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Insurance - Mike Kilbride, Ltd. - 2024-07-16ACOIZa CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 7/16/2024 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 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 GMGS Risk Management & Insurance Services 6201 Oak Canyon, Suite 100 Irvine, CA 926y18 CONTACT NAME: Charise Ferguson PHONE FAX A/C No Ext): (949)559-3367 ! A/C No): ADDRESS: charisef@gmgs.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Crum & Forster Specialty Insurance Co 44520 www.gmgs.com OB84519 INSURED Mike Kilbride, LTD Coast Water and Power INSURER B: State Compensation Insurance Fund 22314 INSURERC: INSURER D : PO Box 3341 Newport Beach CA 92659 INSURER E : INSURER F: Policv Aqqregate Limit $ 5,000 000 L;UVCKAL!itN CFR I II -ICG I F= NI IMRFR• nnapnnl�l DCVIQIf%K1 All IIIAQCD- 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 ADDLISUBR POLICY EFF WVD' POLICY NUMBER MM/DD/YYW POLICY EXP MM/DD/YYYY LIMITS A COMMERCIAL GENERAL LIABILITY GL0100651 10/30/2023 10/30/2024 EACH OCCURRENCE $ 1,000,000 I CLAIMS -MADE a OCCUR 1 DAMAGE TO RENTED 1 PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ( GENERAL AGGREGATE 1 $ 2,000,000 PRO- n POLICY 7 JECT u LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: Policv Aqqregate Limit $ 5,000 000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED PROPERTY DAMAGE ( $ AUTOS ONLY AUTOS ONLY Per accident $ A UMBRELLA LIAR I Y/ I OCCUR SE0126691 10/30/2023 10/30/2024 I EACH OCCURRENCE $ 5,000,000 EXCESS LIAB ' Ell CLAIMS -MADE U/L: General Liability, Auto & Work Comp I f AGGREGATE ! $ 5,00_0,000 ( ' DED RETENTION $ ( $ B WORKERS OMP COMPENSATION j 9346481-2023 10/1/2023 10/1/2024 OERH AND EMPLO L A Y/N STATUTE ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? i N / A (Mandatory in NH) I E.L. DISEASE - EA EMPLOYEE $ 1,000 0 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 I � I DESCRIPTION OF OPERATIONS / LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: All operations of the named insured subject to the terms and conditions of the policies. This certificate may be relied upon only if the certificate addendum referred to herein is attached hereto. This certificate of insurance amends and supersedes any previously issued certificate. GERTIFIGATE HOLDER CANCELLATION All Operations Costa Mesa Sanitary District 290 Paularino Ave Costa Mesa CA 92626 -7 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 Calvin Sistrunk ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 80969031 1 23-24 G/XS/W I Charise Ferguson 1 7/16/2024 1:16:49 PM (PDT) I Page 1 of 8 AGENCY CUSTOMER ID: LOC #: ASCO ADDITIONAL REMARKS SCHEDULE Page of L__ _ AGENCY NAMED INSURED GMGS Risk Management & Insurance Services Mike Kilbride, and Power PO Box 3341 Newport Beach CA 92659 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) HOLDER: Costa Mesa Sanitary District ADDRESS: 290 Paularino Ave Costa Mesa CA 92626 RE: All operations of the named insured subject to the terms and conditions of the policies. As respects General Liability coverage, Costa Mesa Sanitary District, its elected and appointed officials, agents, officers and employees added as Additional Insured per CG20101219, and this insurance is primary per CFSIC GL 1002 09/20 attached. As respects General Liability coverage, 30 -day written notice of cancellation (10 days for non-payment of premium) applies, per IL00171198 attached. As respects Workers' Compensation coverage, a Waiver of Subrogation is hereby included, per 2572 attached. As respects Workers' Compensation coverage, 30 -day written notice of cancellation (10 days for non-payment of premium) applies, per 2065 attached. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM 80969031 1 23-24 G/XS/W I Charise Ferguson 1 7/16/2024 1:16:49 PM (PDT) I Page 2 of 8 Mike Kilbride, LTD POLICY NUMBER: GLO100651 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 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 0[9 knization(sL_ Location .s Of Covered Operations Any person or organization you have agreed in a written Locations and operations covered under this policy I contract to add .as an additional insured on your policy when required by written contract signed prior to the provided the: written contract is signed prior to the "bodily injury", "property damage" or "personal and "bodily injury", "property damage" or "personal and advertising injury" advertising injury" 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organ iza,tion(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts. or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by in the performance of your ongoing operations for or on behalf of the additional insured(s) at the the additional insured(s), at the location(s) location of the covered operations has been designated above, completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted other than another contractor or subcontractor by law;. and engaged in performing operations for a 2. if coverage provided to the additional insured principal as a part of the same project. is required by a contract or agreement the C. With respect to the insurance afforded to these insurance afforded to such additional insured additional insureds, the following is added' to will not be broader than that which you are Section III — Limits Of Insurance: required by the contract or agreement to provide for such additional insured. 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: CG 2010 12 19 0 Insurance Services Office, Inc,,. 2018 Page I of 2 80969031 1 23-24 G/XS/W I Charise Ferguson 1 7/16/2024 1:16:49 PM (PDT) I Page 3 of 8 1. Required by the contract or agreement; or 2. Available under the applicable limits o1 insurance; whichever is less. This endorsement shall not increase th applicable limits of insurance. 1 CG 20 10 12 19 0 Insurance Services Office, Inc., 2018 Page 2 of E 80969031 1 23-24 G/XS/W I Charise Ferguson 1 7/16/2024 1:16:49 PM (PDT) I Page 4 of 8 GLO100651 Mike Kilbride, LTD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ' ' ' ' A a • • ' : • ' • :41110 6111 - •] ki 19119 • !"I 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 this 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 prior to the injury or damage that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured where the additional insured is a named insured. However, the insurance provided under this endorsement will not apply beyond the extent required by such contract or agreement. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. CFSI C -GL -1002(09/2020) 80969031 1 23-24 G/XS/W I Charise Ferguson 1 7/16/2024 1:16:49 PM (PDT) I Page 5 of 8 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 deliv- ering to us advance written notice of cancella- tion. 2. We may cancel this policy by mailing or deliver- ing 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 premi- um; 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 in- surance inspections, surveys, reports or rec- ommendations. 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 to cancel, the refund will be pro rata. If the first 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. sets or elevators. 6. If notice is mailed, proof of mailing will be suffi- E. Premiums cient 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 Declarations 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 rec- ords as they relate to this policy at any time during the policy period and up to three years afterward. 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 insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representa- tive. Until your legal representative is appointed, 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 ❑ 80969031 1 23-24 G/XS/W I Charise Ferguson 1 7/16/2024 1:16:49 PM (PDT) I Page 6 of 8 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE OCTOBER 1, 2023 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING OCTOBER 1, 2024 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME COAST WATER AND POWER PO BOX 3341 NEWPORT BEACH, CA 92659 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. lzfti 1. 1 A 910 A PIN 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 9346481-23 NEW SP 6-03-58-53 PAGE 1 OF NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: SEPTEMBER 25, 2023 8092517;223-24 c/xS/w I ChAk)T ED RgpRMNT gVEM (PDT) I Page 7 of s PRESIDENT AND CEO SCIF FORM 10217 (REV.4-2018) 1 OLD OP 217 ENDORSEMENT AGREEMENT MANDATORY RATE CHANGE ENDORSEMENT HOME OFFICE SAN FRANCISCO EFFECTIVE OCTOBER 1, 2023 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME COAST WATER AND POWER PO BOX 3341 NEWPORT BEACH, CA 92659 IT IS AGREED THAT THE PREMIUM AND RATES ARE SUBJECT TO CHANGE IF ORDERED BY THE INSURANCE COMMISSIONER OF THE STATE OF CALIFORNIA PURSUANT TO SECTION 11737 OF THE CALIFORNIA INSURANCE CODE. 9346481-23 NEW SP 6-03-58-53 PAGE 1 OF NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: SEPTEMBER 25, 2023 809202223-24 G/XS/W I ChAkfiTH@pAZE0 I R'EFRMNT 4VLM (PDT) I Page 8 of a PRESIDENT AND CEO SCIF FORM 10217 (REV.4-2018) 1 OLD DP 217