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Insurance - Second Chance Orange County - 2021-02-19Ar-sil... 1 L.-FAM fJ �,..�---� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/ DD/YYYY) 02/1912021 THIS CERTI FI CATE 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 TH E COVERAGE AFFORDED BY TH E POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CO NSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE R(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. Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Chuck Hyneman Chuck Hyneman PHONE FAX 18371-A Lemon Drive (A/C, NO, EXT): 714-777-9823 j (A/c, No), 714-777-9898 Yorba Linda, CA 92886 E-MAIL ADDRESS: — — —� INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: United State Liability Insurance Company 1011 INSURERS: Second Chance Orange County 290 N Paularino Avenue I NSURER G: INSURER D: Costa Mesa, CA 92628 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTC THE INSURED NAMEABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSU ED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREI N IS SUBJECTTOALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN KIAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPEOFINSURANCE ADIDTL INSD SUER VIVO POLICYNUMBER POLICYEFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00C CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea Occurrence) $ _ 100,OQ MED EXP (Any one person) 5,00C PERSONAL & ADV INJURY $ 1,000,00 A Y N PP 1578341 C 02111 /2021 0911412021 GEN`L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,OQ X POLICY PROJECT C1 LOC PRODJCTS-COMP/OPAGG $ Include $ OTHER_ AUTOMOBI LE UABI LITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 BODILY INJURY (Per person) $ ANY AUTO A ❑ SCHEDULED ON ONLY AUTOS N PP 1678341 C 02/11 /2021 09/14/2021 BODILY INJURY (Per accident) $ HIREDAUTOS X NON -OWNED PROPERTY DAMAGE ONLY AUTOS ONLY (Per accident) $X HUMBRELLA LIAR HOCCUR EACH OCCURRENCE �$ I AGGREGATE ? EXCESSLIAB CLAIMS -MADE DED RETENTION $ $ COMPENSATIONWORKERS AND EMPLOYRSIABILITY I STATUTE OTHER $ E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/ Y/N EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA E.L. DISEASE- EA EMPLOYEE E.L. DISEASE- POLICY LIMIT 5 If yes, describe under DESCRIPTION OF OPERATIONS below A Professional E & O Liability EPLI NPP1578341C 02/11/2021 09/14/2021 $1,000,000-Each Ineid $2,000,000-Agg $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) All operations: Costa Mesa Sanitary District, their elected and appointed officials, agents officers, volunteers and employees Said policy should not terminate, nor shall it be canceled nor the coverage reduced, until (30) days after written notice is given to the named insured. CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District 290 Paularino Avenue Costa Mesa, CA 92628 3 i v `, SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THEEXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) 31-1769 11-15 ©1988-2015 ACORD CORPORATION. All Rights Reserved The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 This endorsement modifies insurance provided under the following - SCHEDULE Name of Additional Insured Person(s) Or Organ izatio n(s): Effective Date: 0211112021 12:01 AM COSTA MESA SANITARY DISTRICT, THEIR ELECTED AND APPOINTED AND APPOINTED OFFICIALS, AGENTS.OFFICERS, VOLUNTEERS AND EMPLOYEE, BUT ONLY WHERE REQUIRED THROUGH WRITTEN CONTRACT 290 PAULARINQ AVENUE COSTA MESA, CA 92626 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 injuryu, "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: The insurance afforded to such additional insured only applies to the extent permitted by law, and 2. If coverage r 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. Witn 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 20 26 04 13 -0 Inswance Ssrvicas Office. Inc., 2012 Page 2 Of 2 UNITED STATES LIABILITY INSURANCE GROUP WAYNE,,, PENNSYLVANIA This endorsement modifies insurance provided under the following - COMMERCIAL GENIKERAL LIABILITY COVERAGE FORM Primary And Non -Contributory - Written Contract :dame of Person or Organization: Effective Date: 0211 V2702 1 12:01 AM COSTA MESA SANITARY DISTRICT, THEIR FUCTED AND APPOINWET) ANID APPOIW.F.D OFFICIAT.S,, AGENTS,017FICERS, VOLUNTEERS AN1,D ENWLOYEE, BUT ONLY WHER-E. REQUfRED THROUGH WRITTEN. CONTR-AC 290 _PAULkRINO AVENUE COSTA MESA, CA 92626 (If no entry appears above, the information required to complete this cndorsement %vill bc shoNvn in the D.-Clarations as applicable to this endorsenvot) Paragraph 4. OTHFtR SECTION IV - COMMERCIAL{ E'NERAL LIABILITY COND1110\1TS? INSURANCE. a. Primary Insurance is amended with the addition of the following: 'riie coverage aft"Orded by this policy to the person( s)car orgailization(s) listed alx)ve is primary and non- contributory if: 1. This insurance is required to be primary and tort -contributory under a written contract; and I The loss to tx-, covered occurs on or after the effective date of the written contract; and 3. The loss to be covered resulted solely and, exclusively from your ongoing acts or omissions or the ongoing acts or omissions of those acting on your behalf in perfornling "your work" under a NArritten contract referred to above, 4. The person(s) or organization(s) is an additional insured under this policy. However, the coverage. provided by this endorseinent does not apply to any coverage provided for all -auto" on a "'non -owned auto", "hired auto", uulinsured motorists coverage, u-nderinsuriod motorists coverage, personal injury protection, property protection or siniilar no-fault coverage by whatever nanne called and/or an "auto" coverage of ally type. SECTION V - DEFINITIONS is hereby ainiended by the addition of the following: "Hired auto" means any "auto" you lease, hire,,, rent or borrow. This does not include any "aura" you lease for a period of tnore than thirty (30) consecutive days nor does it include any "'auto" you lease, hire, rent or borrow rToill any of your "employees", your partner or your -executive officers" or mernbers of their household. "Non-owlied auto" means wiy "auto" you do not own, lease, hire, rent or borrow which is used in connection with your business. However, if you are a partnership, a"non-owned auto" does not include any `*auto" owned by any partner. All otherterms and conditions of this policy remain unchanged. This endorsement is a part of your policy and Lakes elTect on the effective date of your policy unless antler effective date is shown. L 776 0 0- 13)) Page 2 of 3) UNITED STATES LIABILITY tN.,SURANCE GROUP WAYN,E, PENNSYLVANIA This endorsement modifies insurance provided under the followkog: COMME,RCIAL GENERAL LIABILITYCOVERAGE FORM Primary And on -Contributory - Written Contract L 776 (10-13) Page 3 of