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Insurance - Golden Bell Products, Inc. 2023-09-20 (2)Ac R CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 09/20/2023 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 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 Van Beurden Ins. Serv, Inc. - Kin sbur g g PO Box 67 CONTACT NAME: Recia Shelton PHONE FA Ext): (559) 897-2975 A/C No : (559) 897-4070 E-MAIL Kingsburg CA 93631 ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Evanston Insurance Company 35378 INSURED RECEIVE' Golden Bell Products, Inc. ECEIVE 630-3861 INSURERS: INSURER C: INSURER D: P.O. Box 366 HP P 2 5. 2023 INSURERE: Atwood CA 92811 INSURER F • .,t. a COVERAGESrt ID 50484 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 TR TYPE OF INSURANCE IVSD ADDL WVD SUER POLICY NUMBER MM/ DYLICY EFF MMPOLICYEXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE T OCCUR MKLVSENV104315 10/25/2023 10/25/2024 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 X Incid. Prof . Services X 1 $10,000 SIR PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY � PEC LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident A UMBRELLA LIAR X OCCUR MKLV5EFX101242 10/25/2023 10/25/2024 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 X EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A PER 170TH STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under vESGRIPT401 l.3P, ,RAT4CNS betsu E. .OLES FNSE - P0LiCY LIMIT ,, S A Cont. Pollution Liab. MKLV5ENV104315 10/25/2023 10/25/2024$25,000 SIR $2M Agg/1M Oc A Environ. Impairment Liab. MKLV5ENV104315 10/25/202310/25/2024$25,000 SIR $2M Agg/1M Oc DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Manhole spraying for roaches at various city locations. It is agreed that the Costa Mesa Sanitary District, its elected and appointed officials, officers, agents, and employees are named as additional insureds as respects to General Liability per attached additional insured form only when required by written contract. CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District 290 Paularino Avenue Costa Mesa CA 92626 to ve) 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: MI«V6ENV104316 COMMERCIAL GENERAL LIABILITY .0 G 23.10 0413 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE REACH IT CAREFULLY ADDITIONAL INSURED — OWNER LESSEES -OR . CONTRACTORS - � SCHEDULED PERSON SJR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIAE31LITY COVERAGE PART SCHEDULE Name Of Additional Insured persons) Or Or anizatlon s Locatlon(s) Of Covered'O era€Ions As required by written contract slyned by both parties All locations and executed prior to cornmenoernent of operations, A, Section -11 _ Who -Is An insured is amended to Include as- an additional Insured the person(s) or organlzation(s) shown In the Schedule, but only with respect to liability for "bodily injury", "property damage" or if *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 addltlonal exclusions apply; This Insurance does not apply to "bodily Injury" or "property damage" occurring after: 1. All work,. Including materlals, ' parts or equipment furnished Int -connection With such work,. on the . projeot (other- than service, maintenance or repairs) to be performed by or on behalf of the additional Insureds) 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 organlzatlon 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 -- L.Imits 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 appicable Limits of Insurance shown in the Declaration; whichever is less, This endorsement shall not increase the applicable Limits of Insurance shown -in the Declarations. ��zo1�a�1� a Insurance Services office, Inc., 2012 Page 1 of 1 POLICY NUMBER: MKLV5ENV104315 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As required by written contract signed by both parties All locations and executed prior to commencement of operations. 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 O Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: MKLV5ENV104315 COMMERCIAL GENERAL LIABILITY CG 24531219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS 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 against any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. CG 24 63 12 19 O Insurance Services Office, Inc,, 2018 Page 1 of 1 POLICY NUMBER: MKLV5ENV1O4315 COMMERCIAL GENERAL LIABILITY CG20D1 U413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROD U CTS/CO MPLE TED 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 cunh1buUonhom any other insurance mvoUeb|e to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (3) You have agreed in writing inmcontract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the CG 20 01 04 13 0 Insu.rance Services Office, Inc., 2012 Page I of 1 ''I INTERLINE MARKEL POLICY NUMBER: MKW5ENV104315 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICEOF • - AS REQUIREDBY_ • ADDITIONAL All Coverage Forms included in this policy are subject to the following. Number of days: 30 The following is added to the Cancellation condition: We will provide written Notice of Cancellation to an additional insured stating when, not less than the number of days shown in the Schedule above, cancellation will become effective. This condition only applies if: 1. Cancellation is for reasons other than: a. Nonpayment of premium; or b. Non-payment of any deductible reimbursement; 2. You are required by written contract to provide the additional insured with such notice; and 3. You agree to provide us with a list of the applicable additional insureds, including their complete mailing addresses, within 7 days of our request. If notice is mailed, proof of mailing is sufficient proof of such notice. All other terms and conditions remain unchanged. MEIL 1233 11 13 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission.