunteers ACORD 101 (2008/01) Page 1 of 1 v "vo M%'vnu IrvKt'Ut1A I IUIV. All rights reserved. The ACORD name and logo are registered marks of ACORD 3' of 8 178 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 0100064903-2 04/11/2020 12:01AM at the Named insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium; $0 5© 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 17e THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100064903-2 04/11/2020 12:01AM at the Named insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: $0 $0 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, 290 Paularino Avenue, Costa Mesa, CA 92626 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 insured any state or governmental agency or subdivision 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 governmental agency or subdivision or political subdivision has issued a permit or authorization. CG 20 12 05 09 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. © insurance Services Office, Inc., 2008 Page 1 of 1 5• of 8 178 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SCHEDULE ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY Attached To and Forming Port of Policy Effective Date of Endorsement Named Insured 0100064903-2 04/11/202012:01AM at the Named Insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: $0 $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE SCHEDULE 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 to the 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. 2. 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. This insurance does not apply to "bodily injury" or "property damage" arising out of "your work or "your product" included in the "products -completed operations hazard" unless you are required to provide 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 to defend the Additional Insured. Where there is no duty to indemnify the Named Insured, there is no duty to indemnify the Additional Insured. 5. This insurance does not apply to "bodily injury" or "property damage" arising out of: a. The sole negligence of the Additional insured or any employee of the Additional Insured; or b. Any obligation of the Additional Insured to indemnify another because of damages arising out of such injury or damage. C. Duties of the Additional Insured in the event of "occurrence", claim or "suit": 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. CAS50010717 Page 1 of 2 6' of 8 17; The Additional Insured must promptly tender the defense of any claim made or "suit " to any 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. CASS0010717 Page 2 of 2 7` of 8 178 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHER TO US Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100064903-2 04/11/2020 12:01AM at the Named Insured C & R Drains Inc address shown on the Declarations Additional Premium; Return Premium: $fl 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 8' of 8 17f Wood Gutmann & Bogart 15901 Red Hill Ave., Suite 100 Tustin, CA 92780 RECEIVEb APR 2 8 2020 Costa Mesa Sanitary District 178 2 AT 0.774 COSTA MESA SANITARY DISTRICT 290 PAULARINO AVE COSTA MESA, CA 92626-3314 178 1' of 8 178