Loading...
Insurance - Golden Bell Products, Inc. 2023-09-20CC>Rr CERTIFICATE OF LIABILITY INSURANCEDATE (MM/DD/YYYY)09/20/2023 iNSR LTR TYPE OF INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Van Beurden Ins. Serv, Inc. - Kingsburg CONTACT Recia Shelton -- PO Box 67 PHONEAJC No): (55 9) LC.No. Xt): F LA(559} 897-2975 897-4070 X Incid.Prof.Services _ — __ _ E-MAIL _ Kingsburg CA 93631 ADDRESS: INSURERn AFFORDING COVERAGE --- NAIC # _._.�000 ___ _. PERSONAL & ADV INJURY $ 1,000 000 INSURER A: Evanston Insurance Company 35378 — INSURED (714 ) 630-3861 I GEN`L AGGREGATE LIMIT APPLIES PER: PRO- X POLIO ;-- JECT t LOC --, j GENERAL AGGREGATE-- I $ 2 ,000,000 ----- - Golden Bell Products, Inc. INSURERS: i i- INSURER C PRODJCTS -COMP/OP AGG $ 2,000,000 -_ $ P.O. Box 366 INSURER D: Atwood CA 92811 INSURER E: AUTOMOBILE LIABILITY i— j ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED ! HIRED AUTOS � AUTOS INSURER F: j COVERAGES CERTIFICATE NUMBER: Cert ID 50484 RFVISIt)N NIIMRFR- 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 SUBR -�� D POLICY NUMBER POLICY EFF POLICY EXP MM/DD MM/DD LIMITS A _ X COMMERCIAL GENERAL LIABILITY _ ( CLAIMS -MADE OCCUR i i MKLV5ENV104315 10/25/2023110/25/2024 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 X Incid.Prof.Services _ — __ _ I I I MED EXP (Ary one person) 1$ 5 X $10,000 SIR ` _._.�000 ___ _. PERSONAL & ADV INJURY $ 1,000 000 I GEN`L AGGREGATE LIMIT APPLIES PER: PRO- X POLIO ;-- JECT t LOC --, j GENERAL AGGREGATE-- I $ 2 ,000,000 ----- - f I i i- PRODJCTS -COMP/OP AGG $ 2,000,000 -_ $ AUTOMOBILE LIABILITY i— j ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED ! HIRED AUTOS � AUTOS j ' i I COMBINED SINGLE LIMIT Ea accidenty BODILY INJURY {Per person} $ BODILY INJURY (Per accident} $ --- PROPERTY DAMAGE Per accde_n'�______ $ i i 1 A j UMBRELLA LIAR X OCCUR C X i EXCESS LIAR 1 CLAIMS -MADE DED 1 X 1 RETENTIONS 10,000 i j MKLV5EFX101242 I I f I 10/25/2023;10/25/2024 i I EACH OCCURRENCE Is 2,000,000 --- - ^ (AGGREGATE ; 2, 000, 000 3 I$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITYY / N ANY PROPRIETOR/PARTNEWEXECUTIVE OFFICER/MEMBER EXCLUDED? ❑� {Mandatory in NH} If yes, describe under i DESCRIPTiON OF OPERATIONS below N / A i E i I 1 i i 4 , PER OTE - —_ STATUTc __._._ E_____�_ E.L. EACH ACCIDENT $ -- E.L.DISEASE - EA EMPLOYE $ - - --- E.L. DISEASE -POLICY LIMIT l $ A Cont. Pollution Liab. i MKLV5ENV104315 10/25/202310/25/2024$25,000 SIR $2M Agq/1M Oc A Environ. I>nnairment Liao. MK LV5ENV104315 10/25/2023 10/25/2024$25,000 SIR $2M Agg/1M Oc DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Manhole spraying for roaches at various city locations. It is agreed that the Costa Mesa Sanitary District, its elected and appointed officials, officers, agents, and employees are named as additional insureds as respects to General Liability per attached additional insured form only when required by written contract. CERTIFICATE HOLDER r_ANrFI I ATInN ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 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 c:��ta M�+�a sanitary ACCORDANCE WITH THE POLICY PROVISIONS. 290 Paularino Avenue AUTHORIZED REPRESENTATIVE Costa Mesa CA 92626 I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD P01"ICY NUMBER: 1`4KLV6ENV104816 COMMERCIAL GENERAL LIABILITY CG 20,'100413 TH18 ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERSLESSEES OR CONTRACTORS - SCHEDULED ' ORGANIZATION PERSOWOR Tihis endorsement modifies lnGurM 08 Provided under the following; COMMERCIAL GI NERAL LIAB)LITY COVERAGE PART SCHEDULE Name Of Additional InsLired Person(s) Or Orr S As required icy vvritl9r, 001*80t signed by both paZle—sAll ion;,tions — and executed Prior tot Cori^irnewoement of operations, A, Sacftr`) I! Who 'Is An Insured is Include as all additional 111SUred tho, orgarlizat!0DW ShOM 'III (ho SohedulO, bUt Otljy � - with, respect to liability for "bodliy injury'', V , pr000rty damage" or "personal and advertising Jr'july caused, in whole or in part, i)y: I Yo Jr acts or omIS81,013s; or 2, 'Fha acts or ornisslot)s o behalf-, f those acting oil your perfornnance of your ongoing operations for the addItIonal InSLIMCI(SN at the osi,)rlated above, locallon(s) ci However; 1, The insurance afforded to such additional Insured 0111V aPPIles to the extant permitted by law; and 2, It coverage Mvld6d tO the additlona] Insured Is required by a contract or agreement, the insurance afforded to such additional Insured will not be broader than [Ilat wh(cll you are required bV lho contrpot or agrQoment to provide for such addlfl,onal insured. B. With (OsPect to the 001-dod to these additional 1 ns u r 0 d,5 t the following additional exclusions apply: This i[Murance doea AO( aPPIY 10 tUdlly Injury" or "property damage" 00ourrIng after: 1, All wock, h1oluding materials, Parts car OCIIAIPMbilt furnished In -conneolion with sucil V)Orl<, on the . project (other il"Ean se'rVica, I I Iil"to'laric'e or repairs) to be performed by or on behalf of t1lo additional at the loo,qtlon of the covered operotiono, has beer) completed; or 2. That portior) of "your work" out of F which the 111)Ury or dalllagO afIS03 has been pul, to its Intended use by any person or organ Ization, other than another contractor or subcontrao'lo. engaged In Performing operallons for. principal as a part of thesame project, C, With respect to (lie insurance affordqd to these addl(lon�l Insureds, the following 18 addocl to Section III — Limits Of IIISLIYatlee; If coverage provided to the additional Insured is r':3qu'rec' by a contract or agreement, the nlost we Will Pay on behalf of the additional Insured Is the amount Of 1llsL1rancE), 1 s Req,11red by the contract or agreement; o , 2. Available under the appicable Limits of insurance shown in the Declaration, whichever is less, This endorsement shall not increase the applicable Limits of insurance shown,ir, the Declarations. CG 2010 04 13 lwuranao 1,,Q'' �U,12 Page I of 1 POLICY NUMBER: MKLV5ENV104315 COMMERCIAL GENERAL LIABILITY CG2D37O413 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As required by written contract signed by both parties All locations and executed prior to commencement of operations, A. Section U —VVho Is An Insured is amended to include as an additional insured the penson(m) or organization(s) shown in the Gnhedu/e, but only with respect to liability for "bodily irjury' or ^ property damage" caused, inwhole orinpart, by ^your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". I. The insurance afforded to such additional insured only applies to the extent permitted bylaw; and 2. If coverage provided to the additional insured /s required by a contract or agreement, the insurance afforded tosuch additional insured will not be broader than that which you are required by the contract or agreement to provide for Such additional insured. B. With respect to the insurance afforded to these additional inoureda, the following is added to Section III — Limits OfInsurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf ofthe additional insured is the amount ofinsurance: 1. Required by the contract or agreement- or 2. Available under the applicable Limits of Insurance shown inthe Oec/enat/on�� . whichever isless. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. OQ 20 37 04 13 @ Insurance Gemioao Office, Inc., 2012 Page 1 of POLICY NUMBER: MKLV5ENV104315 COMMERCIAL GENERAL LIABILITY CG 2453 '1219 _i CHANGESIS ENDORSEMENT POLICY. . r1 READ IT CAREFULLY, WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) AUTOMATIC This endorsement modifies insurance provided under tho following. COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITE'S POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/C6MRLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS The following is added to Paragraph 5, Transfer Of Rights Of Recovery Against Others To Us of Section IV -- Conditions; We waive any right of recovery against any person or organization, because of any payrtierji we make umder this Coverage Part, to whom the insured has "valved Its right of recovery in a written contract or agreement. Such waiver by us applies orIiy to the extent that the insured has waived its right of recovery against such person or organization prior o,, loss. CG 24 53 12 19 J Insurance Services OffiGe,, Inc,, 2018 Page 11 of I POLICY NUMBER: MKLV5ENV104315 COMMERCIAL GENERAL LIABILITY OQ20D1U41O THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ |TCAREFULLY, PRIMARY AND NONCONTRIBUTORY _ OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: CO8�K4EROIALGENERAL LIABILITY COVERAGE PART PRODUCTS!COMPLETED OPERATIONS LIABILITY COVERAGE PART The following 's added to the Other Insurance Condition and aupmaedes any provision to the contrary" Primary And Noncontributory Insurance This insurance is primary to and will not seek contr/buUonhom any other insurance available to on 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 evoUeb|e to the additional insured. CG 20 01 04 13 Q Insurance Services Office, Inc., 2012 Page I of I INTERLINE MARKEL POLICY NUMBER: MKLV5EMV1O4315 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION AS REQUIRED BY CONTRACT - ADDITIONAL INSUREDS All Coverage Forms included in this policy are subject to the following. Number ofdays: 3O Thefollowing isadded tothe Cenoe|laboncondition� We will provide written Notice of Cancellation to an additional insured stating when, not less than the number of days shown in the Schedule above, cancellation will become effective. I'his condition only applies if - 1. Cancellation isfor reasons other than, a. Nonpayment ofpremium: or b. Non-payment ofany deductible eimbursemon� 2. You are required by written contract to p,ovide /he additional insured with such notice; and 3. You agree to provide us with o list of the applicable additional inourods, including their complete mailing addresses, within days ofour request. If notice is mai|ed, proof of mailing is sufficient proof of such notice All other terms and conditions remain unchanged. y0BL 1233 11 13 Includes copyrighted material of |nounsnma Services Office, Inc., Page 1 of with its permission, ACOS' CERTIFICATE F LIABILITY INSURANCE DATE(MM/DD/YYYY) ray 09/28/2023 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION CalCoast Insurance Agency P.O. Box 1070 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Los Alamitos, CA. 90720 GENERAL LIABILITY INSURERS AFFORDING COVERAGE NAIC # INSURED Golden Bell Products Inc. INSURER A. Mercury Casualty Company PO BOX 366 INSURER B: State Compensation Ins. Fund ATWOOD CA 92811 INSURER C INSURER D: --` --_ INSURER E: ,Huta n f --Co THE POLICES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ILTR DD' NSR TYPE OF INSURANLY-- POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILI I DAMAGE TO RENTED PREMISES t a, � $ MED EXP (Any one person) S CLAIMS MADE OCCUR PERSONAL & ADV INJURY $ ---- ---- ----- GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER. POLICY PRO-JFCT LOC PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY A Y X ANY AUTO BA040000047332 10-14-2023 10-14-2024 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY (Per person) $ AUTOSBODILY IXH€RED NON -OWNED AUTOS INJURY (Per accident} $ PROPERTY DAMAGE $ (Per accident; GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACG S AUTO ONLY AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ _ AGGREGATE $ E OCCUR L CLAIMS MADE $ DEDUCTIBLE $ RETENTION B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE BER EXCLUDED? Oyes, I 1714034 10-04-2023 10-04-2024 X WC STATU OTH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 000 000 > > describe If yes, describe under ,$ E.L. DISEASE - POLICY LIMIT $ 1,000,000 SPECIAL PROVISIONS below, OTHER DESCRIPTION OF OPERATIONS ! LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS The Costa Mesa Sanitary District, it's elected and appointed officials, officers, agents, and employees are additional insured's. we have Requested that the Certificate Holder be listed as Additional Insured. 10 day notice of cancellation for non-payment of oremium- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Costa Mesa Sanitary District DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 290 Palarino Ave NOTICE TO THE CERTIt-ICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Costa Mesa, CIA. 92626 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1 AUTHORIZED REPRESENTATIVE 949-515-1534 ACORD 25 (2001/08) TIOWI988