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Insurance - California Barricade - 2011-03-04 ..0 3'111' I OATS fMMOPqrYYVY.AFI. ry`r90a_ I`. CERTIFICATE OF LIABILITY INSURANCE • I 03104111 THIS CEIRTFICATE 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. ICS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRES EITATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED,subtract to the terms aid conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate hider In lieu of such endorsement(s). PRODUCER 310-207-9796 CONTACT NAME: Elkins Jonas heurance Agency PHONE FAX Inc 310-207-5337 ((ppA/C,No,Ent P IA/C,NO: 121004YMa11ln Blvd.,#300 • ADDRESS: • Los Angeles,CA 90025 PRODUCER CALIF61 Walt Stoma, ,CUSTOMER ID a: r INSURER(S)AFFORDING COVERAGE ( n NAIC*� INSURED California Barricade Rentals, 4D NAY/' IiNSURERA:Catlin Specialty Ins. Co A X 550 East Saint Gertrude '-D 4J fr/i, INSURER S:Allstate Insurance Af XV- Santa Ana,CA 92705 art A- A-tali c� INSURER C:RSUI Indemnity Company A X-i l A0,414 INSURER o:Hartford Ins Co of the Midwest 14 X✓ INSURER a: - 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 SY PAID CLAIMS. INSR TYPE OF INSURANCE ADOL SUER POLICY E IT—IOU-Mr LIMBS LTR INSR VIVO POLICY NUMBER IMMRIPIYYYY) (MMIDDWYYY1 p GENERALUABILJTY EACH OCCURRENCE $ 1,000,0o019Jt A X COMPaRCIAL GENERAL LIABILITY GLS-196123-0611 06112/10 07101111 DAEAGETO-REN IED 100,000 PREMIS TCRENcurrenm) $ OAIM$MADE X OCCUR MEDEXP(Any one person) $ 6,000 PERSONAL SPOV INJURY f 1,000,000 GENERAL AGGREGATE 3 .2,000,000 GEM.AGGREGATE LIMIT APPLIES PER: ' PRODUCTS-COMPIOPAGG 3 2,000,000 7 POLICY' JL PF/ P1 LOC I $ AUTOMOBLE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 a K B X ANY AUTO 667367934158092 07/01110 07/01!11 (Ee sodden) BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Par accident) $ SCHEDULED AUTOS PROPERTY DAMAGE • HIRED AUTOS (Per accident) f NON-OWNED AUTOS 3 3 UMBRELLA LAB X OCCUR EACH OCCURRENCE f 10,000,00D EXCESS LIAO CLAIMS MADE NHA226167 08112/10 07/01111 AGGREGATE $ 10,000,000 C DEDUCTIBLE $ RETENTION $ 3 WORKERS COMPENSATION x TWARS TN- AND EMPLOYERS'LIABIUTY D ANY PROPRIETORPARTNEREXECUTIVE YIN 51WEOG7053 ' 07/01/10 07/01/11 EL.EACH ACCIDENT 3 1,000,000 N OFFICERAIEMBER EXCLUDED? 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE f If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICV LIMIT 3 1,000,000 - DESCRIPTION Or OPERATIONS!LOCATIONS I VEHICLES(Mach ACORD 101,Additional Remarks Schedule,If more space Is required) The certificate holder and Costa Mesa Sanitary District's employees and agents are named as additional insured's. Primary and Non-contributing wording applies.A Workers Compensation Waiver of Subrogation applies. 'Thirty clay written notice and Ten Day Notice of Cancellation for non-navment of oremltim. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mese Sen(lary District THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Co Co taesa Sanit ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa,CA 92627 AUTHORIZED REPRESENTATIVE Walt Storct�� 1/,�eL I i / ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD California Barricade Rentals,Inc. Policy#GLS-1 9 61 23-0611 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS 'Ms endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Blanket as per written contract. Information required to complete this Schedule,if not shown above,will be shown in the Declarations. 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 darn- age" caused, In whole or In part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional Insured and included in the "products-completed operations hazard". CG 20 37 07 04 ©ISO Properties,Inc., 2004 Page 1 of 1 El THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA Policy Number: 51 WE OG2053 Endorsement Number: 05 Effective Date: Effective hour la the same as stated on the Information Page of the policy. Named Insured and Address:CALIFORNIA BARRICADES RENTAL 1550 E. SAINT GERTRUDE PLACE SANTA ANA CA 92705 We have the right to recover our payments from anyone Ilable 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 5 To of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Costa Mesa Sanitary District,their employees and agents Traffic Control 30.14A... anu Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S,A. Process Date: oa/23/10 Policy Expiration Date: 07/01/11 t,mil 1pUI 17 CII vine wv.!� FUye 1 01 Z DEPAOM NTVDF INSURANCE 1 „`. . q :fre41. '' }� L}, ' �h ir (1% r, • COMPANY PROFILE Compan Y Fofi le Comp and Search Company Information Comp and Search Results CATLIN INSURANCE COMPANY, INC. -1Companl Information 3340 PEACHTREE ROAD NE,SUITE 2950 Old Comany Names ATLANTA, GA 30326 800-876-2499 Agent fa Service Referee° Information Old Company Names Effective Date NAIC Gra,p List Lines of lusiness AMERICAN INDEMNITY COMPANY 06/20/2007 Financia I Satements PDF's back to top Annual Satements Quarterll Statements Agent For Service CA Su ppements CHARLES BACLET Company Gmplaint 2875 MICHELLE DRIVE SUITE 100 Companl Performance IRVINE CA 92606 &Cornpaisan Data Companl Enforcement back to top Action Composi'e Complaints Reference Information Studies Additional Info NAIC#: 19518 Find A Company Representative In Your California Company ID#: 0479-6 Area View Financial Date Authorized in California: 08/23/1916 • Disclaimer License Status: UNLIMITED-NORMAL Company Type: Property&Casualty i State of Domicile: ITEXAS back to top NAIC Group List NAIC Group#: 4574 Catlin US Ins Grp back to top Lines Of Business The company is authorized to transact business within these lines of insurance. For an explanation of any of these terms, please refer to the glossary. AIRCRAFT AUTOMOBILE BOILER AND MACHINERY BURGLARY COMMON CARRIER LIABILITY DISABILITY FIRE LIABILITY MARINE MISCELLANEOUS PLATE GLASS SPRINKLER SURETY http://interactive.web.insurance.ca.gov/companyprofile/companyprofile?event=co... 3/8/2011 * 9:20:46 AM