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Insurance - GCI Construction, Inc. 2023-07-18GCICONS-01 JLOPEZ CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DD/YYYY) 7/18/2023 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(les) 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 Jessica Lopez Commercial The Brokerage !PHONE €4 FAX The Brokerage, an Alera Group Company. w�__E_{g�g� 287'887T,etc.No): 20261 SW Acacia St, Suite 200 A DRESS: jlopez@thebrokerageins.com ---- NewportBeach, CA 92660 _ INSURER(S) AFFORDING_ COVERAGE MAIC INSURED GCI Construction, Inc. 1031 Calle Recodo, Ste D San Clemente, CA 92673 INSURER F: Vallev Forcie Insurance Com f`_f1VC0Af3P9 f`Cl?T1C1f`ATC RI11UMC10. nn%11L%1ni1 art faanr_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. LTH TYPE OF INSURANCE ADDLISUBR POLICY NUMBER POLICY EFF INSDA POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY !EACH OCCURRENCE ---___-_ A_ .___ 1,000,000 CLAIMS -MADE LX!',, OCCUR 7018617460 4/1/2023 r- is_.PREMI.1=tE�? 4/112024 DAMAGE TO RENTED 100,000 grrnSl- ($ X Contractual Liab.15,000 MED EXP (Anyone person) $.PERSONAL _$ _ & ADV INJURY 1,000,000 _GEN'L AGGREGATE LIMIT APPLIES PER: _ -- -- 2,000,000 GENERAL AGGREGATE • _ POLICY X ; PRO- LOC --_ J JECT �� PRODUCTS-_COMPJOP AGG I $ 2,000,000 i OTHER: 6 AUTOMOBILE LIABILITY COMBINED SINGLE LIMITjgaAgrzi )�- I $ 1,000,000 -- — -- X ;ANY AUTO I'll— z X i X 17018616972 411/2023 ( - 411/2024 BODILY INJURY {Peri rson? ---p# OWNED s SCHEDULED t AUTOS ONLY t AUTOS _._. —. _$ BODILY iNJU BO RY (Per accidenti HIRED { NON -OWNED AUTOS ONLY AUTOS ONLY - - - PROPERTY DAMAGE Per acca Z $ t UMBRELLA LIAB X OCCUR I S,�i{I,Ii�IO EACII.00CURRENCE__ - -,0,0 X EXCESS LIAB CLAIMS -MA X j ,�7 i$1i9$ 41112{}2 41112024 AGGREGATE--- $ I DED j X ` RETENTION $ Q( — --- !WORKERS COMPENSATION I # AND EMPLOYERS LIABILITY PER OTH- — STATUTE i I ER_ . Y ! N i ANY PROPRIETORlPARTNERIEXECUTIVE ; Ii OFFICER MEMBER EXCLUDED? N/A: L E.L. EACH ACCIDENT $ -- — _ - (Mande#ory In NH} I If yes , describe under E E.L. DISEASE_EA EMPI{3YEE-- _ I DESCRIPTION OF OPERATIONS below l I E.L. DISEASE -POLICY LIMIT § i � i I I 3 i DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 141, Additional Remarks Schedule, may be attached If more space is required RE: CMSD Project #343; Elden Pump Station Emergency Bypass Replacement; 2864 Elden Ave, Costa Mesa, CA 92627, The District, and its officers, officials, employees, and agents are included as Additional Insureds as agglglaipwv/auaiwv/xsaiwv respects General Liability, Auto Liability, and Excess Liability per attached endorsements. This Insurance shall apply as Primary and Non -Contributory per attached endorsement. Waiver of Subrogation for General Liability, Auto Liability, and Excess Liability: See Attached Endorsements. n=DTICInAT= Uni n=0 ^Akin=§ i A'r1r1k1 A(;UKU Z5 (LU76tU3) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary DistrictTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 290 Paularino Avenue -T, +� ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa, CA 92626 AUTHORIZED REPRESENTATIVE A(;UKU Z5 (LU76tU3) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: GCICONS-01 JLOPEZ Page 1 of 1 F.A1111 MORMON hK"1'tN!4A&14R t L E AGENCY NAMEDINSURED Commercial The B rokerage GCI Construction, Inc. 1031 Calle Recodo, Ste D San Clemente, CA 92673 POLICY NUMBER SEE PAGE 1 CARRIER A MAIC CODE �EE PAGE I �SEE P 1 — I EFFECTIVE DATE: SEE PAGE 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Cancellation: *Should this policy be cancelled before the expiration date, The Brokerage, an Alera Group Company will mail 30 (thirty) days written notice to those Certificate Holders which require such action per contract or agreement.* *Except 10 Days Notice of Cancellation for Non -Payment of Premium. ACORD 101 (2008/01) @ 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CNA PARAMOUNT Contractors' General Liabty Extension Endorsement claims arising solely out of their capacity or status as such and, in the case of a spouse, where such claim seeks damages from marital community property, jointly held property or property transferred from such natural person Insured to such spouse. No coverage is provided for any act, error or omission of an estate, heir, legal representative, or spouse outside the scope of such person's capacity or status as such, provided however that the spouse of a natural person Named Insured and the spouses of members or partners of joint venture or partnership Named Insureds are Insureds with respect to such spouses' acts, errors or omissions in the conduct of the Named Insured's business. 10. EXPECTED OR INTENDED INJURY — EXCEPTION FOR REASONABLE FORCE Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete the exclusion entitled Expected or Intended Injury and replace it with the following: This insurance does not apply to: Expected or Intended Injury Bodily injury or property damage expected or intended from the standpoint of the Insured. This exclusion does not apply to bodily injury or property damage resulting from the use of reasonable force to protect persons or property. I _419WI[MOM-My ;LIT A. For each construction project away from premises the Named Insured owns or rents, a separate Construction Project General Aggregate Limit, equal to the amount of the General Aggregate Limit shown in the Declarations, is the most the Insurer will pay for the sum of: 1. All damages under Coverage A, except damages because of bodily injury or property damage included in the products -completed operations hazard; and 2. All medical expenses under Coverage C, that arise from occurrences or accidents which can be attributed solely to ongoing operations at that construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations, nor the Construction Project General Aggregate Limit of any other construction project. B. All: 1. Damages under Coverage B, regardless of the number of locations or construction projects involved; 2. Damages under Coverage A, caused by occurrences which cannot be attributed solely to ongoing operations at a single construction project, except damages because of bodily injury or property damage included in the products -completed operations hazard; and 3. Medical expenses under Coverage C caused by accidents which cannot be attributed solely to ongoing operations at a single construction project, will reduce the General Aggregate Limit shown in the Declarations. C. The limits shown in the Declarations for Each Occurrence, for Damage To Premises Rented To You and for Medical Expense continue to apply, but will be subject to either the Construction Project General Aggregate Limit or the General Aggregate Limit shown in the Declarations, depending on whether the occurrence can be attributed solely to ongoing operations at a particular construction project. D. 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 shown in the Declarations, regardless of the number of projects involved. CNA74705XX {1-15) Policy No: 7018617460 Endorsement No: Insured Name: GCI Construction, Inc. Effective Date: 4/1/2023 Copyright CNA All Rights Reserved Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNAPARAMOUNT Contractors' General Liability Extension Endorsement E. If a single construction project away from premises owned by or rented to the Insured has been 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. F. The provisions of LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. A quasi in rem action against any vessel owned or operated by or for the Named Insured, or chartered by or for the Named Insured, will be treated in the same manner as though the action were in personam against the Named Insured. Solely with respect to bodily injury that arises out of a health care incident: A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Insuring Agreement is amended to replace Paragraphs 1.b.(1) and 1.b.(2) with the following: b. This insurance applies to bodily injury provided that the professional health care services are incidental to the Named Insured's primary business purpose, and only if: (1) such bodily injury is caused by an occurrence that takes place in the coverage territory. (2) the bodily injury first occurs during the policy period. All bodily injury arising from an occurrence will be deemed to have occurred at the time of the first act, error, or omission that is part of the occurrence; and B. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitlei, Exclusions is amended to: L add the following to the Employers Liability exclusion: This exclusion applies only if the bodily injury arising from a health care incident is covered by other liability insurance available to the Insured (or which would have been available but for exhaustion of its limits). ii. delete the exclusion entitled Contractual Liability and replace it with the following: En C) tn This insurance does not apply to: Contractual Liability CA the Insured's actual or alleged liability under any oral or written contract or agreement, including but not limited to express warranties or guarantees. III. add the following additional exclusions: This insurance does not apply to: Discrimination any actual or alleged discrimination, humiliation or harassment, including but not limited to claims based on an individual's race, creed, color, age, gender, national origin, religion, disability, marital status or sexual orientation. Dishonesty or Crime Any actual or alleged dishonest, criminal or malicious act, error or omission. Medicare/Medicaid Fraud CNA74705XX (1-15) Policy No: 7018617460 Page 9 of 17 Endorsement No: Insured Name: GCI Construction, Inc. Effective Date: 411/2023 Copyright CNA All Rights Reserved, Includes copyrighted material of Insurance Services Office, Inc., with its permission CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions, or the acts or omissions of those acting on your behalf: A. in the performance of your ongoing operations subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if: 1. the written contract requires you to provide the additional insured such coverage; and 2. this coverage part provides such coverage. II. But if the written contract requires: A. additional insured coverage under the 11 -85 edition, 10-93 edition, or 10-01 edition of CG201 0, or under the 10- 01 edition of CG2037; or B. additional insured coverage with "arising out of" language; or C. additional insured coverage to the greatest extent permissible by law; then paragraph 1, above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. Ill. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: CNA75079XX (10-16) -Policy No: 7018617460 Page 1 of 2 Endorsement No: Insured Name: GCI Construction, Inc. . Effective Date: 4/11/2023 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., With its permission. CNA PARAffiOUNT Blanket Additional Insured - Owners, Lessees or ContractorsProducts-Completed Operations Coverage Endorsement Primary and Noncontributory Insurance With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. V11. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following d0finition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: U111111111111111172 =## �U M_�� 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and -expires concurrently with said Policy. CNA75079XX (10- 16) Policy No: 7018617460 Page 2 of 2 Endorsement No: Effective Date: 4/1/2023 Insured Name: GCI Construction, Inc. Copyright CNA All Rights Reserved, Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA Contractors' General Liability Extension Endorsement A. Paragraph 1.b. is amended to delete the $250 limit shown for the cost of bail bonds and replace it with a $5,000. limit; and B. Paragraph 1.d. is amended to delete the limit of $250 shown for daily loss of earnings and replace it with a $1,000. limit. 24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS If the Named Insured unintentionally fails to disclose all existing hazards at the inception date of the Named Insured's Coverage Part, the Insurer will not deny coverage under this Coverage Part because of such failure. Under CONDITIONS, the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended to add the following: The Insurer waives any right of recovery the Insurer may have against any person or organization because of payments the Insurer makes for injury or damage arising out of: 1. the Named Insured's ongoing operations; or 2. your work included in the products -completed operations hazard. However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in a written contract or written agreement, and only if such contract or agreement: 1. is in effect or becomes effective during the term of this Coverage Part; and 2. was executed prior to the bodily injury, property damage or personal and advertising injury giving rise to the claim. 26. WRAP-UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS Note: The following provision does not apply to any public construction project in the state of Oklahoma, nor to any construction project in the state of Alaska, that is not permitted to be insured under a consolidated (wrap- up) insurance program by applicable state statute or regulation. If the endorsement EXCLUSION — CONSTRUCTION WRAP-UP is attached to this policy, or another exclusionary endorsement pertaining to Owner Controlled Insurance Programs (O.C.I.P.) or Contractor Controlled Insurance Programs (C.C.I.P.) is attached, then the following changes apply: A. The following wording is added to the above -referenced endorsement: With respect to a consolidated (wrap-up) insurance program project in which the Named Insured is or was involved, this exclusion does not apply to those sums the Named Insured become legally obligated to pay as damages because of: 1. Bodily injury, property damage, or personal or advertising injury that occurs during the Named Insured's ongoing operations at the project, or during such operations of anyone acting on the Named Insured's behalf; nor 2. Bodily injury or property damage included within the products -completed operations hazard that arises out of those portions of the project that are not residential structures. B. Condition 4. Other Insurance is amend to add the following subparagraph 4.b.(1)(c): This insurance is excess over: (c) Any of the other insurance whether primary, excess, contingent or any other basis that is insurance available to the Named insured as a result of the Named Insured being a participant in a consolidated (wrap-up) insurance program, but only as respects the Named Insured's involvement in that consolidated (wrap-up) insurance program. CNA74705XX (1-15) Policy No: 7018617460 Page 16 of 17 Endorsement No: Insured Name: GCI Construction, Inc. Effective Date: 4/1/2023 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy Number: 7018616972 CNA63350XX THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS EXTENDED COVERAGE ENDORSEMENT - BUSINESS AUTO PLUS - This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The following |eadded to Section 11, Paragraph A.I.,Who ys An Insured: 1. a. Any incorporated entity of which the Named Insured owns o majority of the voting shook on the date of inception of this Coverage Form; provided that, b. The insurance afforded by thisprovision A.I.does not apply boany such entity that isen"inmured" under any other liability "poiny"providing "outo"coverage. 2. Any organization you newly acquire or form, other than a limited liability oompeny, partnership or joint venture' and over which you maintain majority ownership interest. The insurance afforded bythis provision A.2.: a. Is effective on the acquisition mformation date, and is afforded only until the end of the policy period ofthis Coverage Form, orthe next anniversary ofits inception date, whichever isearlier. b. Does not apply to: (1) "Bodily injury" or "property damage" caused by an "accident" that occurred before you acquired orformed the organization; or (2) Any such organization that is an "insured" under any other liability "policy" providing "auto" 3. Any person or organization that you are required by a written contract to name as an additional insured Additional is an 'n---- but only -,- ---their legal'---` for acts or omissionsperson, who qualifies aaan1noured^8 und�r�c�onU-VVhoonan�vwhornU�bi der Insured/Primary -> |AInsured d''� �~'~~=~ '~ -''�'--- -' this policy. If required by written contract, this insurance will be primary and non-contributory to insurance onwhich the additional insured |aoNamed Insured. 4. An "employee" of yours is an "inounad"while operating an "auto" hired or rented under contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct ofyour business. "Policy", as used in this provision A. Who Is An Insured, includes those policies that were in force on the inception date ofthis Coverage Form but: 1. Which are nnlonger |nforce; or 2. Whose limits have been exhausted. B. Bail Bonds and Loss of Earnings Section NLParagraphs A.2. (2) and A.2.(4) are revised emfollows: 1. |na.(2),the limit for the cost ofbail bonds |echanged from $2.O0Dto$5.00O; and 2. In a.(4), the limit for the loss ofearnings iachanged from $25Dto$5OOeday. C. Fellow Employee Section UK,Paragraph 08.5does not apply. Such coverage as is afforded by this provision C. is excess over any other collectible insurance. 11. PHYSICAL DAMAGE COVERAGE A. GlasmBmmakage-HittingA Bird Or Animal - Failing Objects Or Missiles The following iaadded toSection III, Paragraph A.3.: With respect to any covered "mubf, any deductible shown in the Declarations will not apply to glass breakage if such glass is repaired, in a manner acceptable to us, rather than replaced. B. Transportation Expenses Section KKU,Paragraph AAa. is revised, with respect to transportation expense incurred by you, to provide: a. $6Uper day, inlieu of$2O; subject to CNA63359XX Page 1of3 (Ed. 4/12) Policy Number: 7018616972 CNAG3859XX b. $1,8OOmaximum, inlieu of$6U0. C. Loss of Use Expenses Section 111, Paragraph A.4.b.iarevised, with respect to loss of use expenses incurred by you, toprovide: The following haadded toSection M. Paragraph A.: 5LHired mAutos" If Physical Damage coverage is provided under this pohcy, and such coverage does not extend to Hired Autos, then Physical Damage coverage xsextended to: u. Any covered "auto"you lease, hire, rent orborrow without adriver; and b. Any covered "auto" hired or rented byyour "emnp|oyee" without driver, under contract in that individual "employee's" nmme, with your perm|aa|on, vvh||o performing duties related to the conduct ofyour business. c. The most we will pay for any one "accident" or "loss" is the actual cash value, cost of repair, cost of replacement or$75.00D. whichever is leae, minus a $500 deductible for each covered auto. No deductible applies bz"|osa"caused byfire orlightning. d. The physical damage coverage as is provided by this provision |oequal tothe physical damage cmvanuge(a)provided onyour owned "auboa^ e. Such physical damage coverage for hired "mutom"will: (1) Include loss of use, provided it is the consequence of an "aoo|dan[' for which the Named Insured is |eQeUy |iab|e, and as a result of which a monetary |oam is sustained by the leasing or rental concern. (2) Such coverage as is provided by this provision will be subject to a limit of $750 per "accident." E. Airbag Coverage The following iaadded boSection Ill, Paragraph B.3.: The accidental discharge of an airbag shall not be considered mechanical breakdown. F. Electronic Equipment Section Ill, Paragraphs B.4.c and B.4.d. are deleted and nap|aood by the following: c. Physical Damage Coverage on a covered "auto" also applies to "loss" to any permanently installed electronic equipment including its antennas and other accessories d. A $100 per occurrence deductible applies to the coverage provided by this provision. 0. Diminution In Value The following ioadded ioSection Ill, Paragraph B.6.: Subject tothe following, the "diminution in value" exclusion does not apply to: a. Any covered "auto" of the private passenger type you lease, hire, rent or borrow, without a driver for a period of 30 days or less, while performing duties related to the conduct of your business; and b. Any covered "auto"ofthe private passenger type hired orrented by your "employee" without adr|ver for a period of 30 days or |eua' under contract in that individual "employee's" namne, with your permission, while performing duties related to the conduct of your business. c. Such coverage is provided by this provision is ||rn|ted to m "diminution in value" loss arising directly out of accidental damage and not as e naou|t of the failure to make repairs; faulty or incomplete maintenance or repairs; or the installation of substandard parts. d. The most we will pay for "loss" to a covered "auto" in any one accident is the lesser of: (1) $5.000; or (2) 2O%ofthe "aubz'a"actual cash value (ACV). Ill. DrivmOkhenCarCovwmmge-ExecutiveOfficemm The following imadded tmSections UUand Ill: 1. An "auto" don't own, hire orborrow |s e covered "oubffor Liability Coverage while being used by, and for Physical Damage Coverage while in the care, custody or control of, any ofyour "executive officers," except: a. An "auto" owned by that "executive officer"or a member of that person's household; or CNA83358)CX Page 2of3 (Ed. 4/12) Policy Number: 7018616972 CNA8335QXX b. An "auto" used by that "executive officer while working in e business of selling, oorvicing, repairing or parking "autos." Such Liability and/or Physical Damage Coverage as is afforded by this provision. (1) Equal bothe greatest ofthose coverages afforded any covered "euto";and (2) Excess over any other collectible insurance. 2. For purposes of this provision, "executive officer' rneeno a person holding any of the officer positions created by your charter, constitution, by-laws or any other similar governing document, and, while a resident oythe same household, includes that person's spouse. Such "executive officers" are "insureds" while using a covered "auto" described in this provision. A. Duties NmThe Event Of Accident, Claim, Suit Or Loss The following ieadded hoSection IV, Paragraph A.2.a.: (4) Your "employees" may know of an "accident" or "loss." This will not mean that you have such knowledge, unless such "accident" or "loss" is known to you or if you are not an individual, to any of your executive officers orpartners oryour insurance manager. The following is added to Section UV, PanagmmphA.2.b.: (6)Your "ernp|oyeeo" may know of documents received concerning m c|oirn or"uuit."This will not mean that you have such knowledge, unless receipt of such documents is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. B. Transfer Of Rights Of Recovery Against Others To Us The following ioadded toSection IV, Paragraph A.5. Transfer Of Rights Of Recovery Against Others To �w�a�r�����m�h�.b�u�� ��i� �m� � Waiver of Subrogation -> any person or organization for whom mwhich you are requiredbywritten contract magreement to obtain this waiver from us. This injury ordamage must arise out mfyour activities under econtract with that person ororganization. You must agree tothat requirement prior ioan"nooident"or"loso" C. Concealment, Misrepresentation or Fraud The following |eadded hzSection IV, Paragraph 113.2L: Your failure 0mdisclose all hazards existing onthe date ofinception ofthis Coverage Form shall not prejudice you with respect tuthe coverage afforded provided such failure oromission ionot intentional. D. Other Insurance The following |oadded UoSection IV, Paragraph 113J5.: Regardless of the provisions of Paragraphs 5.a. and 5.d. above, the coverage provided by this policy shall beonaprimary non-contributory basis. This provision kaapplicable only when required byewritten contract. That written contract must have been entered into prior to "Accident" or "Loss". E. Policy Period, Coverage Territory Section IV, Paragraph B. 7.(S).(a). is revised 1oprovide: a. 45 days of coverage in lieu of 30 days. Section V. paragraph C.isdeleted and replaced bythe following: "Bodily injury" rneono bodily injury, sickness or disease sustained by a permon, including mental anguish, mental injury or death resulting from any of these. ONA83358>0( Page 3of3 CNA Paramount Excess and Umbrella Liability CNA Policy or organization which may be liable to the Insured because of injury or damage to which this insurance may also apply; and v4. will not voluntarily make o payment, except at its own cost, mmeurne any obligation, or incur any expense, other than for first aid, without the Insurer's prior consent. 3. Cooperation With respect to both Coverage A_Excess Follow Form Liability and Coverage B_Umbrella Liability, the Named Insured will cooperate with the Insurer in addressing all claims required to be reported to the Insurer in accordance with this paragraph 0. Notice of Claims/Crisis Management Accident, and refuse, except solely at its own cost, to voluntarily, without the Insurer's approval, make any payment, admit liability, assume any obligation or incur any expense related thereto. P. Notices Any notices required to be given by an Insured shall be submitted in writing to the Insurer at the address set forth in the Declarations of this Policy. Q. Other Insurance If the Insured is entitled to beindemnified motherwise insured inwhole orinpart for any damages m defense costs by any valid and collectible other insurance for vvhk:h the Insured otherwise would have been indemnified or otherwise insured in whole or in part by this Policy, the limits of insurance specified in the Deo|onndonm of this Policy shall apply in excess of, and shall not contribute to a claim, incident or such event covered by such other insurance. Excess Follow With respect to Coverage A - Excess Follow Form Liability only, if: Form AI/Primary _~ m. the Named Insured has agreed in writing in a contract or agreement with a person or entity that this insurance would be primary and would not seek contribution from any other insurance available; -~ b. Underlying Insurance includes that person or entity as an additional insured; and -� o. Underlying Insurance provides coverage on a primary and noncontributory basis as respects that person or entity; then this insurance is primary to and will not seek contribution from any insurance policy where that person or entity is a named insured. R. Premium All premium charges under this Policy will be computed according to the Insurer's rules and rating plana that apply atthe inception ofthe current policy period. Premium charges may bmpaid tothe Insurer or its authorized representative. S. In Rem Aodmnm A quasi /n rem action against any veaea| owned or operated by or for o Named Insured, or chartered by orfor a Named Insured, will be treated in the same manner as though the action were in personam against the Named Insured. T. Separation ofInsureds Except with respect to the limits of insurance, and any rights or duties specifically assigned in this Policy to the First Named Insured, this insurance applies: 1. as if each Named Insured were the only Named Insured; and 2' separately toeach Insured against whom eclaim iamade. U. Transfer of Interest Form No: omA75eo4xxmo-2o1s> Policy No: rou8616m8e Policy Page: 21 mu Policy Effective Date: 4/1/2023 Underwriting Company: Continental Ins. Co, 333 S Wabash Ave, Chicago, IL 60604 Policy Page: 33 of 49 1�1Copyright CNA All Rights Reserved. CNA Paramount Excess and Umbrella Liability Assignment of interest under this policy shall not bind the Insurer unless its consent is endorsed hereon. V. Unintentional KDrniosimn Based onInsurer's reliance onthe Named |nswred'mrepresentations oatoexisting hazards, if the Named Insured should unintentionally fail to disclose all such hazards at the effective date of this Policy, the Insurer will not deny coverage under this Policy because ofsuch failure. XS/unxm WAIVER W. Waiver of Rights of Recovery The Insurer waives any right of recovery it may have against any person or organization because of payments the Insurer makes under this Policy if the Named Insured has agreed in writing to waive such rights of recovery in a contract or agreement, and only ifthe contract or agreement: 1. iaineffect orbecomes effective during the policy period; and 2. was executed prior to loss. For purposes of this Policy, words in bold face type, whether expressed in the singular or the p|unm|' have the meaning set forth below. Advertisement rneeno e notice that is broadcast or published to the general public or specific market segments about the Named Unaured'mgnods' products or services for the purpose of attracting customers or supporters. For the purposes ofthis definition: A. notices that are published include material placed on the Internet oron similar electronic nxaano of communication; and B. regarding web -sites, only that part of a web -site that is about the Named |nmurmd's goods, products or services for the purposes of attracting customers orsupporters imconsidered onadvertisement. Aircraft means any machine ordevice that iacapable ofatmospheric flight. Arbitration proceeding means a formal alternative dispute resolution proceeding or administrative hearing to which an Insured is required to submit by statute or court rule or to which on Insured has submitted with the Insurer's consent. Asbestos means the mineral inany form whether or not the asbestos was euany time airborne as afibor' particle or dust, contained in or formed a part ofo product, structure or other nau| or personal property, carried on clothing, inhaled or ingested, or transmitted byany other means. Authorized Insured means any executive officer, member of the Named inmured'a risk management or in-house general counsel's office, or any employee authorized by the Named Insured to give or receive notice of obdnm. Auto means: A. eland motor vehicle, trailer or semitrailer designed for travel onpublic roads, including any attached machinery or equipment; or B. any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. However, auto does not include mobile equipment. Bodily injury means bodily injury, sickness or disease sustained by o person, including death, humiliation, shock, mental anguish or mental injury sustained by that person otany time which results as o consequence of the bodily injury' sickness or disease. Claim means a; Form No: CNA75504XX (03-2015) Policy No: 7018616986 Policy Page: 22 of 32 Policy Effective Date: 4/1/2023 Underwriting Company: Continental Ins. Co, 333 S Wabash Ave, Chicago, IL 60604 Policy Page: 34 of 49 �Copyright CNA All Rights Reserved. ,A,C'OORa CERTIFICATE OF LIABILITY INSURANCE 1'' DATE(MM/DD/YYYY) 1 INSR I LTR 7/18/2023 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 Compass Direct Insurance Services, Inc. 13681 Newport Ave., Ste 8 #622 Tustin, CA 92780 CONTACNAME: Jeremy Jerem Seltzer PHONE 714-665-ss00 FAX No : 714-665-9801 E-MAIL ADDRESS: jeremy@cciisi.com INSURERS AFFORDING COVERAGENAIC # www.cdisi.com License #01-116100 INSURER A: Everest National Insurance Company 10120 INSURED GCI Construction Inc. 1031 Calle Recodo, Ste. D INSURER B: Westchester Surplus Lines Insurance Co 10172 INSURER C INSURER 0: San Clemente CA 92673 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 753.7991 REVISION NUMRFR- 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 I LTR TYPE OF INSURANCE ADDL INSD SUBR JMa POLICY NUMBER POLICY EFF M/DD/YYYY`) POLICY EXP (MM(DD/YYYY1 V LIMITS COMMERCIAL GENERAL LIABILITY 0OCCUR EACH OCCURRENCE $ fiEtS CLAIMS -MADE PREMISES Ea occurrence $ MED EXP {Any one person} $ _ __-------- _._ ..._.______.-------_-_-_ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: JPRO- POLICY D 1:1 LOC i PRODUCTS - COMP/OP AGG $------ _ ._-F'� $ OTHER: AUTOMOBILE --- LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ � } HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ EXCESS LIAB AGGREGATE DED RETENTION $ $ �v- A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? N / A 7600022190221 8/1/2022 8/1/2023s�ATUTE oRH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below $0 Deductible -- E.L. DISEASE - POLICY LIMIT $1 D00 000 B Pollution 646866435 005 2/2/2023 2/2/2024 $5,000,000/$10,000,000 Deductible $5,000 DESCRIPTION OF OPERATIONS! LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may to attached i1 more space is required) Certificate of insurance is issued as information only with respects to the coverage limits of the named insured. Waiver of subrogation applies to Costa Mesa Sanitary District, its directors, officers, engineers, employees, and authorized agents. RE: CMSD #343 Elden Pump Station Emergency Bypass Replacement CERTIFICATE HOLDER CANCELLATION Costa Mesa SanitaryDistrict SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 290 Paularin0 Avenue a THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa CA 92626 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Jeremy Seltzer 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 75357921 1 22-23 WC.. Poll I ,Taramv fiat rear I 7J?R/Jf(72 4.1r. ti PM (Mort I Paan 1 of WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS 0 r• 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 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 81112022 Policy No. 7600022190221 Endorsement No. 001 Insured: GCI Construction, Inc. Premium $ INCL. Insurance Company: Everest National Insurance Company Countersigned By: - 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual - 1999. 4".1S'74i1 t 'i? -9A Wf' pn17 1 ,t.-- tZ."+ - • '7/1 qi-)'t7Z i i1G 11 ti ;mcrri 1 u- ) nF i