Insurance - CR&R - 2006-09-05 CR&RINC-03 ERTH
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
8/30/2006
PRODUCER R L C L V El THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Solid Waste Insurance Managers ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Molino Ave HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
115 N. El P.O. Box Molino - 5 2006 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Pasadena,CA 91101 COSTA MESA SANITARY DiSIRiuJ INSURERS AFFORDING COVERAGE NAIC#
INSURED CR&R Incorporated INSURERA Greenwich Ins. Co.
Haulaway Storage Containers, Inc. INSURER B RSUI Indemnity Company
11292 Western Avenue --
Stanton, CA 90680- INSURER C
INSURER D
INSURER E
COVERAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR ADD'y POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR INSRD TYPE OF INSURANCE DATE IMMIDDNYI DATE IMMIDD/YYI
GENERAL LIABILITY EACH OCCURRENCE I $ 1,000,000
A X X COMMERCIAL GENERAL LIABILITY GEC001932501 9/3/2006 9/3/2007 DAMAGE TO R ED
PREMISES(Ea occurence) $ 300,000
CLAIMS MADE X OCCUR 10 day notice of cancellation in the event of non payment MED EXP(Anyo pe n) $ 10,000
of premium. PERSONAL ACV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/0P AGG $ 2,000,000
POLICY I PRO-
I LOC
ECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
A X ANY AUTO AEC001932301 9/3/2006 9/3/2007 (Ea olden°
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Pe pe n)
HIRED AUTOS
BODILY INJURY
NON-OWNED AUTOS (Pe accident)
PROPERTY DAMAGE $
(Pe accident)
GARAGE LIABILITY AUTO ONLY EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY
AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 4,000,000
B OCCUR CLAIMS MADE NHA217110 9/3/2006 9/3/2007 AGGREGATE $ 4,000,000
DEDUCTIBLE $
X RETENTION $ 10,000 $
WORKERS COMPENSATION AND TOORSLATT- ER
LIMITS ER
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED' EL DISEASE EA EMPLOYEE $
If yes de cube under
SPECIAL PROVISIONS below E L DISEASE POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
10 day notice of cancellation in the event of non payment of premium.
Re:All Operations
The certificate holder is included as Additional Insured per attached CG20100704 endorsement.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Costa Mesa Sanitary District DATE THEREOF THE ISSUING INSURER WILLMOIXIX)OMAIL 30 DAYS WRITTEN
628 W. 19th Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,B tXIXJ XXSXX%XXIXXL
Costa Mesa, CA 92627 ) XsXXd XXXX1XXX XXEXiXrXXXX,X74Afdri)WX,X1tA ISXFXIXAdhXdAXXXXX
XX:XXXLXXXXX
AUTHORIZED REPRESENTATIVE _0/
ACORD 25(2001/08) 0 ACORD CORPORATION 1988
CR&RINC-03 ERTH
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED the policy(ies) must be endorsed.A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer and the certificate holder nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25(2001/08)
POLICY NUMBER: GEC001932501 COMMERCIAL GENERAL LIABILITY
CG 20 10 07 04
THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - 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
Costa Mesa Sanitary District Re: All Operations
628 W 19th Street
Costa Mesa, CA 92627
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 This insurance does not apply to 'bodily injury' or
include as an additional insured the person(s) or 'property damage' occurring after
organization(s) shown in the Schedule, but only 1 All work, including materials, parts or equip-
with respect to liability for 'bodily injury' 'property ment furnished in connection with such work,
damage' or 'personal and advertising injury' on the project (other than service, mainte-
caused, in whole or in part, by nance or repairs) to be performed by or on
1 Your acts or omissions; or behalf of the additional insured(s) at the loca-
2. The acts or omissions of those acting on your tion of the covered operations has been com-
behalf; pleted; or
in the performance of your ongoing operations for 2. That portion of 'your work' out of which the
the additional insured(s) at the location(s) desig- injury or damage arises has been put to its
Hated above. intended use by any person or organization
other than another contractor or subcontractor
B. With respect to the insurance afforded to these engaged in performing operations for a
additional insureds, the following additional exclu- principal as a part of the same project.
sions apply'
CG 20 10 07 04 Copyright, ISO Properties, Inc. 2004 Page 1 of 1
UNIFORM