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Insurance - Torres Sanitation System Construction dba Torres Sanitation Sys - 2024-05-15�fi' ® CERTIFICATE OF LIABILITY INSURANCE DATE (MMiDD/YYYY) 05/15/2024 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 CONE: NAMC Karina Rodriguez Logic Insurance Solutions, Inc H ONE E j;_ (858) 878-0125 FAX Not:_ _ PO Bax 21535 E-MAIL a to icins.com ADDRESS: karmg INSURERS) AFFORDING COVEiGE NAIL # EI Cajon CA 92021 INSURER A: Gemini Insurance C mpany } 10833 INSURED INSURER B : State Fund 35076 Torres Sanitation System Construction INSURER C : 9617 Otis Street INSURERD: INSURER E: South Gate CA 90280 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADDL'S UBR, POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD, POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS X „ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �/ DAMAGE TO RENTED CLAIMS -MADE X OCCUR PREMISES (Ea occurrence) $ 100000 MED EXP (Any one person) $ 5,000 _---- A Y Y VIGPO26995 04/23/2024 04/23/2025 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- 2,000,000 JECT LOC PRODUCTS - COMP/OP AGG $ OTHER: $ 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)_ _ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB ----. - --- _ CLAIMS -MADE' AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X PER STATUTE OTH AND EMPLOYERS' LIABILITY -ER ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L. EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBEREXCLUDED? Y❑ N / A y 9274538-24 04/15/2024 04/15/2025 _ - ------- (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under _-_ _. _ _ __ ____ _ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS t LOCATIONS ! VEHICLES (ACORD 141, Additional Remarks Schedule, may be attached if more space is required) All operations: Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees are 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 Non Contributory. Waiver of Subrogation applies to the General Liability and Workers Compensation policies. FICATE 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 AUTHORIZED REPRESENTATIVE Costa Mesa CA 92626 O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACCORD® CERTIFICATE OF LIABILITY INSURANCE Ill%.� DATE (MM/DDmnrY) 05/15/2024 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 CONTACT NAME: Brenda Nava Best California Insurance Services LLC 1649 W. Cha man Ave p A/CNNo Et): (714) 453-0700 (A/C No): (714) 634-2400 E-MAIL ADDRESS: info@bestcalins.com INSURERS AFFORDING COVERAGE NAIC # INSURERA : INFINITY SELECT INS CO 20260 Orange CA 92868 INSURED INSURER B: CERTAIN UNDERWRITERS AT LLOY'S LONDON INSURER C : Torres Sanitation System Construction dba Torres Sanitation Sy: INSURER D : 9617 OTIS ST INSURER E INSURER F SOUTH GATE CA 90280 COVERAGES CERTIFICATE NUMBER: 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. ILICY LTR TYPE OF INSURANCE IVSD WVD POLICY NUMBER EFF MM DPOLI D/YYYY MCY EXP M DDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FIOCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 1 PRO JECT ❑ LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY Ea accident) SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ A WNE � OSDONLY AUTOSULED 50001858901 01/12/2024 01/12/2025 BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ 1,000,000 UMBRELLA LIABOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB _ CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A STATUTE I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Equipment Floater Limit of Insurance: $21,000 B IMEB14638 04/03/2024 04/03/2025 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Excavation. 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. Equipment Floater Information: Vehicle ROLLER - 2017 - HAMM HD10C, VIN # H1994912 Commercial Auto Information: 2007 CHEVROLE - SILVERADOC3500 VIN # 1 GBJC34U37E185799 COL $500 / COM $500 2017 WATER TA - TRAILER WATER TANK M VIN # 5VUTM1323HP000655 COL $500 / COM $1000 2023 CHEVROLE - SILVERADO C2500 HEAV VIN # 1 GB2WLE79PF1 74806 COL $500 / COM $500 GCK 1 It•IUA I t MULUtK CANCELLATION Costa Mesa Sanitary District 290 Paularino Avenue 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ACOR" ADDITIONAL REMARKS SCHEDULE L -1 - Page of AGENCY Best California Insurance Services LLC NAMED INSURED Torres Sanitation System Construction dba Torres Sanitation System Construc 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 Insurance 2015 FORD - F750 SUPER DUTY VIN # 3FRNF7FA9FV727525 COL $500 / COM $1000 2015 FREIGHTL - CASCADIA 125 VIN # 3AKJGEBG4FSGR6070 COL $500 / COM $1000 Drivers: Rogelio Torres Ponce, Manuel Torres, Ismael Orosco. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE APRIL 15, 2024 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING APRIL 15, 2025 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. crWrnTTT.P 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 9274538-24 RENEWAL NA 9-88-90-05 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: 4. 2572 AUTHORIZED REPRESENT IVE SCIF FORM 10217 (REV.4-2018) APRIL 16, 2024 PRESIDENT AND CEO 1 OLD DP 217 Policy Number: VIGPO26995 CG 20 10 04 13 Insured Name: Torres Sanitation Systems Construction Number: 39 Effective Date: 04/23/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS,OR • •'S — 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): Location(s) Of Covered Operations Any person or organization when you have agreed All locations for which you have agreed in a written in a written and executed contract prior to an and executed contract prior to an "occurrence." "occurrence", that such person or organization be added as an additional insured on your policy. 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 CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 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. 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 shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 Policy Number: VIGPO26995 CG 20 37 04 13 Insured Name: Torres Sanitation Systems Construction Number: 40 Effective Date: 04/23/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s): Operations Any person or organization when you have agreed All locations and completed operations for which in a written and executed contract, prior to an you have agreed in a written and executed "occurrence", that such person or organization be contract prior to an "occurrence." added as an additional insured on your policy 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" 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 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 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 shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number: VIGP026995 VE 01 8412 13 Insured Name: Torres Sanitation Systems Construction Number: 19 Effective Date: 04/23/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECTS(S) GENERAL AGGREGATE LIMIT -SUBJECT TO A MAXIMUM AGGREGATE This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part SCHEDULE Designated Construction Project(s): All construction projects for which you have agreed in writing in a contract, prior to an occurrence that causes "bodily injury", "property damage" or "personal and advertising injury", to provide project specific limits. 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 shown in the Schedule above: 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 shown in the Schedule above. VE 01 84 12 13 Page 1 of 2 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense 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. 5. All payments under this endorsement are subject to the Maximum Aggregate Limit of: $ 5,000,000 The Maximum Aggregate Limit is the most we will pay under this endorsement regardless of the number of Designated Construction Project General Aggregate Limits. The Maximum Aggregate Limit is not available to pay for damages or expenses other than as set forth in the endorsement. 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 shown in the Schedule above: 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. E. The provisions of Section III — Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. VE 01 84 12 13 Page 2of2 CITY OF COSTA MESA BUSINESS LICENSE TAX CERTIFICATE - HDL -65100 77 FAIR DRIVE • COSTA MESA, CA 92626 COSTA MESA, CA 92628-1200 PO BOX 1200 PHONE (714) 754-5235 BUSINESS NAME TORRES SANITATION SYSTEMS EXPIRATION DATE: August 31, 2025 /DBA CONSTRUCTION BUSINESS 9617 OTIS ST LOCATION SOUTH GATE, CA 90280-4929 PRINCIPAL'S NAME: Alexandro Torres SPECIAL CONDITIONS: DESCRIPTION: SEWER REPAIRS AND CONSTRUCTION ISSUED FOR TAX PURPOSES ONLY - NOT TRANSFERABLE - TO BE POSTED IN A CONSPICUOUS PLACE This Business Tax Certificate does not guarantee compliance with State or Federal licensing requirements. Issuance of this certificate indicates that the entity has paid the applicable Business Tax, pursuant to the CMMC Title 9 Chapter 1, and is issued for revenue purposes only. California Civil Code §51.6 prohibits businesses from engaging in genderbased discrimination. A full notice is available in English or other languages by going to: https://www.dca.ca.gov/publications/ Above is your Business License Certificate Please Note Every business is responsible for the annual renewal of this license. Contact the Business License Division at (714) 754-5235 prior to any of the following changes: 1. Name change 2. Location change 3. Ownership change 4. Business activity change 5. Business type change Your business license certificate must be kept at the place of business and made available for inspection. ,`�ytR MFs9 'SyC�RPORiiTfa 19,. BUSINESS LICENSING 77 FAIR DRIVE Alexandro Torres 9617 OTIS ST SOUTH GATE, CA 90280-4929 ° City of Costa Mesa p f BUSINESS LICENSE TAX CERTIFICATE License Number: HDL -65100 Date of Issue: 9/1/2024 ID: 12