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Insurance - Sancon - 2011-09-29 IA CORE) CERTIFICATE OF LIABILITY INSURANCE 9/29/2011�' 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 NAME Mary Healy Pours & Associates Insurance Broke "� (A/LO ao F Ii (800)578-8802 FAX Not (818)449-9321 •` � ��IJ EiMAIL CA License #0814733 ADDRESS "'k'ealy @pomsassoc corn 5700 Canoga Ave #400 r n n INSURER(S)AFFORDING COVERAGE NAIC# Or L i nii Woodland Hills CA 91367 I L INSURERA Travelees Indemnity Co. of CT 25682 INSURED LiA SANITARY DISTRIC INSURERS Travelers Insurance Companies 25674 Sancon Engineering Inc INSURER C.Starr Indemnity & Liability/WW 38318 5841 Engineer Drive INSURERD INSURER E. Huntington Beach CA 92649 INSURERF COVERAGES CERTIFICATE NUMBER:11 12 ALL LINES 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN R WVD POLICY NUMBER IMMIDDIYYYYI IMM/DDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 — X COMMERCIAL GENERAL LIABILITY PRI ES RENTED AEMAGET l ER NTED occurrence) S 50,000 A CLAIMS-MADE I X I OCCUR DTE-C0-9181R93A-TIL 11 10/1/2011 10/1/2012 MED EXP(Any one person) $ 5,000 PERSONAL 8ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENt AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG S 1,000,000 R 1 POLICY[PRT n LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) S 1,000,000 B X ANY AUTO BODILY INJURY(Pe pe n) S ALL OWNED SCHEDULED DT-810-9181R93A-TCT 11 10/1/2011 10/1/2012 BODILY INJURY(Pe accede It 5 AUTOS _ AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE S AUTOS Per accident) Uninsured motorist combined $ 1,000,000 UMBRELLA LIAB _ OCCUR EACH OCCURRENCE 5 4,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 X 10/1/2011 10/1/2012 10 000 DTSM-CUP9181R93A-TIL-11 DED RETENTION$ $ A WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER • ANY PROPRIETOR/PARTNER/EXECUTIVE _ -E L EACH ACCIDENT __ $ 1,000,000 OFFICERIMEMBER EXCLUDED, NIA 10/1/2011 10/1/2012 (Mantlatory' NH) DTJ-UB-9818R93A-11 EL DISEASE EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE POLICY LIMIT S 1,000,000 C Contractor s Pollution SISIEIL70061310 10/1/2010 10/1/2012 Li lit Per Oc $2 000 000 Liability Aggregate Limit $2 000 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additi nal Remarks Schedule if mo space equ ed) Re System Wide Sewer Reconstruction - Phase 1 Project No 185 It is agreed that Costa Mesa Sanitary District and the City of Newport Beach are named as Additonal Insured per the attached endorsement It is further agreed that insurance is Primary and that Waiver of Subrogation (GL and WC) apply per the attached endorsements and policy wording *10 Days Notice of Cancellation will apply for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District 628 West 19th Street Costa Mesa CA 92627 AUTHORIZED REPRESENTATIVE N Calzadillas/NIDIA c-'--- � ---� ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)01 The ACORD name and logo are registered marks of ACORD