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Insurance - Jimni Systems, Inc. - 2020-07-02A CERTIFICATE OF LIABILITY INSURANCE UAI r- tMM/UUIT T T TI 7/2/2020 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 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 confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Bowermaster & Associates 10805 Holder St Ste 350 Cypress CA 90630 CONTACT NAME: Llzette Orozco PHONE 6 714-733-200 A/C No --- ADDRESS: lOrOZCO@bowermaster.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Admiral Insurance Company 24856 INSURED socPAc o02 Jimni Systems, Inc. 11161 Jeffrey Rd INSURER B : Praetorian Insurance Company _ 37257 INSURER C : AmGuard .I 42390 INSURER D : Travelers Casualty & Surety Company 24066 Irvine CA 92602 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:682548160 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 i TYPE OF INSURANCE LTR ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD LIMITS A j X j COMMERCIALGENERALlIABILrrY Y FEIECC21334-05 4/1/2020 4/1/2021 EACH OCCURRENCE $1,000,000 CLAIMS -MADE I OCCUR DAMAGE TO RENTED PREMISES Ea occurrence _� $ 50,000 1NCL Pollution MED EXP (Any one person) T - $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 _ ___J i GEN'L AGGREGATE LIMIT APPLIES PER: PRO- j X POLICY JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 I OTHER: C I AUTOMOBILE LIABILITY ANY AUTO JIAU096672 4/1/2020 4/1/2021 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ i X i HIRED X NON -OWNED __j AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ —_ $ A UMBRELLA LIAB X jX EXCESS LIAB OCCUR CLAIMS -MADE FEIEXS21335-05 4/1/2020 4/1/2021 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED RETENTION $ $ B ! WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A Y EQB0102429 4/1/2020 4/1/2021 OT- X STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT - $ 1,000,000 D ! Crime i 106875312 2/15/2019 2/15/2022 Retention: 1,000 50,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: 23rd, Mendoza, Adams, Iowa, Gisler, South Coast Plaza DISTRICT, its directors, officials, officers, employees, agents, and volunteers shall be covered are Additional Insured as respects to General Liability; coverage is Primary and non-contributing, per attached forms. Waiver of Subrogation applies to Workers Compensation per attached endorsement form. I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitation District °II � - -n^ 290 Paularino Avenue vl� AU HORJZ EDREPRE5ENTATIVE Costa Mesa CA 92626 ©1988-2015 ACORD CORPORATION. All rights reserved. Af`npn 9S /9n1R/n zi Tho Ar-nii2ri name and Innn aro ronietorori mnrkc of A(_non WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Person or Organization Schedule Job Description Any person or organization for which you have agreed to waive your rights of recovery in a written contract, provided such contract was executed prior to date of loss. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The Information below Is required only when this endorsement Is issued subsequent to preparation of the policy.) Endorsement Effective 0 4/ 01 / 2 0 2 0 Policy No. EQB 010 2 4 2 9 Endorsement No. 000 Insured JIMNI SYSTEMS INC Insurance Company PRAETORIAN INSURANCE COMPANY Countersigned By EQB0102429 20200401 000 .............. K11 Jimni Systems, Inc. Endorsement Number: 20 Additional Insured -- Owners, Lessees or Contractors -- Completed Operations This endorsement, effective 4i1/2020 attaches to and forms a part of Policy Number FEI ECC21334-05 This endorsementchanges the Policy. Please read it carefully. In consideration of an additional premium of $Applied, this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s): I Qoerations .Any person(s) or organization(s) whom the Named Insured Those project locations where this agrees, in a written contract, to name as an additional insured. endorsement is required by contract. However, this status exists only for the project specified in that contract. Information reginired to complete this Schedule, if not shown above, will be shown in the Declarations. 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". CG 20 37 07 04 t0 ISO Properties, Inc., 2004 Jimni Systems, Inc. Endorsement Number: 19 1�i8J�.�(3aew�nriv e Additional Insured — Owners, Lessees or Contractors — Scheduled Person or Organization This endorsement, effective 4/1/2020 attaches to and forms a part of Policy Number FEIECC21334-05 This endorsement changes the Policy. Please read it carefully. In consideration of an additional premium of $Applied, this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Oreanization(s): I Location(s) Of Covered Operations Any person(s) or organizations) whom the Named. Insured agrees, in a written contract, to name as an additional insured. However, this status exists only for the project specified in that contract.. Those project locations where this endorsement is required by contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section H - 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. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: CG 2010 0413 0 ISO Properties, Inc. Jimni Systems, Inc. Endorsement Number: 15 *C=VfiW-", e 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. 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. CG 2010 0413 0 ISO Properties, Inc. Jimni Systems, Inc. Endorsement Number: 13 Automatic Primary and Non -Contributory Insurance Endorsement Designated Work or Project(s) This endorsement, effective 4/1/2020 attaches to and forms a part of Policy Number FEIECC21334-05 This endorsement changes the Policy. Please read it carefully. SCHEDULE Name of Person or Organization: Any peison(s) or organization(s) whom the Mamed Insured agrees, in a written contract, to provide Primary and/or Non-contributory status of this insurance. However, this status exists only for the project specified in that contract. In consideration of an additional premium of SApplied and notwithstanding anything contained in this policy to the contrary, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third pal -ties in respect to work performed by you under any writtencontractual agreement with such third party. It is further agreed that any other insurance which the person(s) or organization(s) named in the schedule may have is excess and non- contributory to this insurance. g�CC-548-07'12