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Insurance - Gallagher - 2009-10-29 Gallagher Construction Services/ Arthur J Gallagher 6 Co Insurance Brokers of CA Inc �•/ - 1 Market St. Spear Tower #200 x San Francisco, CA 94105 B PO USA Costa Mesa Sanitary District mmmmm 628 W 19th Street RECEIVED , Costa Mesa, CA 92627 NOV 0 3 2009 USA .309 309 COSTA MESA SAIL;AM OIS[RLC1 Thi document was brought to you by Gallagher Construction Services in San Francisco, CA. via CertificatesNow The data included in this notice and in the attached document is confidential to ConfirmNet and Gallagher Construction Services in San Francisco, CA. If you have questions regarding the content of this document, please contact. Gallagher Construction Services Main Phone (415) 391 1500 Email gcssfcerts @ajg com cc: The data included thi oti and the attached document confidential to Ebix BPO and the party espon ible for br nging you thi informati 10 Cedificate Delivery by CeNficatesNow www ConfinnNet com 877669S600 LCOR°® CERTIFICATE OF LIABILITY INSURANCE II DATE(MMmrmrY) I 10/29/09 PRODUCER LIC #0726293 1-415-391 1500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gallagher Construction Services/ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Arthur J Gallagher & Co Insurance Brokers of CA Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1 Market St. Spear Tower #200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Francisco CA 94105 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A:ZURICH AMERICAN INS CO 16535 [IR] Howard S Wright Constructors LP INSURER B:ACE PROP 6 CAS INS CO 20699 1901 Nancita Circle INSURER C: Placentia, CA 92870 INSURER U I 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'ADEN_ POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR N -D TYPE OFINSU•.NCE DATE(MM/DDIAYYI r ATF CM MID 0NYYYl A X GENERAL LIABILITY G1.04277092-05 11/01/09 11/01/10 EACH OCCURRENCE $ 2,000,000 DAMAGE TO ED X COMMERCIAL GENERAL LIABILITY PREMISES(EaEoccurrence) $ 1,000,000 CLAIMS MADE X OCCUR MEDEXP(Any one person) $ 10,000 PERSONAL&ADV INJURY f 2,000,000 GENERAL AGGREGATE X000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG f 4,000,000 -I POLICY X PRO- JFCT n LOC A X AUTOMOBILE LIABILITY BAP4277093-05 11/01/09 11/01/10 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) f 1,000 000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per Person) X HIRED AUTOS BODILY INJURY f X NON-OWNED AUTOS (Pe acddent) PROPERTY DAMAGE f (Pe accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG $ B E�XCESS/UMBRELLA LIABILITY XOO G23891645 [10XS] 11/01/09 11/01/10 EACH OCCURRENCE $ 10,000,000 X I OCCUR CLAIMS MADE AGGREGATE $ 10,000,000 $ DEDUCTIBLE $ RETENTION f $ A WORKERS COMPENSATION WC4277091-06 11/01/09 11/01/10 X I TW IM 5 TH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT $ 1,000,000 (Mandatory NH)EXCLUDED? I I (Mandatory NH) EL.DISEASE-EA EMPLOYEE f 1,000,000 II yes,deecriba 1SIO SPECIAL PROVISIONS below EL.DISEASE POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS NSW Job #68519 RE. Costa Mesa Sanitary District New Corporate Yard ADDITIONAL INSURED(S) Costa Mesa Sanitary District and its employees and agents CERTIFICATE HOLDER CANCELLATION 10 Day Notice for Non-Payment of Premium RSW Job #68519 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Costa Mesa Sanitary District DATE THEREOF THE ISSUING INSURER WILL WRITTEN XXXXYMAIL 30 DAYS W NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, I , .. , . . .. . . . 'a ._ . 628 W 19th Street _ _ _ _ A Y . - Costa Mesa, CA 92627 AUTHORIZED REPRESENTATIVE j/ I USA A ACORD 25(2009/01) imongcs ©1988-2009 ACORD CORPORATION. All rights reserved. 13485798 The ACORD name and logo are registered marks of ACORD 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 This Certificate of Insurance 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(2009/01) 3.10 Additional Insured — Automatic — Owners, Lessees Or ZURICH Contractors Pali , N� Exp. Date of Pol. Ell: Date of End. Age No Addl. Prem Return Preni. GLO 4277092-05 11/1/10 11/1/09 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY This endorsement modifies insurance provided under the: Commercial General Liability Coterage Part A. Section II—Who Is An Insured is amended to include as an insured any person or organization who you arc re quired to add as an additional insured on this policy under a written contract or written agreement. B. The insurance provided to the additional insured person or organization applies only to 'bodily injury 'property damage' or 'personal and advertising injury covered under SECTION 1 Coverage A Bodily injury And Property Damage Liability and Section I Coverage B Personal And Advertising Injury Liability but only with respect to liability for 'bodily injury 'property damage' or 'personal and advertising injury caused, in whole or in part.by 1. Your acts or omissions:or 2. The acts or omissions of those acting on your behalf: and resulting directly from. a. Your ongoing operations performed for the additional insured. which is the subject of the written contract or written agreement: or b. 'Your work completed as included in the 'products-completed operations hazard' performed for the ad- ditional insured,which is the subject of the written contract or written agreement. C. However. regardless of the provisions of paragraphs A.and B above 1. We will not extend any insurance coverage to any additional insured person or organization: a. That is not provided to you in this policy or b. That is any broader coverage than you are required to provide to the additional insured person or organi- zation in the written contract or written agreement: and 2. We will not provide Limits of Insurance to any additional Insured person or organization that exceed the lower of a. The Limits of Insurance provided to you in this policy or b. The Limits of Insurance you are required to provide in the written contract or written agreement tack de optnghted ate it if In Sent OIL In ads pent tJ-GI-1175-11 C'(3/2007) Page 1 oft D. The insurance provided to the additional insured person or organization does not apply to: _ 'Bodily injury 'property damage' or 'personal and advertising injury arising out of the rendering or failure to render any professional architectural,engineering or surveying services including 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 E. The additional insured must see to it that: 1. We are notified as soon as practicable of an 'occurrence' or offense that may result in a claim: 2. We receive written notice of a claim or 'suit' as soon as practicable:and 3. A request for defense and indenutity of the claim or 'suit' will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity This provision does not apply to insurance on which the additional insured is a Named Insured, if the written contract or written agreement requires that this coverage be primary and non-contributory F For the coverage provided by this endorsement: 1. The following paragraph is added to Paragraph 4.a. of the Other Insurance Condition of Section IV—Com- mercial General Liability Conditions. This insurance is primary insurance as respects our coverage to the additional insured person or organization. where the written contract or written agreement requires that this insurance be primary and non-contributory In that event, we will not seek contribution front any other insurance policy available to the additional insured on which the additional insured person or organization is a Named Insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV—Com- mercial General Liability Conditions. This insurance is excess over Any of the other insurance, whether primary excess. contingent or on any other basis. available to an addi- tional insured, in which the additional insured on our policy is also covered as an additional insured by at- tachment of an endorsement to another policy providing coverage for the same 'occurrence' claim or 'suit' This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the ad- ditional insured on a primary and non-contributor'basis. C. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds. and which endorsement applies specifically to that identified additional insured. Any provisions in this Coverage Part not changed by the terns and conditions of this endorsement continue to apply as written Includes opyrighted animal of li ice Sevres 0tli In ith n per iss' U-GL-1175 13 Cw(3/2007) Pipe 2 of to 0 Waiver Of Subrogation (Blanket) Endorsement ZURICH Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff Date of End. Producer Adel Prem Return Prem. GL04277092-05 11/1/09 11/1/10 11/1/09 $ $ THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: If you are required by a written contract or agreement,which is executed before a loss,to waive your rights of recovery from oth- ers,we agree to waive our rights of recovery This waiver of rights shall not be construed to be a waiver with respect to any other operations in which the insured has no contractual interest. U-GL-925-B CW(12/01) Page I of I WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed.4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED,EXECUTED PRIOR TO THE ACCIDENT OR LOSS,THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND OR ORGANIZATON. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective it-01-09 Policy No. WC4277091-06 Endorsement No. Insured: Premium$ Company: Countersigned By WC DO 0313 (Ed.4-84) Copyright 198:1 National Council on Compensation Insurance. AGENT COPY ZURICH Waiver Of Transfer Of Rights Of Recovery Against Others To Us Poll No Eli Date of Pol. Exp. Date of Pol Eli Date of End. Age No Addl.Pr Return Pr 13AP4277093-05 11/1109 11/1/10 11/1/09 Thus endorsement is issued by the company named in the Declarations. It changes the policy on the effective date listed above at the hour stated in the Declarations THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY Named Insured Address(including ZIP code): This endorsement modifies insurance provided under the: Business Auto Coverage Form Truckers Coverage Form Garage Coverage Form Motor Carrier Coverage Form SCHEDULE Name of Person or Organization: ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED EXECUTED PRIOR TO THE ACCIDENT OR LOSS,THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY We waive any right of recovery we may have against the designated person or organization shown in the schedule because of payments ee make for injury or damage caused by an accident' or 'loss' resulting from the ownership. maintenance. or use of a covered auto' for which a Waiver of Subrogation is required in conjunction with work performed by you for the designated person or organization. The waiver applies only to the designated person or organization shown in the schedule. Countersigned: Date Authorized Representative U-CA-320-B C W(4,94) Page I of I DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 10/29/09 NAME OF INSURED: [IR] Howard S Wright Constructors LP Additional Description of Operations/Remarks from Page 1 Additional I nformation: GENERAL LIABILITY *Additional Insured Required by Written Contract per OGL1175BCW *Coverage Primary and Non-Contributory as required by written contract per OGL1175BCW *Waiver of Subrogation When required by written contract per OGL925BCW AUTO LIABILITY *Waiver of Subrogation When required by written contract per UCA320B WORKERS COMPENSATION *Waiver of Subrogation Form WC000313 SUPP(05/04)