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Insurance - Avala Engineering, Inc. - 2020-12-18'AC40RL>� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/18/2020 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 LIC #OF70482 1-562-283-5333 JL Gurrola Insurance Agency CONTACT NAME: Jose L. Gurrola PHONE FAX o . 562-283-5333 A/C No: 562-283-5393 100 W. Broadway Suite 3000 ADDRESS: jose@jlgia.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:ASSOCIATED INDUSTRIES INS CO INC 23140 Long Beach, CA 90802 INSURED INSURERB: STATE COMPENSATION INS FUND 35076 Ayala Engineering, Inc. INSURER C : PHILADELPHIA INS CO 23 850 INSURER D : NATIONAL LIABILITY & FIRE INSURANCE 20052 8482 E . Meadowridge St. INSURER E : INSURERF: Anaheim, CA 92808 COVERAGES CERTIFICATE NUMBER: 60852891 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 TR TYPE OF INSURANCE INSD ADDL WVD SUER POLICY NUMBER MM/DDY EFF POLICY MM DD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X X AES119410500 02/08/20 02/08/21 EACH OCCURRENCE $ 1,000,000 DAMAGEPREMISESS (RENTED Ea occurrence $ 100, 000 X MED EXP (Any one person) $ N/A Ded: $5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED X SCHEDULED AUTOS ONLY AUTOS HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X X 73APS092845 43 ! 15 ! 20 03 ! 15 / 21 x BODILY INJURY (Per accident) $ x PROPERTY DAMAGE Per accident $ A UMBRELLA LIAB X OCCUR EXA119182800 02/08/20 02/08/21 EACH OCCURRENCE $ 51000,000 X AGGREGATE $ 51000,000 EXCESS UAB CLAIMS -MADE DED X RETENTION $ N/A $ WORKERB AND YERS'LSATIONILIT AND EMPLOYERS` LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N ! A X 900495520 02/08/20 02/08/21 X I PER 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 C Excess Liability PUB710993 02/08/20 02/08/21 Occurance & Agg 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached,Ef more space Js required) Re: Costa Mesa Sanitary District and each of their directors, elected officials, officers, employees and agents, and any other public entities required by contract are additional insured in regard to general and auto liability per attached endorsement(s). Coverage is primary and non-contributory per attached endorsement(s). Waiver of subrogation applies per attached endorsement(s). A 30 day notice of cancellation/ 10 days for non-payment. Excess Liability is follow form. UtK I It-IUA I t MULUtK CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 628 W. 19th Street AUTHORIZED REPRESENTATIVE Costa Mesa, CA 92627 "I,'� ( USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD JLGIA06 60852891 POLICY NUMBER: AES119410500 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERI AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART Name Of Person Or Organization: I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: 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 ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 C Insurance Services Office, Inc., 2008 Page 1 of 1 0 POLICY NUMBER: AES1194105-00 COMMERCIAL GENERAL LIABILITY NX GIL 009 08 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTING INSURANC (THIRD -PARTY) I This endorsement modifies insurance provided under the following: SCHEDULE Third Party: All persons or organizations where required by written contract with the Named Insured (Aosence OT a speciticany named I hird Party above means that the provisions of this endorsement apply as required by written contractual agreement with any Third Party for whom you are performing work.) Paragraph 4. of SECTION IV: COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance: With respect to the Third Party shown above, this insurance is primary and non-contributing. Any and all other valid and collectable insurance available to such Third Party in respect of work performed by you under written contractual agreements with said Third Party for loss covered by this policy, shall in no instance be considered as primary, co-insurance, or contributing insurance. Rather, any such other insurance shall be considered excess over and above the insurance provided by this policy. NX GL 009 08 09 Page 1 of I Includes copyrighted material of Insurance Services Office, Inc., with its permission POLICY NUMBER: AES1 194105 00 COMMERCIAL GENERAL LIABILITY NX GIL 093 08 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - AGGREGATE LIMITS OF INSURANCE a4gom:10 F This endorsement modifies insurance provided under the following: Schedule Subject to an Overall Policy Aggregate Limit: $5,000,000 (Information required to complete this Schedule, if not shown above, will be shown in Declarations.) A. Paragraphs 2. and 3. of SECTION III — LIMITS OF INSURANCE are replaced by the following: 2. The Overall Policy Aggregate Limit is the most we will pay for the sum of a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard",; and c. Damages under Coverage B. 3. The Products -Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "products -completed operations hazard" to each of your projects away from premises owned by or rented to you. B. The following is added to SECTION III — LIMITS OF INSURANCE: 8. Subject to Paragraph 2. and 3. above, the General Aggregate Limit is the most we will pay under for the sum Coverage A, Coverage B, or Coverage C to each of your projects away from premises owned by or rented to you. NX GIL 093 08 09 Page I of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission POLICY NUMBER: AES119410500 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. rr- This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ izations : Location And Description Of Completed Operations Costa Mesa Sanitary District 628 W. 19th Street Costa Mesa, CA 92627 USA Information required 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 de- scribed in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: AES119410500 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSU' i OWNERS, OCONTRACTORS - SCHEDULED PERSON OR ORGANIZATION R endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or ©rganization(s): I Location(s) Of Covered Operations I Information 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 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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, 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 equip- ment 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 in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE FEBRUARY 8 , 2020 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING FEBRUARY 8. 2021 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME AYALA ENGINEERING 8482 E MEADOWRIDGE ST ANAHEIM, CA 92808 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. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION REP D1 9004955-20 RENEWAL NA 5-72-51-30 PAGE 1 OF 1 NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: FEBRUARY 6, 2020 r AUTHORIZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) 2572 OLD DP 217