Insurance - Schuler - 2011-12-13 Acc•R D CERTIFICATE OF LIABILITY INSURANCE lzil IIIE/zoi
THIS CERTIFICATE 19 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 pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the farina 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 Patriot Risk and Insurance Services CONTACT
License #0055454 PHONE (949)486-7900 FAX •,:(949)496-7930
8105 Irvine Center Dr #400
Irvine, CA 92618 PRODUCER_COMER ID a:
INSURER(S)AFFORDING COVERAGE NAME
INSURED INSUREaA National Fire Insurance Company 20478
saunas Continental Casualty Company 20443
INSURER C:Companion Property & Casualty 12157
Schuler Engineering Corporation
INSURER D:
564 W Bateman Circle INSURER E.
Corona CA 92880-2011 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 WTH 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.
ILTR TYPE OF INSURANCE IN p)y SR POLICY NUMBER Mime NYW) IMM1 POLICY UNTIE
A GENERAL UABiLITY 4030400346 7/1/2011 7/1/2012 EACH OCCURRENCE S 1,000,000
X COMMERCIAL GENERAL UABLRY PREMISES(Ea Ea omaurrenc, $ 100,000
CLAIMS-MADE X OCCUR MEDEXP(Any one person) S 5,000
PERSONAL&„ow INJURY $ 1,000,000
GENERAL AGGREGATE S 2,000,000
GENL AGGREGATE LIMIT APPUES PER PRODUCTS-COMP/OP AGG 1 2,000,000
POUCY IEIPRO fI LOC S
B AUTOMOBILEUABIUTY 4029165427 7/1/2011 7/1/2012 COMBINED SINGLE UMR S 1,000 000
(Ea cdIsn)
X ANY AUTO BODILY INJURY(Par parson) S
ALL OWNED AUTOS BODILY INJURY(Per accident) S
_ SCHEDULED AUTOS PROPERTY DAMAGE
X HIRED AUTOS (Per acaden)
X NON-OWNED AUTOS Uninsured mdoda BI spa nine S
UNnsued mmmmt mnhined S 1,000,000
A X UMBRELLA LAB IX OCCUR 4029165444 7/1/2011 7/1/2012 EACH OCCURRENCE S 5,000,000
EXCESS uaa I CLAIMS-MADE AGGREGATE S 5,000,000
DEDUCTIBLE 3
RETENTION S S
C WORMERS COMPENSATION CrCA13231 7/1/2011 7/1/2012 XI VCSTTLI. DR
AND EMPLOYERS UABIUTY Y IN
ANY PROPRIETORPARTNEWEXECUTNE❑ NIA EL EACH ACCIDENT $ 1,000,000
OFFICERAIEMBER EXCLUDED?
(Mandatory In NH) EL DISEASE EA EMPLOYEE S 1,000,000
II yes desalt*under
DESCRIPTION OF OPERATIONS below - EL.DISEASE POLICY LIMIT S 1,000,000
DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarke Schedule,if more space Is required)
Re: Sea Bluff Pumping Station Improvement Project
Costa Mesa Sanitary District and its officers agents and employees are named as Additional Insured includes Primary 6
Non-Contributory as respects to General Liability per endorsement 0-140331-C (Ed. 10/10) attached where required by
written contract. 30 days notice of cancellation, 10 days 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 W 19th Street
Costa Mesa, CA 92627 AIrIHOR�OREPRESENTATNE
David Jacobson/LI9A
ACORD 25(2009/09) 01988.2009 ACORD CORPORATION. All rights reserved.
INS026 f200eo9) The ACORD name and logo are registered marks of ACORD
POLICY' #4030400346 G-140331-C
CNASCHULER ENGINEERING CORPORATION (Ed. 10/10)
THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS
-WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE(OPTIONAL)
Name of Additional Insured Persons Or Organizations
(As required by"written contract' per Paragraph A. below.)
Locations of Covered Operations
(As per the"written contract, provided the location is within the 'coverage territory"of this Coverage Part.)
A. Section II Who Is An Insured is amended to 2. We will not provide the additional insured any
include as an additional insured: broader coverage or any higher limit of
1. Any person or organization whom you are insurance than the least that is:
required by "written contract' to add as an a. Required by the"written contract"
additional insured on this Coverage Part;and
b. Described in BA.above;or
2. The particular person or organization, if any c. Afforded to you under this policy.
scheduled above.
B. The insurance provided to the additional insured is 3. This insurance is excess of all other insurance
limited as follows: available to the additional insured whether on a
primary, excess, contingent or any other basis.
1. The person or organization is an additional But if required by the "written contract, this
insured only with respect to liability for 'bodily Insurance will be primary and non-contributory
injury, 'property damage, or 'personal and relative to insurance on which the additional
advertising injury"caused in whole or in part by: insured is a Named Insured.
a. Your acts or omissions; or 4. The insurance provided to the additional insured
b. The acts or omissions of those acting on does not apply to 'bodily injury, 'property
your behalf damage, or 'personal and advertising injury
arising out of:
in the performance of your ongoing operations a. The rendering of, or the failure to render,
specified in the"written contract" or any professional architectural, engineering,
c. 'Your work' that is specified in the "written or surveying services, including:
contract" but only for 'bodily injury' or
'property damage' included in the (1) The preparing, approving, or failing to
prepare or approve maps, shop
products-completed operations hazard, drawings, opinions, reports, surveys,
and only if: field orders, change orders or drawings
(1) The 'written contract' requires you to and specifications;and
provide the additional Insured such (2) Supervisory,
coverage; and ( ) P ry, inspection, architectural or
engineering activities;or
(2) This Coverage Part provides such
coverage.
0-140331-C Includes copyrighted material of Insurance Services Office,Inc. with its permission Page 1 of 2
(Ed. 10/10)
CNA POLICY #4030400346 GEd. 10/ )
SCHULER ENGINEERING CORPORATION (Ed. 10!10)
b. Any premises or work for which the We have no duty to defend or Indemnify an
additional insured is specifically listed as an additional insured under this endorsement until
additional insured on another endorsement we receive from the additional insured written
attached to this Coverage Part. notice of a claim or 'suit.
C. SECTION IV — COMMERCIAL GENERAL 2. With respect only to the insurance provided by
LIABILITY CONDITIONS is amended as follows: this endorsement, the first sentence of
1. The Duties In The Event of Occurrence, Paragraph 4.a.of the Other Insurance Condition
Offense,Claim or SuIt condition is amended to is deleted and replaced with the following:
add the following additional conditions 4. Other Insurance
applicable to the additional insured:
a. Primary Insurance
An additional insured under this endorsement This insurance is primary and non-
will as soon as practicable: contributory except when rendered
(1) Give us written notice of an 'occurrence' or excess by endorsement G-140331-C,
an offense which may result in a claim or or when Paragraph b. below applies.
'suit' under this insurance, and of any claim D. Only for the purpose of the insurance provided by
or 'suit"that does result this endorsement, SECTION V— DEFINITIONS is
(2) Except as provided in Paragraph B.3 of this amended to add the following definition:
endorsement, agree to make available any 'Written contract' means a written contract or
other insurance the additional insured has written agreement that requires you to make a
for a loss we cover under this Coverage person or organization an additional insured on this
Part; Coverage Part, provided the contract or agreement:
(3) Send us copies of all legal papers received, 1. Is currently in effect or becomes effective during
and otherwise cooperate with us in the the term of this policy;and
investigation, defense, or settlement of the
claim or 'suit' and 2. Was executed prior to;
(4) Tender the defense and indemnity of any a. The 'bodily injury or 'property damage' or
claim or 'suit' to any other insurer or self b The offense that caused the 'personal and
insurer whose policy or program applies to a P
loss we cover under this Coverage Part. advertising injury'
But if the "written contract" requires this for which the additional insured seeks coverage
insurance to be primary and non- under this Coverage Part.
contributory, this provision (4) does not
apply to insurance on which the additional
insured is a Named Insured.
G-140331-C Includes copyrighted material of Insurance Services Office,Inc. with its permission Page 2 of 2
(Ed. 10/10)