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Insurance-John Dickens Inc - 2012-05-21ACORD. CERTIFICATE OF LIABILITY INSURANCE 1 0 055 /21/21 /22012 012YY) Mi PRODUCER L #0551220 1 -949- 769 -3108 Goodman Insurance Services +14 Pacifica, suite 430 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. .vine, CA 92618 Justin Goodman INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Montpelier US Insurance INSURER B: PRAETORIAN INS CO 37257 John Dickens, Inc. INSURER Cr BENCHMARK INS CO 41394 P.O. Box 1882 INSURER O: Costa Mesa, CA 92628 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 DD' GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY POLICYNUMBER POLICY EFFECTNE E 0 POLICY EXPIRATION DATE ff LIMBS LT A X MPOO81003000508 01/02/12 01/02/13 EACH OCCURRENCE $1,000,000 A TO- —R R PREMISES Ea omurenee $ 50,000 MED EXP(Any one person) $5,000 CLAIMS MADE OCCUR PERSONAL SADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS- COMP /OP AGO $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOG B AUTOMOBILE LIABILITY 8010001327 01/02/12 01/02/13 COMBINED SINGLE LIMIT (Ea acddent) $1,000,000 X ANYAUTO ALLOWNEDAUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS -X HIRED AUTOS - BODILY INJURY (Perawdent) $ X NON- OWNEDAUTOS PROPERTYDAMAGE (Peraccident) $ GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ OTHERTHAN EAACC AUTOONLV: AGO, $ ANYAUTO $ EXCESS/UMBRELLA LIABILITY EACHOCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE $ $ DEDUCTIBLE X WC SLAM U- QTR- $ - C RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY CST5001926 10/01/11 10/01/12 E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 ANY OFFICER/ME BEREXCLUDED7 XUTIVE E.L. DISEASE - POLICY LIMIT $1,000,000 Uyes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONSI LOCATIONS /VEHICLES I EXCLUSIONSADDED BY ENDORSEMENT/ SPECIAL PROVISIONS The certificate holder(a), is /are named additional insured per the attached form CG 2010 11/85, including primary wording, GL waiver CG 2404 10/93 attached, Auto additional insured with waiver PI CA 0592 09/07 attached, and a Workers Compensation waiver of subrogation WC 04 03 06, where required by written contract, with regards to the following project: All Operations as required by written contract. of Costa Mesa .eerina Division 77 Pair Drive CANCFLLAIHJN IU Dave ror nocice er ,v.n- wayeenc �L riam!. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ff&WAfdWMMAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, PO Box 120 TNIRI " AUUTHORIZEED D REPRESENTATIVE Costa Mesa, CA 92628 -1200 USA mandersonl ©ACORD CORPORATION 1988 27205879 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 The Certificate of Insurance on the reverse side of this form 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. 25 (2001108) Under SECTION III - PHYSICAL DAMAGE COVERAGE, if a long term leased "auto" is a covered "auto" and the les- sor is named as an Additional Insured — Lessor, in the event of a total "loss ", we will pay our additional legal obligation to the lessor for any difference between the actual cash value of the "auto" at the time of the "loss" and the "out- standing balance" of the lease. "Outstanding balance" means the amount you owe on the lease at the time of "loss" less any amounts representing taxes, overdue payments, penalties, interest or charges resulting from over due payments, additional mileage charges, excess wear and tear charges and lease termination fees. We will not pay any administrative costs or overhead fees assessed by the finance company that has leased the cov- ered "auto" to you. 11. ADDITIONAL INSUREDS — BY CONTRACT, AGREEMENT, OR PERMIT SECTION II — LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured is amended to include as an "insured" a person or organization you may become obligated to add to this policy with respect to the operation, maintenance, or use of a covered "auto" you own if: 1) You are obligated to add that person or organization, as an additional insured to this policy by: a. an expressed provision of an "insured contract ", or written agreement; or b. an expressed condition of a written permit issued to you by a governmental or public authority; and 2) The "bodily injury" or "property damage" is caused by an "accident" which takes place after: a. You executed the "insured contract" or written agreement; or b. The permit has been issued to you. 12. WAIVER OF SUBROGATION We waive any right of recovery we may have against any additional insured under SECTION II — LIABILITY COVER- AGE, A. Coverage, 1. Who Is An Insured, but only as respects 'loss" arising out of the operation, maintenance or use of a covered "auto" you own pursuant to the provisions of the "insured contract ", written agreement, or permit. This provision does not apply unless the written contract or agreement has been executed or permit has been issued prior to the "bodily injury" or the "property damage ". 13. CANCELLATION CONDITION Under Common Policy Conditions, A. Cancellation, 2.b. is replaced by the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. 14. GLASS— DEDUCTIBLE Under SECTION III - PHYSICAL DAMAGE COVERAGE, no deductible applies to glass damage if the glass is re- paired rather than replaced. PI CA 05 92 09 07 Page 4 of 4 POLICY NUMBER: MPOO81003000508 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: Any person or organization to which you are obligated by virtue of a written contract to provide in- surance such as is afforded by this policy, but only, with respect to (1) occurrences taking place af- ter such written contract has been executed and (2) occurrences resulting from work performed by you during the policy period, or occurrences resulting from the conduct of your business during the policy period. A person or organization that qualifies as an "Insured" under the above paragraph of this En- dorsement shall be an additional Insured solely with respect to such additional insured's vicarious liability for "bodily injury," property damage" or "personal and advertising injury" caused in whole or in part by your acts or omissions in the performance of "your work" for the additional insured on or at "commercial construction projects." For the purposes of this Endorsement, "commercial construction projects" are defined as build- ings or structures constructed for commercial use and also Include apartments, hotels, homes for the aged, dormitories or barracks. However, "commercial construction projects" shall not include any building or structure which, in whole or in part, contains individual owner occupied units or dwellings. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an Insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. Coverage provided by this policy to the Additional Insured(s) shown in the Schedule shall be primary insurance and any other insurance maintained by the Additional Insured(s) shall be excess and non - contributory, but only if required of the Named Insured and by written contract. CG 20 10 11 85 . Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 ❑ POLICY NUMBER:'iMeooa1oo3000sos COMMERCIAL GENERAL LIABILITY CO 24 0410 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization to which you ate obligated by virtue of a written contract to provide insurance such as is atrarded by this policy, but only with respect to (1) occuxrwoa tiling ptace after such written contract has been executed and (2) orcvmtneestesulting from work perrotmod by you during the policy period, or occumunces resulting from the conduct of your business during the policy period, (If no entry appears above, Information required to complete this endorsement will be shown In the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMER- CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and Included in the "products- completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. CG 24 0410 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 ❑ WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA — 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 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization for whom RE: All California Operations The named insured is required under Written contract to furnish this waiver 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 10101/11 to 10/01/12 Policy No CST5001926 . Endorsement No. 1 insured: John Dickens, Inc Insurance Company: BENCHMARK INSURANCE COMPANY Benchmark Insurance Company Countersigned by