No preview available
Insurance - Vadnais Corporation - 2013-01-25 AW®R®° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) L-----' 2/1/2014 1/25/2013 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 et EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLD RTE A CONTRACT BETWEEN OTHE ISSUING INSURER(S)TAUTHOR C F I\E D IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subjeo °� 1 2013 the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer right'fd e" certificate holder in lieu of such endorsement(s). , t`\p eta j��V(1IC PRODUCER Lockton Insurance Brokers,LLC CONTACT �UJittI1ILUftSt11�1I1!nti Cr,IRO 19800 MacArthur Blvd.,Suite 1250 PHHONN,Ext): FAX (A/C,No): CA License#0F15767 E-MAIL Irvine 92612 ADDRESS: 949-252-4400 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Old Republic General Ins Corporation 24139 INSURED Vadnais Corporation INSURER B: Allied World Assurance Company,Ltd 1326310 2130 La Mirada Dr. INSURER C: OneBeacon Insurance Company 21970 Vista CA 92081 INSURER D: INSURER E: INSURER F: COVERAGES VADCO02 CERTIFICATE NUMBER: 10771787 REVISION NUMBER: XXXXXXX 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)(MMIDDIYYYY) LIMITS A GENERAL LIABILITY y N AICG36531306 2/1/2013 2/1/2014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES O(Ea occurrence) $ 100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 X $10,000 Ded.(BUPD) PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 —1 POLICYI I JECOT n LOC 0 AUTOMOBILE LIABILITY Y N A1CA36531306 2/1/2013 2/1/2014 COMBINED SINGLE LIMIT BODILY i INJURY $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident $ XX NON-OWNED PROPERTY DAMAGE $ XXXXXXX X HIRED AUTOS X AUTOS (Per accident) _ Comp./Coll.Ded $ 1,000 13 X UMBRELLA LIAB X OCCUR N N 0305-2756 2/1/2013 2/1/2014 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED I RETENTION$ $ XXXXXXX A WORKERS COMPENSATION A1CW36531306 2/1/2013 2/1/2014 X ORS LIMITSI PR AND EMPLOYERS'LIABILITY Y/N Y I 1 ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 1,000,000 . C Property/IniandMarine N N 710-02-89-97-0003 • 2/1/2013 2/1/2014 Real Property:$900,000 BPP&BUEE:$723,400 Scheduled Equipment:$6,913,119 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/(Attach ACORD 101,Additional Remarks Schedule,if more space is required) For Property:Leased/Rented Equipment:Limit:$852,000 per item. RE:Vadnais Job#741;Costa Mesa Sanitary District Job#168;Irvine Pumping Station Relocation.Costa Mesa Sanitary District,its employees and agents and County of Orange are included as Additional Insureds to the extent provided by the policy language or endorsement issued or approved by the insurance earner. CERTIFICATE HOLDER CANCELLATION See Attachments JD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE �� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1 ACCORDANCE WITH THE POLICY PROVISIONS. 10771787 ^�tvt� AUTHORIZED REPRESENTATIVE Costa Mesa Sanitary District ` 1^J 629 W.19th Street Costa Mesa CA 92626 I _ ACORD 25(2010/05) ©1 88-201 :C D C RPORATION.All rights reserved The ACORD name and logo are registered marks of ACORD POLICY NUMBER: A1CG36531306 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) Location(s) Of Covered Operations: Or Organization(s): Costa Mesa Sanitary District, its employees and agents and County of Orange 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, 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; in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or"property damage" occurring after: 1. All work including materials parts or equipment furnished in connection with such work, on the project(other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location 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 part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 S Attachment Code :D456623 Certificate ID : 10771787 • OLD REPUBLIC GENERAL INSURANCE CORPORATION CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILI"IY COVERAGE FORM Named of Additional Insured Person(s) Or Location(s) of Coverage Operations Organization(s): Where required by written contract Information required to complete this Schedule,if not shown above, will be shown in the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other insurance of a like kind available to the person or organization shown in the schedule above unless the other insurance is provided by a contractor other than the person or organization shown in the schedule above for the same operation and job location. If so,we will share with that other insurance by the method described in paragraph 4.c. of Section IV - Commercial General Liability Conditions. All other terms and conditions remain unchanged. • Named Insured: Vadnais Corporation Policy Number: A1CG36531306 Policy Period: 2/1/2013 to 2/1/2014 Endorsement No.: Endorsement Effective Date: 2/1/2013 Producer's Name: Producer Number: CG EN GN 0029 09 06 • Attachment Code :D462834 Certificate ID : 10771787 Policy Number:A1CA36531306 COMMERCIAL AUTO • CA 20 0103 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LESSOR - ADDITIONAL INSURED AND LOSS PAYEE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 2/1/2013 Named Insured:Vadnais Corporation Schedule Insurance Company: Old Republic General Insurance Corporation Policy Number:A1CA36531306 Effective Date:2/1/2013 to 2/1/2014 Named Insured:Vadnais Corporation Address: 2130 La Mirada Drive,Vista CA 92081 Designation Or Description of"Leased Autos": WI-[ERE REQUIRED BY WRITTEN CONTRACT OR LEASE AGREEMENT. ***SEE CADE0002 0906-ITEM THREE Coverages Limit of Insurance Liability $1,000,000 Each Accident Comprehensive Actual Cash Value Or Cost Of Repair Whichever Is Less,Minus ** Deductible For Each Covered"Leased Auto" Collision Actual Cash Value Or Cost Of Repair Whichever Is Less,Minus ** Deductible For Each Covered"Leased Auto" Specified Actual Cash Value Or Cost Of Repair Whichever Is Less,Minus Causes of Loss ** Deductible For Each Covered"Leased Auto" Information required to complete this Schedule,if not shown above,will be shown in the Declarations. CA 20 0103 03 Copyright,ISO Properties,Inc.,2005 Page 1 of 2 • Attachment Code : D463440 Certificate ID : 10771787 • A. Coverage 1. Any "leased auto" designated or described in the Schedule will be considered a covered "auto" you own and not a covered"auto"you hire or borrow. 2. For a "leased auto" designated or described in the Schedule,Who Is An Insured is changed to include as an "insured" the lessor named in the Schedule. However, the lessor is an "insured" only for "bodily, injury" or "property damage"resulting from the acts or omissions by: a. You; b. Any of your"employees" or agents;or c. Any person,except the lessor or any"employee" or agent of the lessor, operating a "leased auto"with the permission of any of the above. 3. The coverages provided under this endorsement apply to any "leased auto" described in the Schedule until the expiration date shown in the Schedule, or when the lessor or his or her agent takes possession of the "leased auto",whichever occurs first. B. Loss Payable Clause 1. We will pay,as interest may appear,you and the lessor named in this endorsement for"loss" to a "leased auto". 2. The insurance covers the interest of the lessor unless the "loss" results from fraudulent acts or omissions on your part. 3. If we make any payment to the lessor,we will obtain his or her rights against any other party. C. Cancellation 1. If we cancel the policy,we will mail notice to the lessor in accordance with the Cancellation Common Policy Condition. 2. If you cancel the policy,we will mail notice to the lessor. 3. Cancellation ends this agreement. D. The lessor is not liable for payment of your premiums. E. Additional Definition As used in this endorsement: "Leased auto"means an"auto"leased or rented to you,including any substitute,replacement or extra "auto"needed to meet seasonal or other needs,under a leasing or rental agreement that requires you to provide direct primary insurance for the lessor. CA 20 0103 03 Copyright,ISO Properties,Inc.,2005 Page 2 of 2 • Attachment Code: D463440 Certificate ID : 10771787 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 • (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-BLANKET 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). The additional premium for this endorsement shall be 3%of the total California Workers'Compensation premium otherwise due. Schedule Person or Organization Job Description Where Required By Written Contract Costa\'Iesa Sanitary District,its employees and agents and County of Orange Policy Number:r11CW36531306 Insured:Vadnais Corporation Endorsement Effective 2/1/2013 Coverage Provided by: Old Republic Insurance Company Issue Date: 2/1/2013 • WC 99 06 34 (Ed.8-00) • Attachment Code :D463437 Certificate ID : 10771787