Loading...
Insurance - C & R Drains Inc - 2021-03-25ACORD® CERTIFICATE OF LIABILITY INSURANCE `6*� DATE (MM/DD/YYYY) 17 3/25/2021 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 Wood Gutmann & Bogart Insurance Brokers 15901 Red Hill Ave., Suite 100 Insurance License #0679263 CONTACT NAME: Melissa I nelis PHONE FAX A/C No Ext : 714-450-1669 A/C No): 714-573-1770 AD RIESS: mignelis@wgbib.com Tustin CA 92780 INSURER(S) AFFORDING COVE GE NAIC # INSURER A: Kinsale Insurance Company INSURED C&RDR-1 INSURER B : Westchester Surplus Lines C & R Drains, Inc 1525 W. Macarthur Blvd.#11 INSURER C: Nationwide Mutual Ins Co INSURER D : Insurance Company of the West 27847 Costa Mesa CA 92626 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1015104536 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. TYPE OF INSURANCE ADDL IN D SUBR WVD POLICY NUMBER POLICY EFF /Y MM/DDYYY POLICY EXP MM/DD/YYYY LIMITS rA X COMMERCIAL GENERAL LIABILITY Y Y 01000649032 4/11/2020 9/10/2021 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE I OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ excluded PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECOT- F-1 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 _ $ OTHER: C AUTOMOBILE LIABILITY ACPBA3039887550 9/10/2020 9/10/2021 COMBINED SINGLE LIMIT Ea accident $ 1 000 000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X Peer PERTY a cidentDAMAGE $ HIRED AUTOS X AUTOS ED A X UMBRELLA LIAB X OCCUR 1 01000649152 4/11/2020 9/10/2021 EACH OCCURRENCE $1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N WSD505051101 9/10/2020 9/10/2021 X STATUTE OERH E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑� OFFICER/MEMBER EXCLUDED? N / A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Pollution Liability G71117200003 4/11/2020 9/10/2021 Each Condition 1,000,000 General Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder(s) is/are named as additional insured per the attached endorsements as required by written contract subject to the terms & conditions of the policy: GL Additional Insured - Ongoing Operations Form CG20100704 GL Additional Insured - Completed Operations Form CG20370704 GL Waiver of Subrogation Form CAS40020110 GL Per Project Aggregate Form CAS40050310 WC - Waiver of Subrogation per Form WC990634 See Attached... CERTIFICATE HOLDER CANCELLATION Ion.. 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE t THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District 290 Paularino AUTHORIZED REPRESENTATIVE Costa Mesa CA 92626, x ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AC" ili. --' AGENCY CUSTOMER ID: C&RDR-1 IW-ews ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Wood Gutmann & Bogart Insurance Brokers NAMED INSURED C & R Drains, Inc 1525 W. Macarthur Blvd.#11 Costa Mesa CA 92626 POLICY NUMBER 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) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS 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 Name of Additional Insured Person(s) or Organization(s) Location and Description of Completed Operations Blanket, as required by written contract, executed prior to the start of work on the project. Locations as required and specified by written contract, executed prior to the start of work on the project. 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 desig- nated and described in the schedule of this endorse- ment performed for that additional insured and in- cluded in the "products -completed operations hazard". ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION 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 1 $0 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 Blanket, as required by written contract, executed prior to the start of work on the project. Locations as required and specified by written contract, executed prior to the start of work on the project. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include B. 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. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 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. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CG 2010 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY LIMITATION - AMENDED AGGREGATE PER PROJECT OR LOCATION 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 1 $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE SCHEDULE General Aggregate applies to EACH LOCATION in the amount of: Total ALL LOCATIONS Aggregate Limit: General Aggregate applies to EACH PROJECT in the amount of: $2,000,000 Total ALL PROJECTS Aggregate Limit: $5,000,000 SECTION III — LIMITS OF INSURANCE — 2, is amended by the addition of the following: d. The General Aggregate Limit applies separately to each "project" of the Named Insured or to each "location" of the Named Insured as indicated in the Schedule above. Notwithstanding the application of the General Aggregate Limit to each "project" or each "location" of the Named Insured, under no circumstances will we pay more than the TOTAL ALL LOCATIONS AGGREGATE LIMIT or the TOTAL ALL PROJECTS AGGREGATE LIMIT shown in the Schedule above for all claims arising out of all "locations" or all "projects" as applicable under this policy. The following are added to the DEFINITIONS section of this policy: "Project" means all work done by you or on your behalf, away from premises owned or rented to you, to complete an individual bid or negotiated contract to provide services for a specified period of time. Multiple jobs, work orders, purchase orders, change orders or work done at multiple locations under one contract are not separate "projects" within the meaning of this coverage. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS4005 0310 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US -BLANKET 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE SECTION IV — CONDITIONS, S. 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 persons or organizations 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. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS4002 0110 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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 otherwise due. Person or Organization ANY PERSON / ORG WHEN REQUIRED BY WRITTEN CONTRACT 2 % of the total California Workers' Compensation premium Schedule Job Description ALL CA OPERATIONS 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 09/10/2020 Policy No. WSD 5050511 01 Endorsement No. Insured C & R DRAINS INC Premium $ INCL . Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. 8-00) INSURED