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Insurance - GCI Construction, Inc. 2023-07-28 (2)GCICONS-01 MSEGURA A�,,,,,,�,,.,'�.. Rev CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/28/2023 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 Commercial The Brokerage The Brokerage, an Alera Group Company 20261 SW Acacia St, Suite 200 Newport Beach, CA 92660 CONTACT Jessica Lopez PHONE FAX (A/C, No, Ext): (949) 287-5677 (A/C, No): EAbmDARILEss:jlopez@thebrokerageins.com X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR X INSURERS AFFORDING COVERAGE NAIC # INSURER A:Valley Forge Insurance Company 20508 4/1/2023 INSURED INSURER B: Continental Casualty Company 20443 INSURER C: GCI Construction, Inc. INSURER D: 1031 Calle Recodo, Ste D San Clemente, CA 92673 URER E r""a INSURER F: COVERAGES CERTIFICATE NUMBER' RFVICI[1N NI IMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL IND SUBR WVD POLICY NUMBER POLICY EFF MM/DD1YYYYI POLICY EXP (MMID12NYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR X 7018617460 4/1/2023 4/1/2024 EACH OCCURRENCE $ 1,000,000 DAMAGETO (Ea occurrence)$ 100'000 MED EXP (Anv oneperson) $ 15,000 PERSONAL & ADV INJURY $ 1'000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT F LOC GENERAL AGGREGATE $ 2'000'000 PRODUCTS - COMP/OP AGG $ 2'000'000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS 7018616972 4/1/2023 4/1/2024 BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident) ccident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 X EXCESS LIAB CLAIMS -MADE 7018616986 4/1/2023 4/1/2024 AGGREGATE $ 4'000'000 DED I X I RETENTION $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITYTAT ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? F—]N/A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below X 7039536050 8/1/2023 8/1/2024 X PER I OTH- T ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1'000'000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Removal and Installation of Godwin Unit from Elden Pump Station. glaip/wcwv The District, its directors, officials, officers, employees, agents, and volunteers are included as Additional Insureds as respects General Liability per attached endorsement. Waiver of Subrogation for Workers' Compensation: See Attached Endorsement. This Insurance shall apply as Primary and Non -Contributory per attached endorsement. CERTIFICATE HOLDER CANCFI I ATInN ACORD 25 (2016/03) ©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 SanitaryDistrict THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 290 Paularino Avenue /� � � o-_ � ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa, CA 92626 AUTHORIZED REPRESENTATIVE J' ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: GCICONS-01 LOC #: 1 ADDITIONAL REMARKS SCHEDULE MSEGURA Page 1 of 1, AGENCY Commercial The Brokerage NAMED INSURED GCI Construction, Inc. 1031 Calle Recodo, Ste D San Clemente, CA 92673 POLICY NUMBER EE PAGE 1 CARRIER EE PAGE 1 NAIC CODE SEEP 1 EFFEcnvE DAT—E: SEE PAGE 1 AIJIJI i IVIVAL KtMAKr%b 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. © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CNA 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: 1. 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 CG2010, 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. 111. 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. �a 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: NA75079XX (10-16) Policy o: 7018617460 Page 1 of 2 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. CNA CNA PARAMOUNT Blanket Additional Insured -Owners, Lessees or Contractors -with Products -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. VI. 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 definition: 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: 1. the bodily injury or property damage; or 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. CNA75079XX10-16 Policy o: 7018617460 Page 2 of 2 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. gm 9� .3r„^',�'�F ' < �'i' Pg '� v 'Y .y .,:Y>' a•,'.'{,i� � �., , .w fi . � � . - 3�w4„., u > £..> ''t : � � This endorsement changes the policy to which it is attached. It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two - Employers' Liability Insurance H. Recovery From Others are amended by adding the following: We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) PREMIUM CHARGE - Referto the Schedule of Operations The charge will be an amount to which you and we agree that Is a percentage of the total standard premium for California exposure. The amount Is harge%. 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 Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Form No: G -19160-B (11-1997) Policy No: 7039536050 Endorsement Effective Date: 8/1/2023 Endorsement Expiration Date:8/1/2024 Policy Effective Date: 8/1/2023 Endorsement No: Underwriting Company: Valley Forge Insurance Company Insured Name: GCI Construction, Inc. © Copyright CNA All Rights Reserved.