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Insurance - Southern California Fleet Services Inc. - 2022-02-10A�coR" CERTIFICATE OF LIABILITY INSURANCE DATE02110 D/YYYY, IMI 02/10!2022 F 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 terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer ri hts to the certificate holder In lieu of such endorsements . PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 CONTANAME: CT CLIENT CONTACT CENTER A CN No Ext : 888-333-4949 FAX No)- 507-446-4664 ADDRESS: CLIENTCONTACTCENTER FEDINS.COM OWATONNA, MN 55060 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 EACH OCCURRENCE $1,000,000 INSURED 336-585-5 INSURER B: SOUTHERN CALIFORNIA FLEET SERVICES INC 34211 PACIFIC COAST HWY UNIT 104 INSURER C: INSURER D: DANA POINT, CA 92629-3859 INSURER E: 03/01/2023 A INSURER F: r.:VYCKAVtJ QLHI WICAI L NUMBER: 3U3 REVISION NUMBER' 0 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 LTR ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DDlYYYY POLICY EXP MMIDDiYYYY LIMITS X( C� COOMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR AUTHORIZED REPRESENTATIVE l w,441,4 4A,�_ EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $ PREMISES Ea occurrence 00,000 MED EXP (Any one person) EXCLUDED UDED Y N 9823225 03/01/2022 03/01/2023 A PERSONAL & ADV INJURY $1,000,000 L EN'L AGGREGATE LIMIT APPLIES PER: POLICY ECT C LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMPIOP AGG $2,000,000 j OTHER: 7 AUTOMOBILE LIABILITY ! �. X I ANY AUTO OWNED AUTOS ONLY )SCHEDULED A '^� AUTOS N N 9823225 03/01/2022 03/01/2023 COMBINED SINGLE LIMIT Ea accident) $1,000,000 BODILY INJURY (Per person) — BODILY INJURY (Per accident) HIRED AUTOS ONLY NON -OWNED AUTOS ONLY PROPERTY DAMAGE Per accident X (UMBRELLA UAB X OCCUR EACH OCCURRENCE $10,000,000 A ! EXCESS UAB CLAIMS -MADE N N 9823226 03/01/2022 03/01/2023 AGGREGATE $10,000,000 DED RETENTION WORKERS COMPENSATION AND RS' LIABILITYER ANY PROPRIETORIPARTNER/EXECUTIVE Y / NN PER STATUTE OTI17 T E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N / A — E.L. DISEASE - EA EMPLOYEE (Mandatory in NH) jyes describe under DDESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT i i DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. ADDITIONAL INSURED INCLUDES: COSTA MESA SANITARY DISTRICT, THEIR ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS AND EMPLOYEES FOR REASONS OTHER THAN NON-PAYMENT OF PREMIUM, 30 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. CERTIFICATE HOLDER CANCELLATION 336-585-5 3030 COSTA MESA SANITARY DISTRICT 290 PAULARINO AVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COSTA MESA, CA 92626-3314 `�/�o-L 0� / ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE l w,441,4 4A,�_ Q 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD '4 a CERTIFICATE OF LIABILITY INSURANCE JRMVVDIYYYY) DAT 02/15 2/15!2022 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 ri hts to the certificate holder in lieu of such endorsement(s). PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 CONTACT NAME: CLIENT CONTACT CENTER 'ITION., No Ell: 888-333-4949 FAC No): 507 -446-4664 ADDRESS: CLIENTCONTACTCENTER FEDINS.COM OWATONNA, MN 55060 INSURER(S) AFFORDING COVERAGE NAIC # DAMAGE TO RENTED PREMISES Ea occurrence $1Q0,000 INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 A ; �I GE TL AGGREGATE LIMIT APPLIES PER: PRO - X (POLICY ❑ ECT C LOC OTHER: INSURED 336-585-5 INSURER B: SOUTHERN CALIFORNIA FLEET SERVICES INC 34211 PACIFIC COAST HWY UNIT 104 INSURER C: INSURER D: DANA POINT, CA 92629-3859 INSURER E: 9823225 INSURER F: 03/01/2023 CVVCKAGtS CtRIII-ICA It: NUMBER: 3U3 RFVISION NUMRFR, n 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 LTR ADDL INSR SUER WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS j X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR LZI iI Y N 9823225 03/01/2022 03/01/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $1Q0,000 MED EXP (Any one person) EXCLUDED A ; �I GE TL AGGREGATE LIMIT APPLIES PER: PRO - X (POLICY ❑ ECT C LOC OTHER: PERSONAL& ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS • COMPIOP AGG $2,000,000 AUTOMOBILE LIABILITY X ANY AUTO OWNED AUTOS ONLY r� SCHEDULED A AUTOS NON -OWNED HIRED AUTOS ONLYAUTOS ONLY N N 9823225 03/01/2022 03/01/2023 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident) j X UMBRELLA LIAB X OCCUR A r EXCESS LIAB CLAIMS -MADE DED I I RETENTION N N 9823226 03/01/2022 03/01/2023 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITYy / N j ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatoryin NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A OTH- PER STATUTE ER E.L. EACH ACCIDENT _.. E.L. DISEASE - EA EMPLOYEE E.L DISEASE •POLICY OMIT DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SEE ATTACHED PAGE CERTIFICATE HOLDFR cnNeFl I &TIMN 336-585-5 3030 COSTA MESA SANITARY DISTRICT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 290 PAULARINO AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COSTA MESA, CA 92626-3314 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - 4" © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • • • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance 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 (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. © Insurance Services Office, Inc., 2012 Page 1 of 1 CG 20 0104 13 Policy Number: 9823225 Transaction Effective Date: 03/01/2022 POLICY NUMBER: 9823225 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 Organizations: Location(s) Of Covered Operations COSTA MESA SANITARY DISTRICT See IL -F-40-0021 290 PAULARINO AVE COSTA MESA CA 92626 nformation 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. SOUTHERN CALIFORNIA FLEET SERVICES INC 34211 PACIFIC COAST HWY UNIT 104 DANA POINT CA 92629 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. © Insurance Services Office, Inc., 2012 Page 1 of 2 CG 20 10 04 13 Policy Number: 9823225 Transaction Effective Date: 02-14-2022 EXTENSION ENDORSEMENT Extension - CG 20 10 - COSTA MESA SANITARY DISTRICT ANY COVERAGE PROVIDED BY THIS ENDORSEMENT APPLIES ONLY WITH RESPECT TO NAMED INSURED'S SERVICE AND REPAIR OF CERTIFICATE HOLDER'S VEHICLES. ADDITIONAL INSUREDS ALSO INCLUDE: COSTA MESA SANITARY DISTRICT, THEIR ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS AND EMPLOYEES IL -F-40-0021 (05-10) Policy Number: 9823225 Transaction Effective Date: 02-14-2022