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Insurance - Wildan Engineering - 2013-11-08ACORO® CERTIFICATE OF LIABILITY INSURANCE F 1 / DA 8/20TE(M 13 3 YYVI 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 endorsement(s). PRODUCER Dealey, Renton & Associates P. O. Box 10550 L �VEJ Santa Ana CA 92711 -0550 66 TACT NACON ME: PHONE E .7 4 427- 1 A/G No ADDRESS: a. om INSURERS AFFORDING COVERAGE NAIC If INSURER A.TrayelerS Pronedy Casualty Co of A 25674 NOV 15 2013 INSURED INSURERB:Catlln Insurance Company, In Q. INSURER C: Willdan Engineering ;all, MLSASANItARYMIS N, 2401 E. Katella Avenue, Ste. 300 Anaheim CA 92806 INSURER D DAMAGE TOR N D PREMISES Eaoccunen a $1,000,000 NSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: 1266286719 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 LTR TYPE OF INSURANCE ADDL INSR UBR MD POLICY NUMBER POLICY EFF MMIDO NYYY) POLICY EXP (MMIDDfYYNYI LIMITS A GENERAL LIABILITY Y 6301158PO20 1/912013 1/912014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TOR N D PREMISES Eaoccunen a $1,000,000 CLAIMS -MADE F] OCCUR MED EXP Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 X Contractual X BFPD,XCU GENERAL AGGREGATE $2,000,000 GEMLAGGRIE LIMIT APPLIES PER: PRODUCTS- COMP /OP AGG $2,000,000 POLICY %t PRO- LOC JECT $ A AUTOMOBILE LIABILITY 8101158P020 '11/9/2013 1/9/2014 Ea accident 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per acciden t $ NON -OWNED HIREDAUTOS X AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION$ $ A WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN y UB7D417816 11/9/2013 1/912014 X WCSTATU- OTH- E.L. EACH ACCIDENT $1,000,000 ANY OFFICER/MEMBER EXCLUDED PROPRIETOR/PARTNER/EXECUTIVE FN NIA E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I $1,000,000 B Professional Liability AED977441114 111912013 1/912014 Per Claim $1,000,000 Claims Made Annual Aggregate $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) General Liability policy excludes claims arising out of the performance of professional services. Independent Contractors are included as respects to General Liability. 30 Day NOC /10 Day for NonPay of Prem Re: Permit technician counter services Costa Mesa Sanitary District, its directors, officials, officers, employees, agents, and volunteers are additional insured as respects to General Liability as required by written contract. Primary and Non - Contributing coverage applies to GL as required by written contract. Waiver of See Attached... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa Sanitary District \\`\ , ACCORDANCE WITH THE POLICY PROVISIONS. Attn: District Clerk `C\ 628 West 19th Street AUTHORIZED REPRESENTATIVE Costa Mesa CA 92627 \ \� P © 1988 -2010 ACORD CORPORATION. All Hahtx reserved ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: A n0 ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Dealey, Renton & Associates NAMEDINSURED Willdan Engineering 2401 E. Katella Avenue, Ste. 300 Anaheim CA 92806 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE or Rights applies to Workers' Compensation policy only as required by a written signed contract prior to any loss occurring. ACORD 7111 r2nna /nit n 9nnR ArnRn The ACORD name and logo are registered marks of ACORD All rw6ho monn•n.i COMMERCIAL GENERAL LIABILITY 6301158PO20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - WRITTEN CONTRACTS (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II —WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. The insurance provided to such additional insured is limited as follows: c. In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the 'Written contract requiring insurance ", the in- surance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance ". This endorsement shall not increase the limits of insurance described in Section III — Limits Of Insurance. d. This insurance does not apply to the render- ing of or failure to render any "professional services" or construction management errors or omissions. e. This insurance does not apply to "bodily in- jury" or "property damage" caused by "your work" and included in the "products - completed operations hazard" unless the "written contract requiring insurance" specifi- cally requires you to provide such coverage for that additional insured, and then the insur- ance provided to the additional insured ap- plies only to such "bodily injury" or "property damage" that occurs before the end of the pe- riod of time for which the "written contract re- quiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 2. The following is added to Paragraph 4.a. of SEC- TION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the ad- ditional insured under this Coverage Part must apply on a primary basis or a primary and non- contributory basis, this insurance is primary to "other insurance" available to the additional in- sured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance'. But this insur- ance provided to the additional insured still is ex- cess over any valid and collectible "other insur- ance", whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any "other insurance ". 3. The following is added to SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDITIONS: Duties Of An Additional Insured As a condition of coverage provided to the addi- tional insured: a. The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: CG D4 114 04 08 0 2008 The Travelers Compares, ,nc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY I. How, when and where the 'occurrence" or offense took place; If. The names and addresses of any injured persons and witnesses; and III. The nature and location of any injury or damage arising out of the 'occurrence" or offense. b. If a claim is made or "suit' is brought against the additional insured, the additional insured must: I. Immediately record the specifics of the claim or "suit' and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit' as soon as practicable. c. The additional insured must immediately send us copies of all legal papers received in con- nection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and oth- erwise comply with all policy conditions. d. The additional insured must tender the de- fense and indemnity of any claim or "suit' to any provider of other insurance which would cover the additional insured for a loss we cover. However, this condition does not affect whether this insurance provided to the addi- tional insured is primary to that other insur- ance available to the additional insured which covers that person or organization as a named insured. 4. The following is added to the DEFINITIONS Sec- tion: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or or- ganization as an additional insured on this Cover- age Part, provided that the "bodily injury" and "property damage" occurs and the "personal in- jury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 0 2008 The Travelers Companies. Inc. CG D4 14 04 08 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 (00) -- POLICY NUMBER: U$7D417816 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization: Job Description: Any person or organization for which the Insured has completed a written agreement to provide this waiver DATE OF ISSUE: 11/09/13 -11 /9/2014