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Insurance - F.M. Thomas Air Conditioning - 2012-03-01 ------""4, DOKA ,4CORO CERTIFICATE OF LIABILITY INSURANCE DAT D2VYY) 1/4.....-- 3/1/2 311/2012 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 (888) 825-4322 NAME:ACT Michelle Piluso Bowermaster&Associates (A/cC,N,EXt).714-733-6208 I IA/c,Nor P.O. Box 6026 E-MAIL 10805 Holder Street Suite 350 'michellepiluso @gmail.com PRODUCER Cypress, CA 90630 CUSTOMER ID a FMTHOMA-01 INSURER(S)AFFORDING COVERAGE NAIC N INSURED F M. Thomas Air Conditioning, Inc. &Thomas & INSURER A:Golden Eagle Insurance Corporation Carolyn Feyka INSURER B Insurance Company of the West 231 Gemini Ave. INSURERC:RSUI Indemnity Company Brea, CA 92821 INSURER0 INSURER E INSURER F I 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 BY PAID CLAIMS ILTRI TYPE OF INSURANCE NSRIS DI POLICY NUMBER I IMM`DDIYYYY)I(MMIDD/YYYY)I LIMITS 1 GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 •AMA • •ENTrED A X COMMERCIAL GENERAL LIABILITY X CBP8636340 4/1/2011 4/1/2012 PREMISES Ea occurrence) I8 500,000 CLAIMS-MADE X OCCUR MED EXP(Any . n) I- 10,000 I PERSONAL ADV INJURY $ 1,000,000 GENERAL AGGREGATE I $ 2,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGO I $ 2,000,000 GE I POLICY I X I FjEET fl LOC I I $ I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 4/1/2011 4/1/2012 (Ea cadent) A X ANVAUro BA8636640 aoDlLrlrvdunv(pe po n)p $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY(Pe c,den I $ PROPERTY DAMAGE X HIRED AUTOS (Pe accident) $ X I NON-OWNED AUTOS I i I I i I X UMBRELLA LIAB OCCUR I EACH OCCURRENCE S 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE I $ 2,000,000 A CU8765526 4/1/2011 4/1/2012 DEDUCTIBLE I $ RETENTION $ . I I I $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X TORY LIMITS ER B ANY PROPRIETORJPARTNERIEXECUTIVE YIry NIA WSD500540401 1/1/2012 1/1/2013 I EL EACHACCIDENT I $ 1,000,000 OFFICER/MEMBER EXCLUDED' (Mandatory NH) E L DISEASE EA EMPLOYEE $ 1,000,000 II yea,describe under 1,000,000 DESCRIPTION OF OPERATIONS below I E L DISEASE POLICY LIMIT $ C Commercial Umbrella NHA227834 41112011 4/1/2012 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Addrtio al Remarks Schedule if mo spa equ ad) Costa Mesa Sanitary District is Additional Insured as respects General Liability per form GECG6020904. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ry ACCORDANCE WITH THE POLICY PROVISIONS. 628 W 19th Street Costa Mesa,CA 92627 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Insured: F.M. Thomas Air Conditioning Inc. Policy# CBP8636340 COMMERCIAL LIABILITY GOLD ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION I COVERAGES COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY 2. Exclusions Item 2.g. 2) is replaced with the following 2.g. 2) A watercraft you do not own that is: a) less than 50 feet long; and b) Not being used to carry persons or property for a charge. Item 2.g. 6) is added: 6) An aircraft in which you have no ownership interest and that you have chartered with crew. The last paragraph of 2. Exclusions is replaced with the following: Exclusions c. through n. do not apply to damage by fire explosion, sprinkler leakage or lightning to premises while rented to you, temporarily occupied by you with the permission of the owner or managed by you under a written agreement with the owner A separate limit of insurance applies to this coverage as described in Section III Limits of Insurance. SECTION I COVERAGES COVERAGE C. MEDICAL PAYMENTS If Medical Payments Coverage is provided under this policy the following is changed: 3. Limits The medical expense limit provided by this policy shall be the greater of: a. $10,000; or b. The amount shown in the declarations. Coverage C Medical Payments is primary and not contributing with any other insurance even if that other insurance is also primary (}ECG 602 (09:01) hslude opyt ;ht ed ile al of It Se Otti h all its p Page I of I The following is added: COVERAGE D PRODUCT RECALL NOTIFICATION EXPENSES Insuring Agreement We will pay 'product recall notification expenses' incurred by you for the withdrawal of your products, provided that: a Such withdrawal is required because of a determination by you during the policy period, that the use or consumption of your products could result in 'bodily injury' or 'property damage' and b. The 'product recall notification expenses' are incurred and reported to us during the policy period The most we will pay for 'product recall notification expenses' during the policy period is $100,000. SUPPLEMENTARY PAYMENTS COVERAGES A AND B Item b. and d are replaced with: b. The cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or 'suit' including actual loss of earnings up to $500 a day because of time off from work. SECTION II-WHO IS AN INSURED Item 4. is replaced with. 4 Any subsidiaries, companies, corporations, firms, or organizations you acquire or form during the policy period over which you maintain a controlling interest of greater than 50% of the stock or assets, will qualify as a Named Insured if: a) you have the responsibility of placing insurance for such entity- and b) coverage for the entity is not otherwise more specifically provided: and c) the entity is incorporated or organized under the laws of the United States of America. However coverage under this provision does not apply to 'bodily injury' or 'property damage' that occurred before you acquired or formed the entity or 'personal injury' or advertising injury' arising out of an offense committed before you acquired or formed the entity Coverage under this provision is afforded only until the end of the policy period, or the twelve (12) month anniversary of the policy inception date whichever is earlier SECTION III LIMITS OF INSURANCE Paragraph 2 is amended to include. The General Aggregate Limit of Insurance applies separately to each 'location' owned by you rented to you, or occupied by you with the permission of the owner USCG 602 (09:04) L,clude op)) opted vte 91 of Ina. ce Sen 01)1 In ith ns p P 2 of 2 Paragraph 6. is replaced with the following: 6 Subject to 5. above, the Fire Damage Limit is the most we will pay under Coverage A for damages because of 'property damage' to premises while rented to you, temporarily occupied by you with permission of the owner or managed by you under a written agreement with the owner arising out of any one fire explosion or sprinkler leakage incident. The Fire Damage Limit provided by this policy shall be the greater of: a $500,000 or b. The amount shown in the Declarations. SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS Item 2. a.is replaced with: 2. Duties In The Event of Occurrence, Offense, Claim or Suit a. You must promptly notify us. Your duty to promptly notify us is effective when any of your executive officers, partners, members, or legal representatives is aware of the 'occurrence offense, claim, or 'suit' Knowledge of an 'occurrence' offense claim or 'suit' by other employee(s) does not imply you also have such knowledge. To the extent possible, notice to us should include' 1) How when and where the 'occurrence' or offense took place 2) The names and addresses of any injured persons and witnesses; and 3) The nature and location of any injury or damage arising out of the 'occurrence' offense claim or 'suit' Item 4 b. 1) b) is replaced with: b. Excess Insurance 1) b) That is Fire, Explosion or Sprinkler Leakage insurance for premises while rented to you, temporarily occupied by you with permission of the owner or managed by you under a written agreement with the owner or Item 6. is amended to include. 6. Representations d If you unintentionally fail to disclose any hazards existing at the inception date of your policy we will not deny coverage under this Coverage Part because of such failure However this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. Item 8. is replaced with: 8. Transfer of Rights Of Recovery Against Others To Us a. If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request,the insured will bring suit or transfer those rights to us and help us enforce them. GECG 602 (09:04I Include cope gi,ted fir it of Ii Se 0111 In di,nx pert Pag 3 )I 3 b. If required by a written 'insured contract we waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of your ongoing operations or 'your work' done under that written 'insured contract' for that person or organization and included in the 'products-completed operations hazard' Item 10 and Item 11 are added: 10. Cancellation Condition If we cancel this policy for any reason other than nonpayment of premium we will mail or deliver written notice of cancellation to the first Named Insured at least 60 days prior to the effective date of cancellation 11 Liberalization If we adopt a change in our forms or rules which would broaden your coverage without an extra charge the broader coverage will apply to this policy This extension is effective upon the approval of such broader coverage in your state SECTION V DEFINITIONS The following definitions are added or changed: 9 'Insured contract' a. Is changed to: a. A contract for a lease of premises. However that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, explosion or sprinkler leakage to premises while rented to you, or temporarily occupied by you with permission of the owner or managed by you under a written agreement with the owner is not an 'insured contract' 23 and 24 are added: 23. 'Location' means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway waterway or right-of-way of a railroad. 24 'Product recall notification expenses' means the reasonable additional expenses (including, but not limited to cost of correspondence, newspaper and magazine advertising, radio or television announcements and transportation cost), necessarily incurred in arranging for the return of products, but excluding costs of the replacement products and the cash value of the damaged products. The following Provisions are also added to this Coverage Part: A. ADDITIONAL INSUREDS BY CONTRACT AGREEMENT OR PERMIT 1 Paragraph 2. under SECTION II WHO IS AN INSURED is amended to include as an insured any person or organization when you and such person or organization have agreed in writing in a contract, agreement or permit that such person or organization be added as an additional insured on your policy to provide insurance such as is afforded under this Coverage Part. Such person or organization is not entitled to any notices that we are required to send to the Named Insured and is an additional insured only with respect to liability arising out of a. Your ongoing operations performed for that person or organization or b. Premises or facilities owned or used by you GECG 602 (09:01) Gtclude coppt °hied mvenal at Ina Se Ott in dL its p Pi 4014 With respect to provision 1.a. above a person's or organization's status as an insured under this endorsement ends when your operations for that person or organization are completed With respect to provision 1.b. above a person's or organization's status as an insured under this endorsement ends when their contract or agreement with you for such premises or facilities ends 2. This endorsement provision A. does not apply a. Unless the written contract or agreement has been executed, or permit has been issued prior to the "bodily injury"'property damage or 'personal and advertising injury' b. To 'bodily injury' or 'property damage occurring after (1) All work, including materials, parts or equipment furnished in connection with such work, in the project (other than service maintenance or repairs)to be performed by or on behalf of the additional insured(s) at the site 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 pad of the same project; c. To the rendering of or failure to render any professional services including, but not limited to any professional architectural, engineering or surveying services such as: (1) The preparing approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (2) Supervisory inspection architectural or engineering activities; d. To 'bodily injury' 'property damage or"personal and advertising injury arising out of any act, error or omission that results from the additional insured's sole negligence or wrongdoing, e. To any person or organization included as an insured under provision B. of this endorsement; f. To any person or organization included as an insured by a separate additional insured endorsement issued by us and made a part of this policy B. ADDITIONAL INSURED —VENDORS Paragraph 2. under SECTION II WHO IS AN INSURED is amended to include as an insured any person or organization (referred to below as 'vendor") with whom you agreed, in a written contract or agreement to provide insurance such as is afforded under this policy but only with respect to 'bodily injury' or 'property damage' arising out of 'your products' which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions 1 The insurance afforded the vendor does not apply to- a. 'Bodily injury" or 'property damage' for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor GECG 602 (09:04) Ii cluck opyt ghted oat, d of It Se 0111 In tilt tta p Pi of 5 d. Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or substitution of pads under instructions from the manufacturer and then repackaged in the original container e. Any failure to make such inspections adjustments tests or servicing as the vendor has agreed to make or normally undertakes to make in the course of business, in connection with the distribution or sale of the products; f. Demonstration installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container part or ingredient of any other thing or substance by or for the vendor or h. To 'bodily injury' or"property damage" arising out of any act, error or omission that results from the additional insured's sole negligence or wrongdoing. 2. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container entering into accompanying or containing such products. ((ECG 602 (09:04) Include opyt glu ed ate il if It Se 0111 hi 0h its p Pi 6 of 6