Insurance - Municipal Underground Services, Inc.Workers' Comp - 2021-04-21MUNIUND-01
Is7.14A4xTtTC9
.4coRv 'RFCF V'A%OERTIFICATE OF LIABILITY INSURANCE
`•�--"�
DATE(MWDD/YYYY)
4/21/2021
THIS CERTIFICATE ISMATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES A NfA TIVELY 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 PRODUC_kR1ASIWERTIFICATE HOLDER.
IMPORTANT: 1 icate 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 License # OM70471
Orion Risk Management Insurance Services, An Alera Group Insurance
Agency, LLC
1800 Quail Street, Suite 110 "CEMD
Newport Beach, CA 92660
RWCT
(PHONE , Ext): (949) 263$850 FAX
, No):(949) 263-8860
S:
INSURE S AFFORDING COVERAGE
NAIC #
INSURER A : ArnGUARD Insurance Com an
42390
INSURED
Municipal Underground Services, Inc
28511 Breckenridge Drive Costa Mesa Sanitary District
Laguna Niguel, CA 92677
INSURER B :
INSURER C :
INSURER D :
INSURER E
INSURER F :
COVERAGES CERTIFICATE NUMBER: 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
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
POLICY EXP
LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
EACH OCCURRENCE
$
DDAMMAGE TO RENTEDPREISES (Ea occurrence)
$
MED EXP (Any oneperson)
$
PERSONAL & ADV INJURY
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY JECT LOC
OTHER:
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED SCFEDULED
AURTEO�S ONLY X AUTOS
AUTOS ONLY X AUTC�> ONLY
X
MUAU200897
4/18/2021
4/18/2022
COMBIINEeD SINGLE LIMIT
$ 1,000,000
BODILY INJURY Per n
BODILY
BODILY INJURY (Per accident
$
X
eOPa c derltAMAGE
$
HNOA
1,000,000
UMBRELLA LIAR
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED I RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
QFFICE�M¢FI2 EXCLUDED?
((�Mand� m n�M��
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
S ARTUTE OR
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate Holder Costa Mesa Sanitary District, it's elected and appointed officials, agents, officers, volunteers and employees are included as additional
insureds subject to the terms and policy endorsements and the written contract. (30) Days Notice of Cancellatin; (10) Days for Non -Payment of Premium.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Costa Mesa Sanitary District THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
290 Paularino Ave. ACCORDANCE WITH THE POLICY PROVISIONS.
�/ 1rJ
Costa Mesa, CA 92626
AUTHORIZED REPRESENTATIVE
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ACORD 25 (2016/03) 9)1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD