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Insurance - Sancon Technologies, Inc. - 2024-09-27ACCA'?a 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, 9/27/2024 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 Acrisure Southwest Partners Insurance Services, LLC 18952 MacArthur Blvd., Suite #300 Irvine, CA 92612 CONTACT PHONE IFAX A/c No Ext): 949 486-7900 A/C No): A DRIESS: INSURER(S) AFFORDING COVERAGE NAIC # 72UEABG9UBH www.patrisk.com OK07568 INSURERA: Hartford Fire Insurance Com an 19682 INSURED Sancon Technologies Inc. 5841 Engineer Dr. Huntington Beach CA 92649 INSURER B : Hartford Casualty Insurance Compariy 29424 INSURER C: Sentinel Insurance Company, Ltd. 11000 INSURER D: Navigators Specialty Insurance Com'n 36056 INSURER E: Scottsdale Insurance Company 41297 INSURER F : ( COVERAGES CERTIFICATE NUMBER: 82143192 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 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 D SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A `/ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE E OCCUR ✓ 72UEABG9UBH 10/1/2024 � 10/1/2025 EACH OCCURRENCE $1,000,000 DAMAGERENTED PREMISESS ( Ea occurrence) $ 300,000 MED EXP (Any one person) $ 10,000 ✓ $5,000 Deductible ( PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ✓❑ JECOT- E LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY 72UEAC14419 10/1/2024 10/1/2025 Ea BINEDtSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ ✓ ANY AUTO I OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) P i ( ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY ( PROPERTY DAMAGE $ Per accident $ B `/ UMBRELLA LIAB ✓ OCCUR ,/ 72HHABG9UCM 10/1/2024 10/1/2025 EACH OCCURRENCE $ 15,000,000 AGGREGATE $ 15,003,000 EXCESS LIAB CLAIMS -MADE DED I ✓ RETENTION $10,000 $ C WORKERS COMPENSATION-✓ AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A 72WEAAUOTGJ 10/1/2024 10/1/2025 V/SPR TATUTE �RH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $1.000.000 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT 1 $1,000,000 DESCRIPTION OF OPERATIONS below D E Pollution Liability Installation Floater SF24ECPZOCBLVIC RBS0329050 10/1/2024 10/1/2024 10/1/2025 10/1/2025 $5,000,000 Each Incident/$10,000,000 Agg $250,000 Any one Job Site E Rented/Leased Equipment RBS0329050 10/1/2024 10/1/2025 $100,000 Any one item DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: #324 Sewer Manhole Rehabilitation — Phase 4, Costa Mesa Sanitary District, its officers, officials, employees, and agents are named as additional insureds per endorsement attached as respects General Liability. Waiver of subro as respects WC attached. Excess is following form. trGIR 1 II-It.#A I G Mit-Lir—M UANUMLLA I IUIV #324 Sewer Manhole Rehabilitation — Phase 4, Costa Mesa Sanitary District 290 Paularino Ave. Costa Mesa CA 92626 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 Dave Jacobson ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 82143192 1 24-25 GL/Auto/Umb/WC/Poll/IM I Tina Wolter 1 9/27/2024 7:38:54 AM (PDT) ( Page 1 of 7 This certificate cancels and supersedes ALL previously issued certificates. POLICY NUMBER: 72UEABG9UBH Sancon Technologies Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - OPTION I This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name Of Additional Insured Person(s) Or Organization (s): Designated Project(s) Or Location(s) Of Covered Operations: All, except Additional Insureds that are insured under a separate additional insured endorsement on this policy Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. With respect to those person(s) or organization(s) shown in the Schedule above when you have agreed in a written contract or written agreement to provide insurance such as is afforded under this policy to them, Subparagraph f., Any Other Party, under the Additional Insureds When Required By Written Contract, Written Agreement Or Permit Paragraph of Section II — Who Is An Insured is replaced with the following: f. Any Other Party Any other person or organization who is not an insured under Paragraphs a. through e. above, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (1) In the performance of your ongoing operations for such additional insured at the project(s) or location(s) designated in the Schedule; (2) In connection with your premises owned by or rented to you and shown in the Schedule; or Form HS 24 80 07 13 (3) In connection with "your work" for the additional insured at the project(s) or location(s) designated in the Schedule and included within the "products - completed operations hazard", but only if: (a) The written contract or written agreement requires you to provide such coverage to such additional insured at the project(s) or location(s) designated in the Schedule; and (b) This Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products -completed operations hazard". The insurance afforded to the additional insured shown in the Schedule applies: (1) Only if the "bodily injury" or "property damage" occurs, or the "personal and advertising injury" offense is committed: (a) During the policy period; and (b) Subsequent to the execution of such written contract or written agreement; and © 2013, The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission.) 82143192 1 24-25 GL/Auto/Umb/WC/Poll/IM I Tina Wolter 1 9/27/2024 7:38:54 AM (PDT) I Page 2 of 7 This certificate cancels and supersedes ALL previously issued certificates. Page 1 of 2 (c) Prior to the expiration of the period of time that the written contract or written agreement requires such insurance be provided to the additional insured. (2) Only to the extent permitted by law; and (3) Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. With respect to the insurance afforded to the person(s) or organization(s) that are additional insureds under this endorsement, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or specifications; or (2) Supervisory, inspection, architectural or engineering activities. The limits of insurance that apply to the additional insured shown in the Schedule are described in the Limits Of Insurance section. How this insurance applies when other insurance is available to the additional insured is described in the Other Insurance Condition in Section IV — Commercial General Liability Conditions, except as otherwise amended below. B. With respect to insurance provided to the person(s) or organization(s) that are additional insureds under this endorsement, the When You Add Others As An Additional Insured To This Insurance subparagraph, under the Other Insurance Condition of Section IV — Commercial General Liability Conditions is replaced with the following: When You Add Others As An Additional Insured To This Insurance (a) Primary Insurance When Required By Contract This insurance is primary if you have agreed in a written contract or written agreement that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in Paragraph (c) below. This insurance does not apply to other insurance to which the additional insured in the Schedule has been added as an additional insured. (b) Primary And Non -Contributory To Other Insurance When Required By Contract This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (i) The additional insured in the Schedule is a Named Insured under such other insurance; and (ii) You have agreed in a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured in the Schedule. (c) Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach, each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. All other terms and conditions in the policy remain unchanged. Page 2 of 2 Form HS 24 80 0713 82143192 ( 24-25 GL/Auto/Umb/WC/Poll/IM I Tina Wolter ( 9/27/2024 7:38:54 AM (PDT) I Page 3 of 7 This certificate cancels and supersedes ALL previously issued certificates. 72UExBo9em Sancon Technologies Inc. When performing operations as o "general contractor", the term that particular part shall not mean the entire construction, improvement or renovation project. For purposes of this provis|on, the term "general contractor" means the contractor signing the prima construction contract for m conatruotion, enection, improvement orrenovation project and that has main responsibility for such project including hiring all of the subcontractors and suppliers. 4. CONTRACTORS LIMITED PROFESSIONAL LIABILITY The following exclusion imadded toParagraph 2., Exclusions of Section I ~ Coverage A ~ Bodily Injury And Property 0annm8a L|abi|ity, and to Paragraph 2.,Exclusions ofSection |-Coverage B~Personal And Advertising Injury Liability: This insurance does not apply ho"bodily in/ury". "property damage" or ''panaona| and advertising injury" oho|ng out ofthe rendering of or Ym||une to render any professional ammimee by you with respect toyour providing engineering, architectural or surveying services in your capacity as an engineer, architect orsurveyor. Professional services include: (1) The preparing, approving, orfailing toprepare or mpprova, maps, shop drawings, opinions, reports, murvaym, field ordera, change ordars, ordrawings and specifications; and (2) Supervisory orinspection activities performed as o part of any related architectural or engineering activities. This exclusion applies even if the claims against any insured o{|oge negligence or other wrongdoing in the supervision, h|ring, emnp|oymont, training or monitoring of others by that insured, if the ''occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising |njury'. involved the rendering oforfailure to render any professional services by you with respect to your providing ongineer1n8, architectural or surveying services in your capacity amonengineer, architect orsurveyor. This exclusion does not apply toyour operations in connection with construction work performed by you oronyour behalf. However, this exception tothe exclusion will not apply if you are in the business or profession of providing the professional services described above independent from the construction work performed byyou oronyour behalf, In the event this insurance applies to any injury, damage, |oso, cost or expense covered by Professional Liability insurance issued by a company unaffiliated with us. then the insurance afforded under this Coverage Port is excess over such other valid and collectible Professional Liability insurance (including any deductible orself- insured retention portion thereof, and any other valid and collectible insurance available to the insured whether primary, excess, contingent oron any other basis. 5. PER PROJECT AND PER LOCATION GENERAL AGGREGATE LIMITS OF INSURANCE A. For all sums which the insured becomes legally obligated to pay as damages caused by "000unenceo"under Section |-Coverage A, and for all rnadico| expenses caused by accidents under Section I - Coverage C. which can be attributed only to ongoing operations at a single "project" or a a|ng|o 1. Aseparate Per Project General Aggregate Limit ora separate Per Location General Aggregate Limit applies to each "project" or"lonation".whichever iaapplicable. The Per Project General Aggregate Limit and Per Location Aggregate Limit is equal to the amount ofthe General Aggregate Limit shown in the Declarations. 2. The Per Project General Aggregate Limit or the Per Location General Aggregate L|mit, whichever opp|iaa, 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 "prod uotn-oonnp|mted operations hazard'', and for medical expenses under Coverage Cregardless of the number of; a. Insureds; b. Claims made or'suKa~brought; or c. Persons or organizations making do\ma or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Per Project General Aggregate Limit for that "project" or the Per Location General Aggregate for that "|ouaUon", whichever applies. Such payments shall not reduce the General Aggregate Limit shown in the Declarations, the per Project General Aggregate Limit for any other "project", or the Per Location General Aggregate Limit for any other ''|ooaUon" 4. The limits shown in the Declarations for Each Ooounenoa, Oornoge To Premises Ranted To You and N1*dion| Expense continue to opp|y. However, instead of Page 2mf7 Form HS 24501220 a����( =m�� being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Per Project General Aggregate Limit if attributable only to ongoing operations at a single "project" or the Per Location General Aggregate if attributable only to ongoing operations at a single "location". B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section 1 - 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 "project" or a single "location"; 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 Per Project General Aggregate Limit or any Per Location 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,or any Per Project General Aggregate Limit or any Per Location General Aggregate Limit. D. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. E. For the purposes of Paragraph 5., the following definitions apply: "Project" means a premises an insured does not own or rent and where such insured performs construction -related operations. Each "project" involving the same or connecting lots, or premises whose connection is separated by a street, roadway, waterway, railroad or right-of-way shall be considered a single "project". 1. If a "project" has been abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the "project" shall be considered a single "project". "Project" does not include a premises that is a "location". Form HS 24 5012 20 2. "Location" means a premises an insured owns or rents and where such insured performs business operations other than construction -related operations. Each "location" involving the same or connecting lots, or premises whose connection is separated by a street, roadway, waterway or right-of-way railroad shall be considered a single "location." "Location" does not include a premises that is a "project". This provision does not apply if the Per Project and the Per Location General Aggregate Limit has been otherwise modified by endorsement. 6. MEDICAL PAYMENTS COVERAGE - INCLUDING PRODUCTS -COMPLETED OPERATIONS Paragraph 1.a. of the Insuring Agreement - Coverage C is replaced by the following: 1. Insuring Agreement a. We will pay medical expenses as described below for "bodily injury" caused by an accident: (1) On premises you own or rent; (2) On ways next to premises you own or rent; (3) Because of your operations; or (4) Included within the definition of the "products -completed operations hazard;" provided that: (1) The accident takes place in the "coverage territory" and during the policy period; (2) The expenses are incurred and reported to us within three years of the date of the accident; and (3) The injured person submits to examination, at our expense, by physicians of our choice as often as we reasonably require. 7. INJURY TO EMPLOYEE'S REPUTATION WITH RESPECT TO INCIDENTAL MEDICAL MALPRACTICE A. The following is added to Paragraph 1.e. of the Insuring Agreement - Coverage A: (3) With respect to incidental medical malpractice, "bodily injury" includes damages claimed for injury to emotions or reputation of an "employee" arising out of the rendering or failure to render professional health care services as a physician, dentist, nurse, emergency medical technician or paramedic services. 'hn*aam q ?q -7n WA i1 ✓Mv�Pau /11Winsiftnnftirtek J/�M= 2&: 30 sla. 5WAWVMTp gaaaciVso6 371 This certificate cancels and supersedes ALL previously issued certificates. Page 3 of 7 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WilaNAA4 4 1, 1111101 *-W 1:11! 111 Policy Number: 72WEAAUOTGJ Endorsement Number: Effective Date:1 0/1 /2024 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Sancon Technologies Inc. 5841 Engineer Dr. Huntington Beach CA 92649 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged In the work described in the Schedule. The additional premium for this endorsement shall be premium otherwise due on such remuneration. Person or Organization WHERE REQUIRED BY WRITTEN CONTRACT 2 % of the California workers' compensation Job Description Countersigned by Authorized Representative Form WC 04 03 06 (11) Printed in U.S.A. Process Date: Policy Expiration Date: 10/1 /2025 82143192 1 24-25 GL/Auto/Umb/WC/Poll/IM I Tina Wolter 1 9/27/2024 7:38:54 AM (PDT) I Page 6 of 7 This certificate cancels and supersedes ALL previously issued certificates. POLICY NUMBER: 72UEABG9UBH THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • • Ake%tNEW • A ' SCHEDULE Number of Days Notice: Name of Certificate Holder: Part A: _30 On File with Agent Part B: 10 Mailing Address Part C: 30 This policy is subject to the following additional Conditions when a number of days are shown in the Schedule for any of the above Parts. A. If this policy is cancelled by the Company, other than for nonpayment of premium, notice of such cancellation will be provided to the certificate holder in the Schedule, at least the number of days in advance of the cancellation effective date, as shown in Part A. B. If this policy is cancelled by the Company for nonpayment of premium, notice of such cancellation will be provided to the certificate holder in the Schedule within the number of days notice of the cancellation effective date, as shown in Part B. C. If this policy is cancelled by the insured, notice of such cancellation will be provided to the certificate holder in the Schedule, within the number of days notice of the cancellation effective date, as shown in Part C. Form IH 0315 06 11 If notice is mailed, proof of mailing notice to the certificate holder's mailing address as shown in the Schedule will be sufficient proof of notice. If the number of days notice in the schedule for any Part is left blank or is shown as zero, no notice will be provided to the Scheduled certificate holder under that Part. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. © 2011, The Hartford 82143192 1 24-25 GL/Auto/Umb/WC/Poll/IM I Tina Wolter 1 9/27/2024 7:38:54 AM (PDT) I Page 7 of 7 This certificate cancels and supersedes ALL previously issued certificates. Page 1 of 1