Insurance - Municipal Maintenance Equipment - 2022-11-20ACCW"
DATE (MM/DD/YYYY)
kb,,.•.. ' CERTIFICATE OF GARAGE INSURANCE
11/20/2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),
AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be
endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A
statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
Sentry Insurance
1800 Nath Point Drive
CONTACT Sentry Customer Service
NAME:
A/ No Ext): 800-473-6879 FAC No ; 800-514-7191
Stevens Point, W154481
EMAIL
ADDRESS: businessproducts_directOsentry.com
INSURER(S) AFFORDING COVER NAIC #
INSURER A: Sentry Select Insurance Company 21180
12/15/2022
INSURED
INSURER 8:
Municipal Maintenance Equipment Inc
4634 Mayhew Rd
INSURER C:
INSURER D:
Sacramento, CA 95827-9700
GARAGE KEEPERS LIABILITYCOMP
INSURER E:
INSURER F:
COVERAGES PROD/ CUSTOMER ID: CERTIFICATE #: 2020788 REVISION #:
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
INSRD
SUER
WVD
POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
A
GARAGE LIABILITY HIRED AUTOS
X ANY AUTO ONLY
NON -OWNED
OWNED AUTOS USED
AUTOS ONLY IN GARAGE
BUSINESS
X Scheduled Autos
A0163992001
12/15/2022
12115/2023
AUTO ONLY (Ea accident) $ 500,000
OTHER THAN
AUTO ONLY
EA ACCIDENT $ 500,000
AGGREGATE $ 2,500,000
GARAGE KEEPERS LIABILITYCOMP
X
/
OTC LOC
1 $ 3,000,000
A
LEGAL LIABILITY
DIRECT BASIS
A0163992001
12/15/2022
12/15/2023
PERILSIED LOC
$
X COLLISION LOC
1 $ 3,000,000
PRIMARY EXCESS
LOC
$
IS500,000
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
CLAIMS -MADE � OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence $ 100,000
MED EXP (Any one person) $ 5,000
A
X
A0163992006
12/15/2022
12/15/2023
PERSONAL &ADV INJURY $ 500,000
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $ 1,500,000
X POLICY PRO-
PRO- LOC
JECT
PRODUCTS - COMP/OP AGG $ 1,500,000
OTHER
$
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE $ 3,000,000
A
X
EXCESS LIAB
CLAIMS -MADE
A0163992007
12/15/2022
12/15/2023
AGGREGATE $ 9,000,000
DED RETENTION $
PRODUCTS - COMP/OP AGGpT $ 9,000,000
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
STATUTE ERH
E.L. EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER,'MEMBER EXCLUDED? Y / N
N / A
E.L. DISEASE - EA EMPLOYEE $
(Mandatory in NH) (—j
If yes, describe under �J
E.L. DISEASE - POLICY LIMIT $
REMARKS below
REMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Refer to attached
CERTIFICATE HOLDER CANCELLATION
Costa Mesa Sanitary District
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
290 Paularino Ave }
Costa Mesa, CA 92626-$314
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE
WITH THE POLICY PROVISIONS.
_J
AUTH RIZ ESENTA IV
ACORD 30 (2016/03)
• A�.I
A0163992
Sentry Select Insurance Company
3 00003 0000001039 22324 N A 0
Page 1 of 2 O 2010-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD 11/20/2022
51 BDC993-4C38-4FB1-99D7-OC1435D3D167
0027020044367594119092626331490
AGENCY CUSTOMER ID: W0=3697
Loc #:
ADDITIONAL REMARKS SCHEDULE
Page 2 of 2
AGENCY
James Simonson
NAMED INSURED
Municipal Maintenance Equipment Inc
POLICY NUMBER
A0163992001
CARRIER
Sentry Select Insurance Company
NAIC CODE
21180
EFFECTIVE DATE: 12/15/2022
0DITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 30 FORM TITLE: Certificate Of Garage Insurance
General Liability
COSTA MESA SANITARY DISTRICT, THEIR ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS,
VOLUNTEERS, AND EMPLOYEES AS ADDITIONAL INSURED- PERSUANT TO ATTACHED ENDORSEMENT.ANY
OTHER INSURANCE MAINTAINED BY THE COSTA MESA SANITARY DISTRICT SHALL BE EXCESS &
NON-CONTRIBUTORING WITH THE INSURANCE PROVIDED BY THIS POLICY. UMBRELLA IS EXCESS OVER
GENERAL LIABILITY AND AUTO LIABILITY POLICIES.
Garagekeepers Liability
Location # State Basis Collision Limit Comp/OTC/Specified Perils Limit
2 CA Natural Disasters Legal $ 2,000,000 $ 2,000,000
Liability
7 NV Natural Disasters Legal $ 60,000 $ 60,000
Liability
8 CA Natural Disasters Legal $ 1,250,000 $ 1,250,000
Liability
ACORD 101 (2008/01) O 2008 ACORD CORPORATION. All rights reserved.
A0163992 The ACORD name and logo are registered marks of ACORD 11/20/2022
Sentry Select Insurance Company
POLICY NUMBER: A0163992006
COMMERCIAL GENERAL LIABILITY
CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s)
Location(s) Of Covered Operations
Costa Mesa Sanitary District
All Locations.
Description:
All Jobs.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section 11 - Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury",
"property damage" or "personal and advertising
injury" caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf;
in the performance of your ongoing operations for
the additional insured(s) at the location(s)
designated above.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured
is required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
CG 20 10 04 13
A0163992
T Sentry Select Insurance Company
5 00003 0000001039 22324 N A 0
B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. All work, including materials, parts or
equipment furnished in connection with such
work, on the project (other than service,
maintenance or repairs) to be performed by or
on behalf of the additional insured(s) at the
location of the covered operations has been
completed; or
2. That portion of "your work" out of which the
injury or damage arises has been put to its
intended use by any person or organization
other than another contractor or
subcontractor engaged in performing
operations for a principal as a part of the same
project.
OO Insurance Services Office, Inc., 2012
F5EBC16A-78 E2-4416-82DC-77A07A17 BE88
0027020044367594184992626331490
Page 1 of 2
11/20/2022
C. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III - Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 2010 0413
A0163992 11/20/2022
Sentry Select Insurance Company