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Insurance - TTS Engineering Inc. - 2013-04-18 ACo D CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDM/W) L.------ 4/18/2013 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 PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ORTANT: 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 NAMEACT Mary Doig James G Parker Insurance Associates IA P/CH .NoNE.Extl: (559)222-7722 FAX (559)222-1724 License #0554959 E-MAIL Ma Doi @jgparker.com (A/C,No): ADDRESS: g 7gP 1753 E Fir Ave INSURER(S)AFFORDING COVERAGE NAIC# Fresno CA 93720 INSURER A:Starr Indemnity & Liability Co 38318 INSURED INSURER B:Praetorian Insurance Company 37257 .T T S Engineering Inc INSURER C: Tim Wilson dba TTS Engineering INSURERD: 16835 Algonquin St #453 INSURERE: Huntington Beach CA 92649 INSURER F: COVERAGES CERTIFICATE NUMBER:12.13 GL AL EX IM 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 INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100 000 PREMISES jEa occurrence) $ r A CLAIMS-MADE X OCCUR X Y SISINRG00090912 5/30/2012 5/30/2013 MED EXP(Any one person) $ 10,000 X XCU Included PERSONAL&ADV INJURY _ $ 1,000,000 X $5000 PD Occ Deductible GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY n PRO JE(:T - LOC $ Ilit_TOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED ^ SCHEDULED CAB01000069304 9/26/2012 9/26/2013 BODILY INJURY(Per accident) $ • AUTOS AUTOS X HIRED AUTOS X ANON-OWNED PROPERTY DAMAGE $ UTOS (Per accident) Uninsured motorist combined $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 X DED RETENTION$ 0 SISIXNR01083912 5/30/2012 5/30/2013 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under . DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Rented Leased Equipment CAB01000069304 9/26/2012 9/26/2013 $1,000 Deductible $125,000 A Contractor Pollution Liab SISINRG00090912 5/30/2012 5/30/2013 $5,000occDeductible $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Costa Mesa Sanitary District, its directors, officers, engineers, employees and authorized agents are named as Additional Insured as per form CG2010 0704, OG023 0611 Primary and Non-Contributory including waiver of subrogation, and CG2503 0509 Per Project Aggregate as attached 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 AUTHORIZED REPRESENTATIVE J Parker III/MDOIG � � ' ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025r,nlnn.sini Tho annp 1 Homo snri Innn sro ronicfororl marks of en non • POLICY NUMBER: SISINRG00090912 COMMERCIAL GENERAL LIABIUTY CG 26 03 06 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): As required by written contract subject to a$5,000,000 annual aggregate cap. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by damages or under Coverage C for medical • "occurrences"under Section I—Coverage A, and expenses shall reduce the Designated for all medical expenses caused by accidents Construction Project General Aggregate Limit under Section I -- Coverage C, which can be for that designated construction project. Such attributed only to ongoing operations at a single payments shall not reduce the General designated construction project shown in the Aggregate Limit shown in the Declarations Schedule above: nor shall they reduce any other Designated 1. A separate Designated Construction Project Construction Project General Aggregate Limit General Aggregate Limit applies to each for any other designated construction project designated construction project, and that limit shown in the Schedule above. is equal to the amount of the General 4. The limits shown in the Declarations for Each Aggregate Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, General Aggregate Limit shown in the except damages because of"bodily injury" or Declarations, such limits will be subject to the "property damage" included in the applicable Designated Construction Project "products-completed operations hazard", and General Aggregate Limit. for medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or"suits" brought; or c. Persons or organizations making claims or bringing "suits". • CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 ❑ • B. For all sums which the insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by "products-completed operations hazard" is "occurrences"under Section I—Coverage A, and provided, any payments for damages because of for all medical expenses caused by accidents "bodily injury" or "property damage" included in under Section I — Coverage C, which cannot be the "products-completed operations hazard" will attributed only to ongoing operations at a single reduce the Products-completed Operations designated construction project shown in the Aggregate Limit, and not reduce the General Schedule above: Aggregate Limit nor the Designated Construction 1. Any payments made under Coverage A for Project General Aggregate Limit. damages or under Coverage C for medical D. If the applicable designated construction project expenses shall reduce the amount available has been abandoned, delayed, or abandoned under the General Aggregate Limit or the and then restarted, or if the authorized Products-completed Operations Aggregate contracting parties deviate from plans, blueprints, Limit,whichever is applicable; and designs, specifications or timetables, the project 2. Such payments shall not reduce any will still be deemed to be the same construction Designated Construction Project General project. Aggregate Limit. E. The provisions of Section III — Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. • • • Page 2 of 2 ©Insurance Services Office, Inc., 2008 CG 25 03 05 09 o POLICY NUMBER: SISINRG00090912 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 As required by written contract As required in by written contract • 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. 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 part of the same project. • CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ c h - _-_fLv. Starr Indemnity & Liability Company • Dallas, TX 1-866-519-2522 Primary and Non-contributory, Additional Insured and Waiver of Subrogation Policy Number: SISINRG00090912 Effective Date: 5/30/2012 at 12:01 A.M. Named Insured: T T S Engineering, Inc. dba: T T S Engineering This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(ies) carefully. Commercial General Liability Coverage Form Owners and Contractors Protective Liability Coverage form Products/Completed Operations Liability Coverage Form Contractors Pollution Liability Coverage Form Professional Liability Coverage Form Site Pollution Liability Coverage Form SCHEDULE All as required by written, signed or executed contract. A. SECTION II -WHO IS AN INSURED is amended to include as an insured the person or organization shown in the schedule of this endorsement, but only with respect to liability arising out of"your work" for that insured by or for • you. B. As respects additional insureds as defined above, this insurance also applies to "bodily injury" or "property damage" arising out of your negligence when the following written contract requirements are applicable: 1. Coverage available under this coverage part shall apply as primary insurance. Any other insurance available to these additional insured's shall apply as excess and not contribute as primary to the insurance afforded by this endorsement. 2. We waive any right of recovery we may have against these additional insured's because of payments we make for injury or damage arising out of"your work" done under a written contract with the additional insured. 3. The term insured is used separately and not collectively, but the inclusion of more than one insured shall not increase the limits or coverage provided by this insurance. Insureds and Agents are advised that certificates of insurance should be used only to provide evidence of insurance in lieu of an actual copy of the applicable insurance policy. Certificates should not be used to amend, expand or otherwise alter the terms of the actual policy. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Signed for STARR INDEMNITY& LIABILITY COMPANY ("AY() /, , ---- f 21 t1 / . 2iu t�t. • Charles H. Dangelo, President Honora M. Keane, General Counsel OG -023 (06/11) Page 1 of 1 Copyright©C.V.Starr&Company and Starr Indemnity&Liability Company. All rights reserved. Includes copyrighted material of ISO Properties,Inc.,used with its permission. • Aco® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/VYYY) �...---- 4/18/2013 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 PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ORTANT: 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 N MEACT Mary Doig James G Parker Insurance Associate.' E C E I V E ONE (559)222-7722 FOX (A/C.No.Eat); (A/C.No): (559)222-1724 License #0554959 E-MAIL Ma Doi @ ' arker.corn APR 2 2 2013 ADDRESS: g 7gP 1753 E Fir Ave INSURER(S)AFFORDING COVERAGE NAIL# Fresno CA 93720 COSTA MESASANITARYDIS_i1 URERA:Security National Ins Co 19879 INSURED INSURER B: T T S Engineering Inc DBA T T S Engineering INSURER C: 16835 Algonquin St #453 INSURERD: INSURER E: Huntington Beach CA 92649 INSURER F: COVERAGES CERTIFICATE NUMBER:12.13 WC 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 INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONALS ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 7 POLICY Ti jE F Ti LOC $ �TOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) _ $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER ry in NH)EXCLUDED? Y N/A (Mandatory SWC1010475 6/1/2012 6/1/2013 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 0 ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District 628 W 19th Street Costa Mesa, CA 92627 AUTHORIZED REPRESENTATIVE J Parker III/MDOIG t.::::17:4 •■•=. acg5 g : ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025oninns‘ni Tho Anripn names anri Innn a►o roniatoror1 marks of Ar`ORrl