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Insurance- TTS Engineering Inc - 2012-06-05__*j'FCLIVFn AC R n DATE (MM DY YYY) �� ')N n 7 7ntp CAE OF LABILITY INSURANCE 61512012 �ATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERT BELO 1MMM�IF�IC�ATEE OF INSURANCE ERDOES ANOT CONSTITUTE A CONTRACT TBETWEEN COVERAGE THER AFFORDED BY THE AUTHORIZED 'tEPRESENTATIVE 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 NAME' Mary Doig Janes G Parker Insurance Associates PHONE (559)222 -7722 FAX No: (559)222 -1729 EXU. License #0554959 noDRes:MaryDoig @jgparker.com 1753 E Fir Ave INSURERS AFFORDING COVERAGE NAIL# Fresno CA 93720 INSURERA:Starr Indemnit & Liabilit Co 38318 INSURED -- ---- r.......�.... �nncn T T S Engineering Inc Tim Wilson dba TTS Engineering 4952 N Warner Ave #203 92649 ■n�ino:eTnaa�wa:au u�re� r aouuarto :Qr�s�ne�>,:��sr.�ar�w�:�au ry ulmouhnrtyr� 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. NSR TR TYPE OF INSURANCE - �/ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE POLICY NUMBER MM/DDEFF MM/DDIYYYY LIMITS District Engineering 629 W 19th GENERAL LIABILITY t/l/Y/ e AUTHORIZED REPRESENTATIVE Costa Mesa, CA 92627 EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMSMADE OCCUR X J Parker III /NIDOIG SISINRGO0090912 /30/2012 /30/2013 DAMAGE TO REN I tU PREMISES Ea oecurre nee $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL B ADV INJURY $ 1,000,000 * XCL Included * $5000 Per Coo Deductible GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: —1 PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X P' LOC IFOT $ AUTOMOBILE LIABILITY (CEO, aBINEDtSINGLE LIMIT $ 1,000,000 BODILY INJURY(Per person) $ ANY AUTO Ix ALL OWNED SCHEDULED AUTOS AUTHIRED 010000693 9/26/2011 9/26/2012 BODILY INJURY(Per accident) $ AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ Uninsured motorist combined $ 1,000,00 7I. UMBRELLA LAB �a: OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 A EXCESS LAB CIAIMS -MADE X DED RETENTION$ 0 $ ISIXNRO1083912 /30/2012 /30/2013 WORKERS COMPENSATION WCSTATU- OTH- LIMTS AND EMPLOYERS' LABILITY YIN E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE❑ OFFICEWMEMBER EXCLUDED? NIA E.L. DISEASE -EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ B Rented Leased Equipment ZAH010000693 9/26/2011 9/26/2012 $1,000 Deductible, $125,000 B Contract, SISINRGO0090912 5/30/2012 5/30/2013 $5000 oce Ded $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, R more space Is required) Certificate holder is named as Additional Insured as per form 0G023 0611 Primary and Non - Contributory including waiver of subrogation attached. ACORD 25 (2010105) © 1988 -2010 ACORD CORPORATION. All rights reserved. WS025ommnslnl The arnoD name and Innn arc rcnic }crcd mar4c of A(HIOD - �/ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District / /�yy /U(' `� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. District Engineering 629 W 19th Street t/l/Y/ e AUTHORIZED REPRESENTATIVE Costa Mesa, CA 92627 J Parker III /NIDOIG ACORD 25 (2010105) © 1988 -2010 ACORD CORPORATION. All rights reserved. WS025ommnslnl The arnoD name and Innn arc rcnic }crcd mar4c of A(HIOD *Starr Indemnity & Liability Company Dallas, TX 1- 886 -51 9-2522 Primary and Non - contributory, Additional insured and Waiver of Subrogation Policy Number: SISINRG00090912 Effective Date: 05/30/2012 at 12:01 AM Named Ineured: TTS Engineering Inc. 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 Llabllfty Coverage Form Site Pollution Liability Coverage Form SCHEDULE All as required by written, signed or executed contract. A. SECTION 11. WHO IS AN INSURED Is amended to Include as an Insured the person or organizatlon shown In the schedule of this endorsement, but only with respect to Ilability 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 oertlfloates of Insurance should be used only to provide evidence of Insurance In Ileu 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 U'uY 'r Charles H. Dangelo, President IFJIy ( 1 Honora M. Keane, General Counsel 00 - 023 (06111) Page 1 of 1 Copyright @ C. V, atarr & Company and Starr Indemnity & Lfabllity. Company. All rights reserved. tnoluaes aopyrightod materlaf of 180 Properties, Ina„ dead with its pormiselon. ,„DECEIVED a� TUN 0 7 F01PERTIFICATE OF LIABILITY INSURANCE sisi2o "y" THIS CE, _Ijl �{F 6rC),T,F,, Jr$rJS${J,FR„AM5 AAT VE MATTER OF INFORMATION C E R TI l��fl'L C�1}�f lill Fi0(j' IlAjj jU NEGATIVELY AMEND, EXTEND OR ALTER THE RIGHTS OVERAGE CERTIFICATE HOLDER. THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 2EPRESENTATIVE 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 CONTACT Ma D01 NAME: g PHONE (5„59)222 -7%22 FAX (559)222 -1724 AID, No: JaRles G Parker Insurance Associates License #0554959 EMAIL Ma Doi @' arker.com ADDRESS: � 4 7gP INSURERS AFFORDING COVERAGE NAIC# 1753 E Fir Ave INSURER A -Security National Ins Co 19879 Fresno CA 93720 INSURED INSURER B: S INSURER C: $ T T S Engineering Inc DBA T T S Engineering INSURER D: GENERAL AGGREGATE 16835 Algonquin St #453 INSURER E: PRODUCTS- COMP /OP AGO $ INSURER F: $ Huntington Beach CA 92649 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. NOTIMTHSTANDING 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. LTR TYPE OF INSURANCE $ V POLICY NUMBER MMIODYEFF MMIDDTYEYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1:1 OCCUR EACH OCCURRENCE $ DAMAGES( RELATE PREMISES RENT rrence ) $ MED UP (Any one person) S PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ SENT AGGREGATE LIMIT APPLIES PER POLICY P'0. LOG PRODUCTS- COMP /OP AGO $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODI LY INJURY (Per perso n) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccident $ IS UMBRELLA LAB EXCESS LAB OCCUR CLAIMSMADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' LABILITY YIN ANY PR /MEIMBER EXCLUDED' � (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N IA C1010475 6/1/2012 6/1/2013 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1 000 000 EL DISEASE- EAEMPLOYE $ 1 000 000 E.L. DISEASE - POLICY LIMIT I $ 1,000,00 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Costa Mesa Sanitary District District Engineering 628 W 19th Street Costa Mesa, CA 92627 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Parker III /hIDOIG ACORD 25 (2010105) ©1988 -2010 AC( INS029 f9nimm)m Th. ar np In namu and Innn one cenie}veed mark. of a( ewn