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Insurance - Mike Kilbride, LTD Coast Water and Power - 2021-12-09ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 12/09/2021 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 Phone: (714) 325-6002 CONTACT M. L. Adams Insurance Services M. L. ADAMS INSURANCE SERVICES "AME: _------ _- GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ PHONE (14 ) 325-6002 FA 7x PRO- - _ POLICY X ! JECT LOC PRODUCTS -COMP/OP AGG $ (A1C. No, EM) i;^JC Ne, i OTHER. $ E-MAIL www.mladamsins.com AUTOMOBILE LIABILITY COMBINED SINGLE UM'T ADDRESS — —� (Ea accident) $ INSURER(S) AFFORDING COVERAGE NAIC # Agency Lic#: 0609232 INSURER A CRUM & FORSTER IKE KILBRIDE, LTD. MIKE INSURER B CRUM & FORSTER ✓ INSURER r_ STATE COMPENSATION INSURANCE FUND COAST WATER AND POWER P.O. BOX 3341 NEWPORT BEACH CA 92659 INSURER D INSURER E INSURER F 2,000,000 COVERAGES CERTIFICATE NUMBER: 24054 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. INSP, ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER LIMITS LTR IhJSD VVVD I {MM/DD/YYYY) (MM/DDIYYYYj A X COMMERCIAL GENERAL LIABILITY X X GLO-084385 10/30/21 10/30/22 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED $ PREMISES (Ea ocnuence) 100,000 MED. EXP (Anyone person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 PRO- - _ POLICY X ! JECT LOC PRODUCTS -COMP/OP AGG $ 2,000,000 i OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE UM'T — —� (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ' ALL OWNED 1, SCHEDULED i AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED PROPERTY DAMAGE' $ AUTOS (per accident) B I UMBRELLA LIAB X OCCUR SEO-115858 10/30/21 10/30/22 EACH OCCURRENCE i $ 2,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 2,000,000 DED RETENTION $ $ C WORKERS COMPENSATIONX 9087110-21 01/01/21 10/01/22 X PER OTH 1,000,000 000 AND EMPLOYERS' LIABILITY STATUTE E_ — - -- YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A E.L. DISEASE -EA EMPLOYEE !, $ INCLUDED (Mandatory in NH) (ryes, describe urder E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below I INCLUDED DESCRIPTION OF OPERATIONS / LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: ALL OPERATIONS THE COSTA MESA SANITARY DISTRICT, IT'S ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSUREDS PERFORM CG 201012 19 ATTACHED. PRIMARY WORDING PERFORM CFSIC-GL-1002 (09/20200 ATTACHED. 30 DAYS NOTICE OF CANCELLATION SHALL APPLY.. I CERTIFICATE HOLDER CANCELLATION 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 AVENUE )� �' ACCORDANCE WITH THE POLICY PROVISIONS COSTA MESA CA 92626 MESA, AUTHORIZED REPRESEENTATIVE Attention: j Michael L. (Mike) Adams ACORD 25 (2014101) ©1988-2014 ACORD CORPORATION. All rights reserved. The AGORD name and logo are registered marks of ACORD POLICY NUMBER: GLO-084385 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations Any person or organization you have agreed in a written Locations and operations covered under this policy contract to add as an additional insured on your policy when required by written contract signed prior to the provided the written contract is signed prior to the "bodily injury", "property damage" or "personal and "bodily injury", "property damage" or "personal and advertising injury" advertising injury" 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 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 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. 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.- CG nsurance: CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 1. Required bythe contract oragreement; or 2. Available under the applicable limits of mmunonc�� . whichever ialess. This endorsement ahoU not increase the applicable limits of insurance. CG 20 1012 19 @|nounanoe Services Office, Inc., 2018 Page of THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. M6111 9': 143W.Ari ki 6111 W.W.W.41FA ki 1 0 a 0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following isadded tothe Other Insurance Condition and supersedes any provision tothe contrary - Primary AnuNonuonthuutoryInsuranou This insurance isprimary uu and will not seek contribution from any other insurance available uoon auoiduno| insured under this policy provided that.- (1) The additional insured ioanamed insured under such other ineurance�and (2) You have agreed in writing in a contract or agreement prior to the injury or damage that this insurance would be primary and would not eaok contribution from any other mouomoa available tothe additional insured vvhmn: the additional insured ioanamed insured. However, the insurance provided under this endorsement will not apply beyond the extent required by such contract or agreement. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. CrQ|C-8L-1002(0e/2020) Page of