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Insurance - Golden Bell Products, Inc. 2022-09-12CERTIFICATE F LIABILITY INSURANCE DATE (PAM'DD(YYYY) 09/12/2022 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 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 1CONTACT Van Beurden ins, Serv, Inc. - Kingsburg ;NAME: Recia Shelton PO Pox 67 i PHONE I_(ALC,No,_Extj., (559) 897-2975 {A1C No):{559} 897-4070 I E-MAIL Kingsburg CA 93631 ADDRESS;_ NSURER(S) AFFORDING COVERAGE NA1C # INSURER A: Evanston Insurance Company 3 5 37 $ {719) _630-38611 - - INSURED I Golden Bell Products, Inc. I .__-. NSURER B i INSURER C ; P.O. Box 366 I INSURER D Atwood CA 92811 INSURER E COVERAGES CERTIFICATE NUMBER: Cert ID 48090 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 CONDI T ION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WKI--H THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY )-'E POLICIES DESCRIBED HEREIN IS SUBJECT TO ALI THE -cRMS. EXCLUSIONS AND CONDITIONS OF SUCH PO_ICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCEPOLICY EFF POLICY EXP A KCOMMERCIAL GENERAL LIABILITY _ INSD' WVD POLICY NUMBER (4tMlDDlYYYY) (MMIDD,YYYY) LIMITS : ---- - _ACH OCCJRREN " 1,000,000 _ �4hAG{;LAIMS-MADE X OCCUR IV'tMKLV5ENVZ03733 1CJ25J2C22 ZOJ25/2C23 RREiv ISE: ? a Lit trce; 50 , 000 X Incid.Prof.Services X $10, 000 SIR _ MED hXP L:" . v e Person) S _ 5,000 -- PERSONAi. x ADV INjjRY $ 1,C00,000 V.AGGREGATE LIMIT APPLIES PEP: GENER,,t iGGREGATE 2,000,000 ?o! X _ PEZC,- it;Y JCS-- _ LOG, OI,P.0;AGG S 2,000,000 AUTOMOBILE LIABILITY _ COMFiR;Ei 51 N G L ^..A T 'AY AUTO ALL OiNNED SCHEDUiED S AUTOS AUT6S NON -OWNED ri.P.ED A_l _.OS AUTOS $ A UMBRELLA LlAB X ! OCCUR MKLV5EEX101007 X EXCESS LIAR CSAAiS-MADE' $ 2 , COC , C 0 C DED X RETENTION a 10,000 S 2,C00,000 g WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANIN PROPR ETC R.%PARTNERrEXEU, I iv= FFICE2, VEtA91 R EXCLUDED'? i N/A' {Mandatory In NH) Yr S, desc• be wider SCR;PT t�lv' OF OPERA II NS below A Cont. Pollution Liab. MKLV5ENV103733 A Environ. Impairment Liab. MKLV5ENV103733 PER OTH- A -,:-1E FR c.L. EAC- ACCIDENT a ..L. DISE,` 7E -E-A EM, _OYEE $ E.L. D'S _r;:SE - GOUwy. LINA T _-- ZO/25/202210/25/2023$25,000 SIR S2M Agg/1M Oc 10/25/2022 10/25/2023$25,000 SIR S2M Agg/1M Oc DESCRIPTION OF OPERATIONS / LOCATIONS t 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 CANCELLATION 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. 290 Paularino Avenue /�a3 AUTHORIZED REPRESENTATIVE Costa Mesa CA 92626 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 3-`DIL v %J tR . � ' r, _ r 1, ar sc,e, S 3GID .Y or 4t _ ,.^', $ 10/25/2022` 10/25/2023 EACH O__U.RRENCE $ 2 , COC , C 0 C VGGRE G,,; E S 2,C00,000 g PER OTH- A -,:-1E FR c.L. EAC- ACCIDENT a ..L. DISE,` 7E -E-A EM, _OYEE $ E.L. D'S _r;:SE - GOUwy. LINA T _-- ZO/25/202210/25/2023$25,000 SIR S2M Agg/1M Oc 10/25/2022 10/25/2023$25,000 SIR S2M Agg/1M Oc DESCRIPTION OF OPERATIONS / LOCATIONS t 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 CANCELLATION 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. 290 Paularino Avenue /�a3 AUTHORIZED REPRESENTATIVE Costa Mesa CA 92626 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: MKLV5ENV103733 COMMERCIAL GENERAL LIABILITY CQ20D10413 THIS ENDORSEMENT CHANGES THE POL/C`/, PLEASE RE/\[] /T CAREFULLY, PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROD U CTS/COMPLETED OPERA71 IONS LIABILITY COVERAGE PARIF The following is added kz the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under you/ policy provided that: (1) The additional insured is oNemed Insured under such other insurance; and (2) You have agreed in writing in a contract or oQneaman\ that this insurance would be primary and would not seek contribution from any other insurance evoi)ob|a to the additional insured. xoInsurance 5ervicoo Office, Inc., 2012 Page 1 or 1 CGDD01 04 13 POLICY NUMBER: MKLV5ENV103733 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person OrOrganization: Aarequired bywritten contract executed by bothparties prior toloss. Information required to completethi Schedule, if not shown above,will be shownin the Declarations. The following is added to Paragraph 8. Transfer Of R|Qhba Of Recovery Against Others To Us of Section |V—Conditions: VVewaive any right ofrecovery wemay have against the person or organization shown in the Schedule above because nfpayments wa make for injury or damage arising out ofyour ongoing operations or "your work" done under e contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 (9)Insurance Services Office, Inc., 2008 Page 1 of POLICY NUMBER: MKLV5ENV103733 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROD U CTSICO M PLETED OPERA IONS LIABILITY COVERAGE PART AT 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 NIA and executed prior to commencement of operations. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section U —VVhm 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" or "property damage" caused, in whole or in part, 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". However 1. The insurance afforded to such additional insured only applies to the extent permitted by law-, and 2. If coverage providedhothe 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. B. 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 contract oragreement, the most we will pay on behalf ofthe additional insured is the amount ofinmunance� 1. Required bythe contract oragreement; or 3. Available under the applicable Limits of Insurance shown inthe Declarations; whichever ialess. This endorsement shall not increase the applicable Limits ofInsurance shown inthe Declarations. 0Insurance Services Office, |nc.2O12 Page 1ofI CG 20 37 04 13 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 CG|201OD413 0Insurance Services Office, Inc..2O12 Page 2of2 POLICY NUMBER: K4KLVSENV1O3733 COMMERCIAL GENERAL LIABILITY CG2U1O0413 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ [TCAREFULLY ADD��n�W��N N�� /�� LESSEES �� ITIONAL xx��o�� `��x��m��, �� n� CONTRACTORS — SCHEDULED PERSON OR ��0��~�� m��u��n�u��mm��x� 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 As required by written contract N/A Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Section U—Who IsAnInsured is amended to include as an additional insured the person(s) or organization(s) shown in the Gchedu|o, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, inwhole orinpart, by: 1. Your acts oromissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(o) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies ho the extent permitted by |avv'. and 2. |fcoverage provided tothe additional insured |o required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that vvh|oh you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional |naunads, the fb||ovv|ng mUd|Uono| 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 worh, on the project (other than eemice, 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 byany person or organization other than another contractor orsubcontractor engaged in performing operations for a principal eoopart ofthe same project. C. With respect to the insurance afforded to these additional inauroda, the following is added to Section III — Limits OfInsurance: If coverage provided to the additional insured is required by a contract or agreament. the most we will pay on behalf of the additional insured is the amount ofinsurance: 1. Required by the contract or agreement; or @ Insurance Services Office, inc. 2012 Page 1 of CG201OO413 ACORD CERTIFICATE OF LIABILITY INSURANCE TM DATE(MMIDD/YYYY) 10/02/2022 PRODUCER CalCoast Insurance Agency P.O. Box 1070 Los Alamitos, CA. 90720 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Golden Bell Products Inc. PO BOX 366 ATWOOD CA 92811 INSURER A: Mercury Casualty Company INSURER B: State Compensation Ins. Fund INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSHRANCE POLICY NUMBER POLICY EFFECTIVE DATE IMMIDDIYYI POLICY EXPIRATIONJ-MINSR DATE (MM1DD1YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ MED EXP (Any one person $ CLAIMS MADE 11 OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO- LOC A Y AUTOMOBILE X LIABILITY ANY AUTO BA040000047332 10-14-2022 10-14-2023 COMBINED SINGLE LIMIT (Ea accident) 1,000,000 BODILY INJURY $ (Per person) X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per accident) X X HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ EA ACC $ OTHER THAN ANY AUTO AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR F—I CLAIMS MADE $ $ DEDUCTIBLE $ RETENTION S WORKERS COMPENSATION AND X WC STATU- OTN- B EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 1714034 10-04-2022 10-04-2023 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS The Costa Mesa Sanitary District, Its elected and appointed officials, officers, agents, and employees are additional insureds. we have Requested that the Certificate Holder be listed as Additional Insured. 10 day notice of cancellation for non-payment of premium. CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District 290 Paiarino Ave Costa Mesa, CA. 92626 949-515-1534 ACORD 25 (2001/08) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE RATIO_ 1988 I Jim Lawrence President 288 Centennial Park Drive Daytona Beach, FL 32124 August 1, 2022 To Whom It May Concern: Toll Free: (888) 781-6955 Cell: 727-365-6995 1, Jim Lawrence, President of JABco, the manufacturing company for Insecta, EPA registration number 45600-1, have granted Golden Bell Products the sole distribution and application rights within the State of California. Golden Bell Products has proven its expertise in selling and applying Insecta 45600-1 since 1997 and will maintain the sole source to Insecta until the year 2030. Any California company that would use Insecta or Insecta Liquid is required to purchase the material from Golden Bell Products. If any bids were received indicating otherwise, the bidding company is misrepresenting itself. All Insecta 45600-1 product used for manhole cockroach control in sewer manholes is sold through Golden Bell Products. Sincerely X I" M4 MAU Jim Lawrence President From: Steve Cano To: Tanisha Tinaling Subject: FW: roach spraying Date: Wednesday, January 25, 2023 8:36:01 AM Attachments: imaae001.rng Costa Mesa SD Ins al aut we 2023.pddf City of Costa Mesa Ins of aut we 2023.pddf Insecta Scone Costa Mesa San Dist.DOC Sole source letter 8-1-22.oddf Sole Source Justification, docx Good morning I do not remember if I sent their latest info to you, thanks Steve Cano Website: Phone: Email: scano crosdca.gov COSTA MESA t.e :11 . SANITARY DISTRICT From: Michelle Webster <michellew@golden bel Iprod ucts.com> Sent: Friday, December 16, 2022 11:01 AM To: Steve Cano <scano@crosdca.gov> Subject: RE: roach spraying H i Steve, am sorry for the late response, been a bit under the weather. 527 manholes were treated in March 2022 536 manholes were treated in May 2022 That was the total 1063 that the purchase order had for 2022 fiscal. Actually we do need to get a PO going and start the phase 1 or first half the May 2021 manholes are due or the May 2020 are due, not exactly sure where we are need to check the overview maps which you have. have attached the scope of work, sole source and updated insurance to get the