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Insurance - C & R Drains - 2014-09-10 (2)A� & CERTIFICATE OF LIABILITY INSURANCE srDa2o14D�) 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(les) 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 `' Wigmore Insurance Agency, Inc. v E® Harbor Blvd. #215 CONTACT NAME: Ken Noden, CPCU PNDNE , 71q_g79 -6543 F ^X . T14- 549 -2943 E -MAIL , �mmercial i m @wg oreins.com Lice License #0811959 i JEP y Costa Mesa CA 92626 1014 INSURE 9 AFFORDING COVERAGE NAICle INSURERA:James River Insurance Company /10/2014 /10/2015 INSURED — - INSURERS:MerCU Casualty CO 11908 INSURER C: Insurance CO Of the West $50,000 C & R Drains, Inc. Ronco Plumbing, Inc. 1525 W. MacArthur Blvd. #11 INSURERD:National Union Fire Ins $Excluded INSURER E: PERSONAL a ADV INJURY Costa Mesa CA 92626 NSURERF: GENERAL AGGREGATE $2,000,000 COVERAGES CERTIFICATE NUMRFR- 1 8382 71 743 RFVIsHAN NII IMRCIa- 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 POLICY NUMBER POLICY EFF M D Y l POLICY EXP IMMIDDNMI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE XI OCCUR V V 00448494 /10/2014 /10/2015 EACH OCCURRENCE $1,000,000 P G S occurtence $50,000 GEN'L MED EXP (Nny one person $Excluded PERSONAL a ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY JECT F-1 LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS'- COMP /OP AGG $2,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO AUTOVJNED SACHOESULED NON-OWNED HIRED Al1T03 AUTOS N N CCA0000775 /1912014 /19/2015 UUMBINLIJ dent $1000 ,000 BODILY INJURY (Per person) $ BODILY INJURY accident) $ GE Peraccident $ D X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIM &MADE Y Y EBUO32459208 /10/2014 /10 /2015 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DIED I I RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE El OFFICER/MEMBER EXCLUDED? (Mandatory in NH) K descdbeunder DE SCRIPTION OF OPERATIONS below NIA y WPL502449101 /10/2014 /10/2015 PER TH- 'X STATUTE OR E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space la required) CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED WHEN REQUIRED BY WRITTEN CONTRACTOR AGREEMENT (GENERAL LIABILITY) PER FORM CG2010 -0704. COMPLETED OPERATIONS LANGUAGE PER FORM CG2037 -0704. WAIVER OF SUBROGATION AS REQUIRED BY CONTRACT (GENERAL LIABILITY) PER FORM AP5004US -1106. PRIMARY AND NON - CONTRIBUTORY LANGUAGE PER FORM AP5031 US-041 0. WORKERS COMPENSATION INCLUDES BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT FORM WC 99 06 34. COSTA MESA SANITARY DISTRICT 628 W 19TH ST _D) COSTA MESA CA 92627 ACORD 25 (2014101) 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 The ACORD name and logo are registered marks of ACORD All darts reserved. W POLICY NUMBER: (0(�(o �qi q93 ba COMMERCIAL GENERAL LIABILITY CG 2010 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) Or Organization(s): Locations Of Covered Operations where required by written contract or agreement 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 orgenization(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(s) desig- nated above. B. VVfth respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other then 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 in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi. pal as a part of the same project. CG 2010 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑