Loading...
Insurance - National Plant Services - 2013-12-11AC "R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DDIYYYY) 72/11/2013 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 REPRESENTATIVE 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 endorsemen _ PRODUCER C F I v MARSH USA INC. 540 W. MADISON CHICAGO, IL 60661 AM: chlcagD.CertRequest marsh.mm CONTACT NAME` - PHONN E A/C No E-MAIL ADDRESS: A GENERAL LIABILITY A CAA T,1p 227309STDUNESI3 -14 NIPS CUM MUA SANIIIIIY DISIMCI INSURERS AFFORDING COVERAGE NAIC# INSURER A: Zurich American Insurance Company 16535 INSURED NATIONAL PLANT SERVICES, INC. INSURER B: -- - INSURER C: 1461 HARBOR AVENUE LONG BEACH, CA 9081 &2741 INSURER D, INSURER E : _ MED EXP one person NSURER F: PERSONAL& ADV INJURY $ 1,000,000 COVERAGES CERTIFICATE NUMBER: CHI - 004640578-04 REVISION NUMBER:4 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, LTR TYPE OF INSURANCE ADDLSUBR 15a POLICY NUMBER POLICY EFF MMLI DIYYYY LIMITS A GENERAL LIABILITY GLO 9377201 -10 1013112013 10/312014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ff] OCCUR DAMAGE TO RENTED PREMISES Ea occur a oe $ 1,000,000 MED EXP one person $ 10,000 PERSONAL& ADV INJURY $ 1,000,000 X XCUINCLUDED GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OPAGG $ 2,000,000 POLICY FX PRO- LOG $ A AUTOMOBILE LIABILITY BAP 9377199 -10 10131/2013 1013112014 qi COMBINED SINGLE LIMIT 2,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ ONOWNED HIRED AUTOS AUTOS PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE OEO I I RETENTION $ A WORKERS COMPENSATION WC 9377202 -10 10131/2013 1013112014 X VJC STATU- OTH- ER AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y� OFFICERIMEMBER EXCLUDED? N (Mandatory In NH) N/A EL. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 If Wended under OESGtRIPTION OF OPERATIONS helm E.L. DISEASE - POLICY LIMIT $ 1,000,01)) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, AddilJonal Remarks Schedule, if more specs is required) RE: PREQUALIFICATION FOR MAINTENANCE PROJECTS UNDER 125,000. COSTA MESA SANITARY DISTRICT, ITS DIRECTORS, OFFICERS, ENGINEERS, EMPLOYEES AND AUTHORIZED A GENTS ARE ADDITIONAL INSUREDS UNDER G ENERAL LIABILITY AND AUTOMOBILE LIABILITY, BUT ONLY TO THE EXTENT REQUIRED BY THEIR WRITTEN CONTRACT WITH THE NAMED INSURED FOR OPERATIONS PERFORMED BY THE NAMED INSURED, A WAIVER OF SUBROGATION IS INCLUDED IN FAVOR OF THE ADDITIONAL INSURED WITH RESPECT TO THE GENERAL LIABILITY, AUTOMOBILE LIABILITY AND WORKERS COMPENSATION COVERAGES, BUT ONLY TO THE EXTENT REQUIRED BY THEIR WRITTEN CONTRACT WITH THE NAMED INSURED, CERTIFICATE HOLDER CANCELLATION ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD COSTA MESA SANITARY DISTRICT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 628 W. 19TH STREET n / \\ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COSTA MESA, CA 92627 / yy (L ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee �11L'v�Lb l.i �Aa...ZCr�a� -e,L ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 227309 _ LOC #: Chicago ADDITIONAL REMARKS SCHEDULE Page 2 a 2 AGENCY MARSH USA INC. NAMED INSURED NATIONAL PLANT SERVICES, INC. 1461 HARBOR AVENUE LONG BEACH, CA 908132741 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE; THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance THE INSURANCE AFFORDED TO THE ADDITIONAL INSUREDS IS PRIMARY INSURANCE OVER ANY OTHER VALID OR COLLECTIBLE INSURANCE THAT THE ADDITIONAL INSUREDS MAY HAVE WITH RESPECT TO LOSS UNDER THIS POLICY. OTHER INSURANCE OF ANY ADDITIONAL INSUREDS APPLICABLE TO LOSS IS IN EXCESS OVER THIS ENDORSEMENT AND THE AMOUNT OF THE COMPANY'S LIABILITY UNDER THIS POLICY SHALL NOT BE REDUCED BY THE EXISTENCE OF SUCH OTHER INSURANCE, PROVIDED, HOWEVER, THAT THIS PARAGRAPH DOES NOT APPLY(!) TO LOSS CAUSED SOLELY BY THE NEGLIGENCE OF SUCH ADDITIONAL INSUREDS, OR (ii) TO LIABILITY OF THE ARCHITECT, ENGINEER OR SURVEYOR ARISING OUT OF (1) PREPARING, APPROVING OR FAILING TO PREPARE OR APPROVE MAPS, SHOP DRAWINGS, OPINIONS, REPORTS, SURVEYS, FIELD ORDERS, CHANGE ORDERS OR DRAWINGS AND SPECIFICATIONS, OR (2) GIVING DIRECTIONS OR INSTRUCTIONS, OR FAILING TO GIVE THEM, IF THAT IS THE PRIMARY CAUSE OF THE INJURY OR DAMAGE. THE INSURANCE PROVIDED UNDER THIS ENDORSEMENT WILL BE PRIMARY AND NON - CONTRIBUTORY ONLY IF A WRITTEN CONTRACT REQUIRES IT. THE INCLUSION OF MORE THAN ONE CORPORATION, PERSON, ORGANIZATION, FIRM OR ENTITY AS A NAMED INSURED OR ADDITIONAL INSURED UNDER THE POLICY SHALL NOT AFFECT THE RIGHTS OF SUCH CORPORATION, PERSON, ORGANIZATION, FIRM OR ENTITY AS RESPECTS ANY CLAIM, DEMAND, SUIT OR JUDGMENT MADE, BROUGHT OR RECOVERED, BY OR IN FAVOR OF ANY EMPLOYEE OF SUCH OTHER NAMED INSURED OR ADDITIONAL INSURED. THE POLICY PROTECTS EACH CORPORATION, PERSON, ORGANIZATION, FIRM OR ENTITY IN THE SAME MANNERAS THOUGH A SEPARATE POLICY HAD BEEN ISSUED TO EACH. HOWEVER, NOTHING IN THIS ENDORSEMENT SHALL INCREASE THE AMOUNTS OF LIABILITY BEYOND THE AMOUNT FOR WHICH THE COMPANY WOULD HAVE BEEN LIABLE HAD ONLY ONE PERSON OR INTEREST BEEN NAMED AS A NAMED INSURED, INSURED OR ADDITIONAL INSURED. ACORD 101 (2008101) © 2008 ACORD CORPORATION_ All rinhts The ACORD name and logo are registered marks of ACORD 0 Additional Insured —Owners, Lessees Or Contractors — ZURICH Ongoing Operations — Scheduled CARYLON CORPORATION Policy No. Eff. Data of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. AddT Prom Return Prem. GLO9377201 -10 10/31/2013 10/31/2014 STATUS IN .A WRITTEN CONTRACT OR WRITTEN 30060 -000 NIA NAI THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE Name of Person or Organization: Location and Description of Ongoing Operations: Additional Premium: ANV PERSON OR ORGANIZATION TO WHOM OR TO ANY LOCATION OR PROJECT WHERE YOU ARE N/A WHICH YOU ARE REQUIRED TO PROVIDE REQUIRED TO PROVIDE ADDITIONAL INSURED ADDITIONAL INSURED STATUS IN A WRITTEN STATUS IN .A WRITTEN CONTRACT OR WRITTEN CONTRACTOR WRITTEN AGREEMENT EXECUTED AGREEMENT EXECUTED PRIOR. TO THE LOSS, PRIOR TO THE LOSS EXCEPT WHERE SUCH EXCEPT WHERE SUCH CONTRACT OR AGREEMENT CONTRACT OR AGREEMENT IS PROHIBITED BY LAW IS PROHIBITED BY LAW A. Section II — Who Is An Insured is amended to include as an insured any person or organization shown in the Schedule of this endorsement, but only with respect to liability arising out of your ongoing operations performed for that insured at or from the corresponding location designated and described in the Schedule. However, if you have entered into a construction contract with an additional insured person or organization shown in the Schedule of this endorsement, the insurance afforded to such additional insured only applies to the extent permitted by law. B. With respect to the insurance afforded to any additional insured shown in the Schedule of this endorsement, the following additional exclusion applies: 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 site 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. All other terms and conditions of this policy remain unchanged. U -GL- 1465 -B CW (04112) Page 1 of 1 Includes copyrighted material of insurance Services Office, Inc., xdth Its permission. 0 Additional Insured —Owners, Lessees Or Contractors — ZURICH Completed Operations — Scheduled CARYLON CORPORATION Policy No. I Eff. Date of Pol. I Exp. Date of Pal. Eff. Date of End. Producer No. Addl. Prom Return Prom. GLO9377201 -10 10/31/2013 1 10/3112014 REQUIRED TO PROVIDE ADDITIONAL INSURED 30060 -000 N/A N!A THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE Name of Person or Organization: Location and Description of Completed Operations: Additional Premium: N/A ANY PERSON OR ORGANIZATION TO WHOM OR TO ANY LOCATION OR PROJECT WHERE YOU ARE WHICH YOU ARE REQUIRED TO PROVIDE REQUIRED TO PROVIDE ADDITIONAL INSURED ADDITIONAL INSURED STATUS IN A WRITTEN STATUS IN A WRITTEN CONTRACT OR WRITTEN CONTRACTOR WRITTEN AGREEMENT EXECUTED AGREEMENT EXECUTED PRIOR TO THE LOSS, PRIOR TO THE LOSS EXCEPT WHERE SUCH EXCEPT WHERE SUCH CONTRACTOR AGREEMENT CONTRACT OR AGREEMENT IS PROHIBITED BY LAW IS PROHIBITED BY LAW Section II — Who Is An Insured is amended to include as an insured any person or organization shown in the Schedule of this endorsement, but only with respect to liability arising out of "your work" at or from the corresponding location designated and described in the Schedule performed for that insured and included in the "products - completed operations hazard ". However, if you have entered into a construction contract with an additional insured person or organization shown in the Schedule of this endorsement, the insurance afforded to such additional insured only applies to the extent permitted by law. All other terms and conditions of this policy remain unchanged. U -GL- 1466 -B CW (04112) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission.