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Insurance - Torres Sanitation System Construction dba Torres Sanitation Sys - 2023-05-01ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) llkk.� 05/01/2023 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 CONTACT Brenda Nava NAME: --- Best California Insurance Services LLC — -- --- --- — AK PHONE Ext __(714) 453-0700 AX1No): (714) 634-2400 1649 W. Cha AveMAIL Chapman P ADDRESS: C info bestcalins.com Orange INSURER(S) AFFORDING COVERAGE NAIC # 11"16871 CA 92868 INSURERA: OBSIDIAN SPECIALTY INSURANCE COMPANY INSURED INSURER B : INFINITY SELECT INS CO 20260 Torres Sanitation System Construction dba Torres Sanitation Sy: INSURERC : TRISURA SPECIALTY INSURANCE COMPANY 16188 9617 OTIS ST _ INSURER D: STATE FUND c 35076 CERTAIN UNDERWRITERS AT LLOY'S LONDO 1,000,000 INSURER E : SOUTH GATE CA 90280 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. ACCORDANCE WITH THE POLICY PROVISIONS. INSR TYPE OF INSURANCE ADDL; LTR SUBR POLICY EFF POLICY EXP T LIMITS i POLICY NUMBER MM/DD/1fYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED CLAIMS -MADE X OCCUR PREMISES CEa_occurrence� S 50,000 MED EXP (Any one person) S 5,000 A Y Y SCB-GL-000028748 04/14/2023 04/14/2024 PERSONAL & ADV INJURY S __-___-_---------_-___ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2,000,000 X POLICY PRO LOC PRODUCTS - COMP/OP AGG s - JECT 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S --- Ea accident 1,000,000 X ANY AUTO BODILY INJURY (Per person) s B OWNED SCHEDULED 504610150187001 01/12/2023 01/12/2024 BODILY INJURY (Per accident); S AUTOS ONLY _ AUTOS _ _ HIRED NON -OWNED PROPERTY DAMAGE $ 1,000,000 AUTOS ONLY AUTOS ONLY Per accident- S UMBRELLA LIAB OCCUR EACH OCCURRENCE S 1,000,000 C X EXCESS LIAB CLAIMS -MADE'' ISCCX03000001208 04/14/2023 04/14/2024 AGGREGATE S 1,000,000 DED RETENTIONS 5 WORKERS COMPENSATION PER XOH _! _STATUTE ER AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT S 1,000,000 D OFFICER/MEMBER EXCLUDED? NN/A: Y 9274538-23 04/15/2023 04/15/2024 - --- - - (Mandatory in NH) E.L.DISEASE - EA EMPLOYEE S 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT S 1,000,000 Equipment Floater E IMEB11985 12/29/2022 12/29/2023 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Water & Sewer Mains Construction All operations: Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees listed as Additional Insured - Pursuant to attached endorsement. Said policy shall not terminate, nor shall it be canceled nor the coverage reduced, until thirty (30) days after written notice is given to the District. Coverage is Primary and Noncontributory. Waiver of Subrogation applies to the General Liability and Worker's Compensation policies. 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 Costa Mesa Sanitary District ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 290 Paularino Avenue Costa Mesa, CA 92626 - --- - ----_ _ © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ,acoRn° ADDITIONAL REMARKS SCHEDULE Page of AGENCY Best California Insurance Services LLC NAMED INSURED Torres Sanitation System Construction dba Torres Sanitation System Construc POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS ITHIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance PROJECT NAME: REDHILL SEWER #149671 REPLACEMENT PROJECT No. 344 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Obsidian Specialty Insurance Company 1330 Avenue of the Americas, Suite 23A • New York, NY 10019 • 800-684-5428 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OBSIDIAN SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS — SCHEDULED PERSON OR ORGANIZATION INCLUDING PRIMARY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Name of Additional Insured: As required by a legally enforceable written agreement entered into prior to commencement of the Named Insured's work. Designated Project/Location to which this endorsement applies: All Projects and Locations (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section III - 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 performed during the policy period for the additional insured(s) at the location(s) designated above. B. This insurance does not apply to "bodily injury" or "property damage" that takes place after, and the Additional Insured's status as an additional insured terminates, upon the earlier of when: I. All work, including materials, parts or equipment furnished by the Named Insured 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 engaged in performing operations for a principal as part of the same project. C. If expressly required by a written and legally enforceable contract entered into by the Named Insured prior to commencement of work by the Named Insured for the Additional Insured, the insurance afforded by the policy to the Additional Insured(s) listed in the Schedule for the described location(s) is primary insurance. Any other insurance or self-insurance maintained directly by the Additional Insured(s) is excess of this insurance and shall not contribute to it. Coverage for any additional insured is governed by the terms, conditions, and exclusions of this policy and all endorsements, including the Insuring Agreement. The coverage provided for any additional insured is only to the extent of and in the proportion the additional Insured is held liable for the negligence or strict liability/conduct/acts of the Named Insured. No coverage is provided for liability based upon the acts, errors or omissions of the Additional Insured. Except as set forth above, all of the terms, conditions and exclusions of this policy apply and remain in effect. Policy No.: SCB-GL-000028748 Obsidian Specialty Insurance Company Date: 04/14/2023 By: Time: 12:01 a.m.I f resident OSIC AIE OOP 00 01 0318 Secretary Page 1 of 1 Obsidian Specialty Insurance Company 1330 Avenue of the Americas, Suite 23A • New York, NY 10019 • 800-684-5428 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OBSIDIAN SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY ADDITIONAL ENSURED -OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON ORGANIZATION ONGOING OPERATIONS ONLY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Name of Additional Insured: As required by a legally enforceable written agreement entered into prior to commencement of the Named Insured's work. Desitmated Proiect/Location to which this endorsement applies: All Projects and Locations (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section III - 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 performed during the policy period for the additional insured(s) at the location(s) designated above. B. This insurance does not apply to "bodily injury" or "property damage" that takes place after, and the Additional Insured's status as an additional insured hereunder terminates, upon the earlier of: 1. All work, including materials, parts or equipment furnished by the Named Insured 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 engaged in performing operations for a principal as part of the same project. Coverage for any additional insured is governed by the terms, conditions, and exclusions of this policy and all endorsements, including the Insuring Agreement. The coverage provided for any additional insured is only to the extent of and in the proportion the additional Insured is held liable for the negligence or strict liability/conduct/acts of the Named Insured. No coverage is provided for liability based upon the acts, errors or omissions of the Additional Insured. Except as set forth above, all of the terms, conditions and exclusions of this policy apply and remain in effect. Policy No.: SCB-GL-000028748 Obsidian Specialty Insurance Company Date: 04/14/2023 By: Time: 12:01 a.m. AiA president Secretary OSIC AIE ONO 00 01 0318 Page 1 of 1 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS BROKER COPY HOME OFFICE SAN FRANCISCO EFFECTIVE APRIL 15, 2023 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING APRIL 15, 2024 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME TORRES SANITATION SYSTEMS CONSTRUC 9617 OTIS ST SOUTH GATE, CA 90280 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 2.00% OF THE TOTAL POLICY PREMIUM. fi('NFTITTT R PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION _ FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION REP 02 9274538-23 RENEWAL NA 9-88-90-05 PAGE 1 OF 1 NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: 4. 2572 AUTHORIZED REPRESENT IVE SCIF FORM 10217 (REV.7-2014) APRIL 18, 2023 PRESIDENT AND CEO OLD DP 217 Obsidian Specialty Insurance Company 1330 Avenue of the Americas. Suite 23A • New York, NY 10019 • 800-684-5428 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OBSIDIAN SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS — COMPLETED OPERATIONS (COMMERCIAL ONLY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Additional Insured: As required by a legally enforceable written agreement entered into prior to commencement of the Named Insured's work. Designated Project/Location to which this endorsement applies: All Projects and Locations - Commercial Work Only If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section III - 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. The Named Insured's acts or omissions; or 2. The acts or omissions of those acting on the Named Insured's behalf in the performance of "your work" for the additional insured(s) at the location(s) designated above. Coverage for any additional insured is governed by the terms, conditions, and exclusions of this policy and all endorsements, including the Insuring Agreement. The coverage provided for any additional insured is only to the extent of and in the proportion the additional Insured is held liable for the negligence or strict liability/conduct/acts of the Named Insured. No coverage is provided for liability based upon the acts, errors or omissions of the Additional Insured. Policy No.: SCB-GL-000028748 Date: Time Obsidian Specialty Insurance Company 04/14/2023 By: 12:01 a.m. resident J, Secretary OSIC AIE COM 2037 00 02 0821 Page 1 of 1 Obsidian Specialty Insurance Company 1330 Avenue of the Americas, Suite 23A • New York, NY 10019 • 800-684-5428 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OBSIDIAN SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS — COMPLETED OPERATIONS (COMMERCIAL ONLY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Additional Insured: As required by a legally enforceable written agreement entered into prior to commencement of the Named Insured's work. Deshinated Proiect/Location to which this endorsement applies: All Projects and Locations - Commercial Work Only If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section III - 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. The Named Insured's acts or omissions; or 2. The acts or omissions of those acting on the Named Insured's behalf in the performance of "your work' for the additional insured(s) at the location(s) designated above. Coverage for any additional insured is governed by the terms, conditions, and exclusions of this policy and all endorsements, including the Insuring Agreement. The coverage provided for any additional insured is only to the extent of and in the proportion the additional Insured is held liable for the negligence or strict liability/conduct/acts of the Named Insured. No coverage is provided for liability based upon the acts, errors or omissions of the Additional Insured. Policy No.: SCB-GL-000028748 Date: Time Obsidian Specialty Insurance Company 04/14/2023 By: 12:01 a.m. J��resident ScretA ar y OSIC AIE COM 2037 00 02 0821 Page 1 of 1 Obsidian Specialty Insurance Company 1330 Avenue of the Americas, Suite 23A • New York, NY 10019 • 800-684-5428 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OBSIDIAN SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION INCLUDING WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Name of Additional Insured: As required by a legally enforceable written agreement entered into prior to commencement of the Named Insured's work. Desijznated Project/Location to which this endorsement applies: All Projects and Locations (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section III - 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: I . Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations performed during the policy period for the additional insured(s) at the location(s) designated above. B. This insurance does not apply to "bodily injury" or "property damage" that takes place after, and the Additional Insured's status as an additional insured terminates, upon the earlier of when: I . All work, including materials, parts or equipment furnished by the Named Insured 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 engaged in performing operations for a principal as part of the same project. C. If expressly required by a written and legally enforceable contract entered into by the Named Insured prior to commencement of work by the Named Insured for the Additional Insured, then we waive any right of subrogation we may have against an entity that is an Additional Insured per the terms of this endorsement because of payments we make for injury or damage arising out of "your work" performed under such written and legally enforceable contract with that Additional Insured. Coverage for any additional insured is governed by the terms, conditions, and exclusions of this policy and all endorsements, including the Insuring Agreement. The coverage provided for any additional insured is only to the extent of and in the proportion the additional Insured is held liable for the negligence or strict liability/conduct/acts of the Named Insured. No coverage is provided for liability based upon the acts, errors or omissions of the Additional Insured. Except as set forth above, all of the terms, conditions and exclusions of this policy apply and remain in effect. Policy No.: SCB-GL-000028748 Obsidian Specialty Insurance Company Date: 04/14/2023 By: Time: 12:01 a.m. y A resident Secretary OSIC AIE OOPWOS 00 01 0318;%'� Page 1 of 1 Obsidian Specialty Insurance Company 1 330 Avenue of the Americas, Suite 23A • New York, NY 10019 • 800-684-5428 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OBSIDIAN SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Designated Proiect/Location to which this endorsement applies: All Projects Scheduled with the Carrier. As used herein, "Designated Projects/Location" includes only those properties and projects that are designated by you to us in writing, and acknowledged and approved to you by Obsidian Specialty Insurance Company, in writing in a Scheduled "Designated Project" endorsement issued by and approved by Obsidian Specialty Insurance Company in advance of the time any insured performs any work in, on, or in connection with such property or project A. For all sums which the insured becomes legally obligated to pay as damages caused by '*occurrences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to ongoing operations at a single designated construction project as Scheduled herein: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project Schedule 4. The limits shown in the Declarations or provided for in this `-policy" for Each Occurrence, Damage To Premises Rented To You, Medical Expense or other applicable sublimit continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project as Scheduled herein. 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. C. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products - completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. OSIC DCPAGG END 00 01 0318 Page 1 of 2 Obsidian Specialty Insurance Company 1330 Avenue of the Americas, Suite 23A • New York, NY I001 9 • 800-684-5428 E. The provisions of Section IV — Limits Of Insurance and any applicable sublimit not otherwise modified by this endorsement shall continue to apply as stipulated. Except as set forth above, all of the terms, conditions and exclusions of this policy apply and remain in effect. Policy No.: SCB-GL-000028748 Obsidian Specialty Insurance Company Date: 04/14/2023 By: Time: 12:01 a.m. resident Secretary OSIC DCPAGG END 00 01 0318 Page 2 of 2 From: Dawn Saidi To: Tanisha Tingling Subject: FW: CMSD 344 - CERTIFICATE OF LIABILITY INSURANCE - COSTA MESA REVISED Date: Wednesday, May 17, 2023 12:20:59 PM Hi Tanisha, Please see email below I received from Torres Sanitation. Let me know if you need me to do anything. Thank you, Dawi1 Saidi I Office Manager Robin B Hamers & Associates, Inc. CIVIL ENGINEERS I PLANNERS I SURVEYORS 3100 Airway Ave., Suite 124, Costa Mesa, CA 92626 Phone (949) 548-1192 1 fax (949) 548-6516 Costa Mesa office email: d.saidi@robhamers.com From: Annette Ochoa <info@torressanitation.com> Sent: Wednesday, May 17, 2023 11:37 AM To: Dawn Saidi <dsaidi@RobHamers.com>; Alex Torres <alex@torressanitation.com> Subject: Re: CMSD 344 - CERTIFICATE OF LIABILITY INSURANCE - COSTA MESA REVISED Good morning, Dawn, Please note that I received the below from our insurance company State Fund does not tailor endorsements to what 3rd parties request. The wording can be on the COI as it is with your specifications but they cannot provide an endorsement with it . Please let us know if this is okay, if not so I can check to see what else we can do Best Regards, Annette Ochoa Torres Sanitation Systems Construction Contact Phone (323)428-5510 Emergency Contact (323)518-9012 o�� From: Annette Ochoa <info@torressanitation com> Date: Friday, May 12, 2023 at 12:13 PM To: Dawn Saidi <dsaidi @RobHamers.com>, Alex Torres <alex@torressanitation.com> Subject: Re: CMSD 344 - CERTIFICATE OF LIABILITY INSURANCE - COSTA MESA REVISED Hello Dawn Let me follow up with my insurance company Thank you Best Regards, Annette Ochoa Torres Sanitation Systems Construction Contact phone: (323)428-5510 Emergency contact: (323)518-9012 From: Dawn Saidi <dsaidit@Robs-lamers.com> Sent: Friday, May 12, 2023 10:04:06 AM To: Annette Ochoa <infoCo)torress, nitation horn>; Alex Torres <aiexfttorressanitation.com> Subject: FW: CMSD 344 - CERTIFICATE OF LIABILITY INSURANCE - COSTA MESA REVISED Good morning Alex, I have been in touch with CMSD regarding your signed contract. I will know more on Monday. CMSD are closed today. It has been approved by the board and is in the hands of the attorney to sign. Please see the email below regarding the insurance certificate. If you have any questions please let me know. Kind regards, Da`vri Saidi I Office Manager Robin B Hamers & Associates, Inc. CIVIL ENGINEERS I PLANNERS ( SURVEYORS 3100 Airway Ave., Suite 124, Costa Mesa, CA 92626 Phone (949) 548-1192 1 fax (949) 548-6516 Costa Mesa office email: dsaidi(@robham.ers.com From: Annette Ochoa <info ((-,)torress<:initatiori.com> Sent: Tuesday, May 2, 2023 9:54 AM To: Dawn Saidi <dsaidi((,-,,)RobF-iarTiers.corri> Subject: Re: CERTIFICATE OF LIABILITY INSURANCE - COSTA MESA REVISED Hello Dawn Yes we should be able to , I'll get back to you Best Regards, Annette Ochoa Torres Sanitation Systems Construction Contact phone: (323)428-5510 Emergency contact: (323)518-9012 From: Dawn Saidi <dsaidi(a)RobI iamers.con7> Sent: Tuesday, May 2, 2023 8:59:12 AM To: Annette Ochoa<it)fo(a)torre,�sariitation.con,» Subject: RE: CERTIFICATE OF LIABILITY INSURANCE - COSTA MESA REVISED Good morning Annette, I received the comments below from the district. The Change in Coverages wording was added to the certificate page, which is fine; but to meet our below District requirement, the wording needs to be on an endorsement page. Change in Coverages — The following wording must be added to the policy by endorsement: "Said policy shall not terminate, nor shall it be canceled nor the coverage reduced, until thirty (30) days after written notice is given to the District." Would the provider be able to make that change? Regards, Dawn Saidi I Office Manager Robin B Hamers & Associates, Inc. CIVIL ENGINEERS ( PLANNERS I SURVEYORS 3100 Airway Ave., Suite 124, Costa Mesa, CA 92626 Phone (949) 548-1192 1 fax (949) 548-6516 Costa Mesa office email: dsaidi(@robhamers.com From: Annette Ochoa <info@torressanitat:ion.com> Sent: Monday, May 1, 2023 2:29 PM To: Dawn Saidi <dsaidi(0)RobHamers.com>; Alex Torres <alex((�torressanitation.corn> Subject: Fwd: CERTIFICATE OF LIABILITY INSURANCE - COSTA MESA REVISED Hello Dawn Please view updated COI Let me know if these are all good Thank you Best Regards, Annette Ochoa Torres Sanitation Systems Construction Contact phone: (323)428-5510 Emergency contact: (323)518-9012 From: Juanita Fonnegra <certs(fbestcalins.com> Sent: Monday, May 1, 2023 12:31:50 PM To: Alex Torres <alex(c-)torres�aiiitation.coin>; Annette Ochoa <irifo(@tprressanitation.com>; dsaidi(@robhamers.com <dsaidi(@robhamers.com> Subject: CERTIFICATE OF LIABILITY INSURANCE - COSTA MESA REVISED Hello, Attached is a Certificate of Insurance for : Torres Sanitation System Construction , DBA Torres Sanitation System Construction Please email us back If there are any questions or concerns: Certs'% •Bestcalins.com Please note: The coverage and policies that appear on this certificate reflect the coverage and policies our agency shows for this insured. Please contact your Vendor if additional coverage, endorsements, and/or special wording is needed including any waivers of subrogation. Please include the followings, when Requesting a Certificate of Insurance. - Certificate Holder Name & Address - Requirements for Insurance (please attach a Sample COI if available) Thank you Best California Insurance Services, Best regards,