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Insurance - Costa Mesa Newport Harbor Lions Club - 2024-05-17AC(:>RL> CERTIFICATE OFF LIABILITY INSURANCE °��� �� ��"'���� EXCLUSi3ONS AND CONDITIONS CST SUCH POLICIES LIMITS SHOWN MAY HA% BEEN REDUCED BY PAID CLAIMS 05/17/2024 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 CONTACT NAME- John Adams a S P I t1 S u ra n ce Services, Inc. � �C� NNE Ext).1-800-316-6705 A . No): 847-934-6186 ADDRESS: lionSClubs f@' dspins.Com 190{} E. Golf Road, Supe 650 Schaumburg, IL 60173 INSURERS AFFORDING COVERAGE NAIca INSURER A: ACE American Insurance Compart 22667 INSURED INSURER 6: E INSURER L Costa Mesa Newport Harbor Lions Club S 5,000 s 1,000.400 Costa Mesa California INSURER p I S 10,000,000 INSPIRER E INSURER F: I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TC' CERTIFY THAT THE POLICIES LILIES O INSURANCE `i'STE BELO'i%' HAVE BEEN !SSUED TO THE INSURED ANTED ABOVE FOR THE POLICY PERI IC INDICATED NE TIWITH'STANDING A'V'M' REOUIRE °ENT, TERM OR 1 -CONDITION OF ANY CON RACT OR OTHER tD{fit UtOEW7 WITH RI 1-31P =C T TO VV'HICH THIS CERTIPIC:ATE NI,AY BE ISSUED OR MAY PERTAIN. THE INSURANCE APPORDEO BY THE POLICIES DESCRIBED HEREIN IS, SUBJECT TO ALL THE T EWM ; EXCLUSi3ONS AND CONDITIONS CST SUCH POLICIES LIMITS SHOWN MAY HA% BEEN REDUCED BY PAID CLAIMS INSR R I TYPE OF INSURANCE A L URI I POLICY EFF I POLICY EXP POLICY NUMBER I IfA'i}D+YYYY IRrtMli717 YYYY ' LIMITS A GENERAL LIABILITY I l EACHOCCURRENCES 1,000,000 X C - f:' :tER lAL aE vErtt LIA8ILI Y ; I PREMISESEa occurren{ e s 1,000,000 CLAVAS -MADE X +Ot, CURHDC1648333205 X Agg. Per Named Insureds 09/01/2023 09/01/2024 ' MED EXP (Arse to mr� ADV INJURY S 5,000 s 1,000.400 is $2,000,000 GENERAL AGGREGATE S 10,000,000 GENL AGGREGATE LIMIT APPLIES PER ' � I rR+ODUCTS - CtX,1F;'OP AGv s 2,000,000 X POLICY PRO- i LCA JECT I t S AUTOMOBILE LIABILITY� € I I I COMBINED SINGLE LIMIT tEa accdentj' S1,000,000 ANY AUTO � BODILY INJURY €Per nj S ALL OVv" ED I SCHEOL,LE0 AUTOS AUTOS f ! ISA H10778906 09/01/2023 109/01/2024 BODILY INJURY (Per accident) S X NON -01a` NEDi HIRED AUTOSX AUTOS j i PROPERTY DAMAGE Per accident) � S f I UMBRELLA LIALi C :CUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAR CLAVAS -MADE >•1S I ASE DED RETENTION S S WORKERS COMPENSATION i I WC STATU• I 10TF1,- AND EMPLOYERS' LIABILITYY I N ANY PROF R ETC)RaPART�,NERrEX-r Ti,'- OF C;.R'MEA!6ER EXCLi OED? F7 NIA€ I i I I c.L Ati Fi A Osi?E iT S S E.L. DISEASE - EA EMPLOYEE S (Mandatory to NH) i descrrbe uncier D aCRIPTION OF OPERATIONS below I I E L. DISEASE - POLICY LIMIT S i I t DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, if more space is required) Provisions of the policy apply to the named insureds participation in the following activity during the policy period shown above: Fish Fry and Carnival Parking June 24, 25, 26, 27, 28, 29, 30, July 1 2024 The following persons or organizations granting use of real property, including structures thereon are included as Additional Insured(s), but only with respect to General Liability arising out of the use of premises by the insured shown above and not out of the sole negligence of said additional insured. *** The Costa Mesa Sanitary District, its elected and appointed officials, agents, officers, volunteers and employees are additional insureds.6E *** 0* -1 :4112 Lei., I3i1*1>1tj1;4V Costa Mesa Sanitary District City of Costa Mesa and it's officers, employees and representatvies 290 Paularino Costa Mesa California 92626 t 109191 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 9988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: HDO G48333205 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) Locations Of Covered Operations The Costa Mesa Sanitary District, it's elected and Lions Park Backyard appointed officials, agents, officers, volunteers and 570 W 18th St, Costa Mesa, CA 92627 employees are additional insureds 290 Paularino Ave Costa Mesa, CA 92626 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — 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. 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. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 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 applicable Limits of Declarations. shall not increase the Insurance shown in the Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 0413 POLICY NUMBER: HDO G48333205 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 Or Organization: Any person or organization from whom you are required to waive your right to recover under a written contract or agreement in effect prior to any loss or damage I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a 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 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ HDO G48333205 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 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 The following is added to 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 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 available to the additional insured. CG 20 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Declara- tions may cancel this policy by mailing or de- livering to us advance written notice of cancel- lation. 2. We may cancel this policy by mailing or deliv- ering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancel- lation if we cancel for nonpayment of pre- mium; or b. 30 days before the effective date of cancel- lation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. IL 00 17 11 98 b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any inspections, surveys, reports or recommendations and any such actions we do undertake relate only to in- surability and the premiums to be charged. We do not make safety inspections. We do not un- dertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we 4. Paragraph 2. of this condition does not apply cancel, the refund will be pro rata. If the first to any inspections, surveys, reports or recom- Named Insured cancels, the refund may be mendations we may make relative to certifica- less than pro rata. The cancellation will be ef- tion, under state or municipal statutes, ordi- fective even if we have not made or offered a nances or regulations, of boilers, pressure ves- refund. sels or elevators. 6. If notice is mailed, proof of mailing will be suf- E. Premiums ficient proof of notice. The first Named Insured shown in the Declara- B. Changes tions: This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declara- tions is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C. Examination Of Your Books And Records We may examine and audit your books and re- cords as they relate to this policy at any time dur- ing the policy period and up to three years after- ward. D. Inspections And Surveys 1. We have the right to: a. Make inspections and surveys at any time; 1. Is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay. F. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named in- su red. If you die, your rights and duties will be trans- ferred to your legal representative but only while acting within the scope of duties as your legal rep- resentative. Until your legal representative is ap- pointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 0