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Insurance - Vortex Industries 2021-07-01ACOOR" CERTIFICATE OF LIABILITY INSURANCE �..,.-' DATE (MM/DD/YYYY) 7/1/2021 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 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 Arthur J. Gallagher & Co. Insurance Brokers of CA Inc. LIC #0726293 18201 Von Karman Ave Suite 200 CONTACT NAME: Arthur J. Gallagher & Company PHONEFAX o Ext): 949-349-9800 AIC No): 818-539-2301 A/C No, AD RIESS: INSURER(S) AFFORDING COVERAGE NAIC # Irvine CA 92612 INSURER A: Old Republic Insurance Com any 24147 INSURED VORTIND-01 INSURER B : Vortex Industries, Inc. Vortex Colorado, Inc. INSURER C INSURER D: 20 Odyssey Irvine CA 92618 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1041025988 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 LTR TYPE OF INSURANCE ADDL IND SUBR WVD POLICY EFF POLICY EXP POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y MWZY30779921 7/1/2021 7/1/2022 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 j GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X ]' PRO JECT LOC �j PRODUCTS - COMP/OP AGG $ 2,000,000 Ultimate Gen Agg $ 10,000,000 OTHER: ( A AUTOMOBILE LIABILITY Y MVVTB30780021 7/1/2021 7/1/2022 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident) BODILY INJURY (Per person) $ X I ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS j BODILY INJURY (Per accident) $ X HIREDX NON -OWNED AUTOS ONLY AUTOS ONLY ( PROPERTY DAMAGE $ Per accident Comp/Coll Ded $ 250/$500 UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB_ CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N YIN Y MWC30779821 7/1/2021 7/1/2022 X STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 ANYPROPRIETOR/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 E.L. DISEASE - POLICY LIMIT $ 1,000,000 I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is included as additional insured/primary non-contributory on the general liability policy, per the attached forms CG20101219, CG20371219 and CG20011219. Waiver of subrogation applies to the certificate holder on the workers compensation, per the attached form WC0403060484. RE: Work performed by the named insured as required per written contract with respects to Costa Mesa Sanitary District. Certificate Holder(s) Continued: Costa Mesa Sanitary District, its directors, officials, officers, employees, agents and volunteers. CERTIFICATE HOLDER CANCELLATION ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 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 Sanitary District 290 Paularino Avenue REPRESENTATIVE Costa Mesa CA 92626AUTHORIZED 1g, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: MWZY30779921 THIS ENDORSEMENT CHANGES THE POLICY. P COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 READ IT CAREFULLY. A S, LESSEES OR PERSON OR This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations All persons and organizations as required by written contract or The locations as 5pecified in the written contracts or agreements agreement 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) 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 exclusion apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All ork, 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 be alf of the additional insured(s) at the location of the covered operations has been completed; or 2. That injury intent other Drtion of "your work" out of which the )r damage arises has been put to its d use by any person or organization ian another contractor or subcontractor d in performing operations for a 0 as a part of the same project. CG 201©1219 0 Insurance Services Office, Inc., 2618 Page 1 of 2 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. Availc, ble under the applicable limits of incur z nce; whichever r is less. This e dorsement shall applica I limits of insurance. Page 2 of 2 @Insurance Services Office, Inc., 20118 not increase the CG 20 10 12 19 Policy #: MWZY30779921 COMMERCIAL GENERAL LIABILITY CO 20 0112 19 111119111111111nik 111111��Jjj i ON 14 :14 1 z M I I 7.17WEF01mv oil, This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other Insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: MWZY30779921 THIS ENDORSEMENT CHANGES THE POLICY. PL COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 E READ IT CAREFULLY. ADDITIONAL INSURED — OWNEIR&• CONTRACTORS — COMPLETE) e go A This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE I SCHEDULE Name Of Additional Insured Person(s) Location And All persons and organizations as required by written contract- The locations as 6 or agreement agreements Information required to complete this Schedule, if not shown above, will 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' 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". 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. V*9n Of Completed in the written contracts or shown in the Declarations. B. 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. Require; J by the contract or agreement; or 2. Available under the applicable limits of insuranc e; whichever I less. This endsement shall not increase the r applicable Ii its of insurance. CG 20 37 12 19 C Insurance Services Office, Inc., 2016 Page 1 of 1 POLICY NUMBER: MWC30779821 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 0 % of the California workers' compensation premium otherwise due on such remuneration. PERSON OR ORGANIZATION AS REQUIRED PER CONTRACT SPECIFICATIONS TO THE EXTENT ALLOWABLE BY LAW SCHEDULE JOB DESCRIPTION ON FILE WITH COMPANY 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's Caffornia Workers' Compensation Insurance Forms Manual 1999. INSURED COPY