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Insurance - Costa Mesa Newport Harbor Lions Club - 2025-02-15Illk 2 P CERTIFICATE OF L.IA IL.ITY INSURANCE DATE /15/2025 02/15/2025 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 CONTA NAME: Brvan Adams Insurance Services, Inc. 1900 E. Golf Rd., Ste. 225: PHODSP LA&- t: 1-800-316-6705 c.NOY 847-934-6186 EMAIL Iionsclubs ds ns.com 'i Schaumburg IL 60173 INSUI2Ei2 SAFFORDING COVERAGE�.� wA�� # INSURER A: ACE American Insurance Compan 22657 ` INSURED INSURER B Costa Mesa Newport Harbor Lions Club Costa Mesa California INSURER C I INSURER D INSURER E INSURER F `01011/4:Z --Tri x4t%F A I it = • r o t o - 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 REOUIRE TENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR K"AY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS Or SUCH POLICIES LthIITS Ss -01 ",N MAY HAVE BEEN REDUCED BY RAID l LAl tS INR TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY NUMBER MMIDDIYYYY � MMfDD POLICY EXP LIMITS A GENERAL LIABILITY i FFit::l-t OCCURRENCE 5 1,000,000 PREMISES Ea occuffence 1,000,000 X CC°°I"�1,-4ERC-- AL GENERA- LIBILI''Y I CLARAS- ,�ADDE 1X1 OCCUR HDOG48914445 09/0112024 1 09/01/2025 s 5,000 X Am. Per Named Insured I PERSONAL & AD'S INJURY s 1,000,000 S is $2,000,000 GENERAL AGGREGATE S 10,000,000 GEEaL AGGREGATE LIIAIT APPLIES PER I PRODUCTS - CO.TAP,,'}P AG G S 2,000,000 Pt y, iCY PRf s- 117 L(' -XL ;�; ' AUTOMOBILE LIABILITY I CONI&NED &N<3LE LIMIT Ea aCc,dent S1,000,000 ANY AUTO ALL ISAH10835549 09/01/2024 09/0112025 BODILY INJURY (PC -r r'e' ll) S O�EG SCHEDULED AUTOS�m AUTOS BODILY I i�RY (Per acc dere; S X N'-�N-OWNED HIRED AUTOS X AUTOS I PROPERTY AI"AAGE s `Per acctdent' S e UMBRELLA LIAR CUR I EACH OCCURRENCE S AGGREGATE 5 EXCESS LIAB CLAPAS-_MACE DED RETENTION S WORKERS COMPENSATION WC STATU- OThH,. AND EMPLOYERS` LIABILITYYIN TORY LIMITS I I ER E L EACH AC ODENT S ANY PROPR ETORfPARTNER'EXECt,1TKIE N t A r 0FF,CER ,%IEM ,BER EXCLUDEDI` (Mantletory in NH) EL. D3 SEASE EA EMPLOYE S If . describe urKier ( 0i SCRIPTION Of OPERATIONS t low = E L DSEASE -POLICY LIMIT FS DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES {Attach ACORD 101, Additional Remarks Schedule, if inofe space is (equired) Provisions of the policy apply to the named insureds participation in the following activity during the policy period shown above: June 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 2025 Fish Fry and Carnival The following persons or organizations granting use of real property, including structures thereon are included as Additional Insureds), 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. Costa Mesa Sanitary District City of Costa Mesa, and its officers and representatives PROVISIONS OF THE POLICY DO NOT APPLY TO THE SALE OR SERVING OF ALCOHOLIC BEVERAGES CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District City of Costa Mesa and its officers, employep SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 290 Paularino THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa California 92626 ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE (q-) 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and Ingo are registered marks of ACORD POLICY NUMBER: HDOG48914445 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. `�� • • - �- • - i 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 11 — 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 2010 0413 © 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 111— 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 0413 POLICY NUMBER: HDOG48914445 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 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I 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 ❑ H DO G48333205 POLICY NUMBER: HDOG48914445 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 0 III Wl SM 1:44 Z441 1 L"! 6-1111 OTA Z Eel 0 B 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 04 13 @ 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. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be ef- fective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be suf- ficient proof of notice. B. Changes 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; IL 00 17 1198 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. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recom- mendations we may make relative to certifica- tion, under state or municipal statutes, ordi- nances or regulations, of boilers, pressure ves- sels or elevators. E. Premiums The first Named Insured shown in the Declara- tions: 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- sured. 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 1198 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 0