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Insurance - Torres Sanitation System Construction dba Torres Sanitation Sys - 2023-12-01ACOR" CERTIFICATE OF LIABILITY INSURANCE `.../ DATE (MM/DD/YWY) 12/14/2023 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 CONTACT NAME: Brenda Nava Best California Insurance Services LLC 1649 W. Chapman Ave p PHONE,/Ext): (714) 453-0700 ac No : (714) 634-2400 E-MAIL ADDRESS: C info bestcalins.com INSURERS AFFORDING COVERAGE NAIC # INSURERA: OBSIDIAN SPECIALTY INSURANCE COMPANY 16871 Orange CA 92868 INSURED INSURER B : INFINITY SELECT INS CO 20260 INSURER C : TRISURA SPECIALTY INSURANCE COMPANY 16188 Torres Sanitation System Construction dba Torres Sanitation Sy: INSURER D : STATE FUND 35076 9617 OTIS ST INSURER E : CERTAIN UNDERWRITERS AT LLOY'S LONDON INSURER F: SOUTH GATE CA 90280 COVERAGES CERTIFICATE NUMBER: RFVI-RION 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50 000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A Y Y SCB-GL-000028748 04/14/2023 04/14/2024 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - X POLICY JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ B OWNED SCHEDULED AUTOS ONLY AUTOS 504610150187001 01/12/2023 01/12/2024 BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ 1,000,000 Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 C X EXCESS LIAB CLAIMS -MADE ISCCX03000001208 04/14/2023 04/14/2024 AGGREGATE $ 2,000,000 DED RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N N / A Y 9274538-23 04/15/2023 04/15/2024 X STER ATUTE EORH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 Equipment Floater E IMEB11985 12/29/2022 12/29/2023 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Water & Sewer Mains Construction All operations: Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees listed as Additional Insured – Pursuant to attached endorsement. Said policy shall not terminate, nor shall it be canceled nor the coverage reduced, until thirty (30) days after written notice is given to the District. Coverage is Primary and Noncontributory. Waiver of Subrogation applies to the General Liability and Worker's Compensation policies. GANGELLATIDN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District l AUTHORIZED REPRESENTATIVE 290 Paularino Avenue tt –r---- __ Costa Mesa, CA 92626— ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD u ",kyr Best'California Insurance SeMces UC, Lic. OG61067 Insured Name: Alexandro Torres dba Torres Sanitation System Construction General Liability Policy#: SCB-GL-000028748 Insurance Company: Obsidian Specialty Insurance Company (NAIC 16871) Policy Term: 04/14/2023 — 04/14/2024 Date: April 28, 2023 To whom it may concern: 1649 W. Chapman Ave Orange, CA 92868 (877) 803-2722 The Broker agrees to provide 30 days' notice of cancellation (10 Day Notice for Non -Payment) to Costa Mesa Sanitary District in the event any of the above subject policy required under contract with Alexandro Torres dba Torres Sanitation System Construction become subject to cancellation by the insurance company. The Broker understands that failure to provide the 30 days' notice of cancellation (10 Day Notice for Non -Payment) shall constitute a breach of contract by Alexandro Torres dba Torres Sanitation System Construction which may result in termination of the contract with Costa Mesa Sanitary District. For any questions or concerns regarding this letter, please contact: (657) 230-7830 or email us: Certs@Bestcalins.com Kam Aryavand, President ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS BROKER COPY HOME OFFICE SAN FRANCISCO EFFECTIVE APRIL 15, 2023 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING APRIL 15, 2024 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME TORRES SANITATION SYSTEMS CONSTRUC 9617 OTIS ST SOUTH GATE, CA 90280 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. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. fi('T-TF'T)TTT R PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION _ FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION REP 02 9274538-23 RENEWAL NA 9-88-90-05 PAGE 1 OF 1 NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: 2572 11 AUTHORIZED REPRESENT IVE SCIF FORM 10217 (REV.7-2014) APRIL 18, 2023 r PRESIDENT AND CEO OLD DP 217 Obsidian Specialty Insurance Company 1330 Avenue of the Americas, Suite 23A • New York, NY 10019. 800-684-5428 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OBSIDIAN SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION INCLUDING WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Name of Additional Insured: As required by a legally enforceable written agreement entered into prior to commencement of the Named Insured's work. Designated Proiect/Location to which this endorsement applies: All Projects and Locations (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section III - 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 performed during the policy period for the additional insured(s) at the location(s) designated above. B. This insurance does not apply to "bodily injury" or "property damage" that takes place after, and the Additional Insured's status as an additional insured terminates, upon the earlier of when: 1. All work, including materials, parts or equipment furnished by the Named Insured 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 engaged in performing operations for a principal as part of the same project. C. If expressly required by a written and legally enforceable contract entered into by the Named Insured prior to commencement of work by the Named Insured for the Additional Insured, then we waive any right of subrogation we may have against an entity that is an Additional Insured per the terms of this endorsement because of payments we make for injury or damage arising out of "your work" performed under such written and legally enforceable contract with that Additional Insured. Coverage for any additional insured is governed by the terms, conditions, and exclusions of this policy and all endorsements, including the Insuring Agreement. The coverage provided for any additional insured is only to the extent of and in the proportion the additional Insured is held liable for the negligence or strict liability/conduct/acts of the Named Insured. No coverage is provided for liability based upon the acts, errors or omissions of the Additional Insured. Except as set forth above, all of the terms, conditions and exclusions of this policy apply and remain in effect. Policy No.: SCB-GL-000028748 Obsidian Specialty Insurance Company Date: 04/14/2023 By: Time: 12:01 a.m.&4.r" i resident Secretary OSIC AIE OOPWOS 00 01 0318 `, Page 1 of 1 Obsidian Specialty Insurance Company 1330 Avenue of the Americas, Suite 23A • New York, NY 10019 • 800-684-5428 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OBSIDIAN SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS — SCHEDULED PERSON OR ORGANIZATION INCLUDING PRIMARY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Name of Additional Insured: As required by a legally enforceable written agreement entered into prior to commencement of the Named Insured's work. Designated Project/Location to which this endorsement applies: All Projects and Locations (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section III - 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 performed during the policy period for the additional insured(s) at the location(s) designated above. B. This insurance does not apply to "bodily injury" or "property damage" that takes place after, and the Additional Insured's status as an additional insured terminates, upon the earlier of when: 1. All work, including materials, parts or equipment furnished by the Named Insured 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 engaged in performing operations for a principal as part of the same project. C. If expressly required by a written and legally enforceable contract entered into by the Named Insured prior to commencement of work by the Named Insured for the Additional Insured, the insurance afforded by the policy to the Additional Insured(s) listed in the Schedule for the described location(s) is primary insurance. Any other insurance or self-insurance maintained directly by the Additional Insured(s) is excess of this insurance and shall not contribute to it. Coverage for any additional insured is governed by the terms, conditions, and exclusions of this policy and all endorsements, including the Insuring Agreement. The coverage provided for any additional insured is only to the extent of and in the proportion the additional Insured is held liable for the negligence or strict liability/conduct/acts of the Named Insured. No coverage is provided for liability based upon the acts, errors or omissions of the Additional Insured. Except as set forth above, all of the terms, conditions and exclusions of this policy apply and remain in effect. Policy No.: SCB-GL-000028748 Obsidian Specialty Insurance Company Date: 04/14/2023 By: Time: 12:01 a.m.% �� resident Gf OSIC AIE OOP 00 01 0318 r. S6cretary Page 1 of 1 Obsidian Specialty Insurance Company 1330 Avenue of the Americas, Suite 23A • New York, NY 10019 • 800-684-5428 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OBSIDIAN SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Designated Proiect/Location to which this endorsement applies: All Projects Scheduled with the Carrier. As used herein, "Designated Projects/Location" includes only those properties and projects that are designated by you to us in writing, and acknowledged and approved to you by Obsidian Specialty Insurance Company, in writing in a Scheduled "Designated Project" endorsement issued by and approved by Obsidian Specialty Insurance Company in advance of the time any insured performs any work in, on, or in connection with such property or project A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to ongoing operations at a single designated construction project as Scheduled herein: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project Schedule 4. The limits shown in the Declarations or provided for in this "policy" for Each Occurrence, Damage To Premises Rented To You, Medical Expense or other applicable sublimit continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project as Scheduled herein. 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. C. 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, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or 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. OSIC DCPAGG END 00 01 0318 Page 1 of 2 Obsidian Specialty Insurance Company 1330 Avenue of the Americas, Suite 23A • New York, NY 10019 • 800-684-5428 E. The provisions of Section IV — Limits Of Insurance and any applicable sublimit not otherwise modified by this endorsement shall continue to apply as stipulated. Except as set forth above, all of the terms, conditions and exclusions of this policy apply and remain in effect. Policy No.: SCB-GL-000028748 Obsidian Specialty Insurance Company Date: 04/14/2023 By: Time: 12:01 a.m. 1 ff "resident Secretary OSIC DCPAGG END 00 01 0318 Page 2 of 2 Obsidian Specialty Insurance Company 1330 Avenue of the Americas, Suite 23A • New York, NY 10019 9 800-684-5428 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OBSIDIAN SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON ORGANIZATION ONGOING OPERATIONS ONLY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Name of Additional Insured: As required by a legally enforceable written agreement entered into prior to commencement of the Named Insured's work. Designated Proiect/Location to which this endorsement applies: All Projects and Locations (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section III - 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 performed during the policy period for the additional insured(s) at the location(s) designated above. B. This insurance does not apply to "bodily injury" or "property damage" that takes place after, and the Additional Insured's status as an additional insured hereunder terminates, upon the earlier of: I. All work, including materials, parts or equipment furnished by the Named Insured 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 engaged in performing operations for a principal as part of the same project. Coverage for any additional insured is governed by the terms, conditions, and exclusions of this policy and all endorsements, including the Insuring Agreement. The coverage provided for any additional insured is only to the extent of and in the proportion the additional Insured is held liable for the negligence or strict liability/conduct/acts of the Named Insured. No coverage is provided for liability based upon the acts, errors or omissions of the Additional Insured. Except as set forth above, all of the terms, conditions and exclusions of this policy apply and remain in effect. Policy No.: SCB-GL-000028748 Obsidian Specialty Insurance Company Date: 04/14/2023 By: r Time: 12:01 a.m. �f 'f` resident f,, �f n Secretary OSIC AIE ONO 00 01 0318 Page 1 of 1