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Insurance - California Building Evaluation and Construction Inc - 2014-12-15CALIF23 OP ID: MC ,acoFZO° CERTIFICATE OF LIABILITY INSURANCE �-^� DATE(MMI Y014 TYPE OF INSURANCE 1?J15/ 2 4 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 pollcy(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 REACT NAME: Miriam E. Rothey Hunter insurance Services, Inc Agency Lic# OD04594 IC No Eat: 886- 815 -7639 AIC NO: 619 -065 -1926 A'ArIL miriam@hunteronline.com 1950 Cordell Ct. Ste 101 El Cajon CA 92020 PREMISES Ea occurrence $ 50,00 Miriam 9. Rothey INSURER(SI AFFORDING COVERAGE NAG INSURERA:Associated Industries Ins. Co. 23140 PERSONAL &ADV INJURY INSURED California Building Evaluation INSURERS: National Union Fire Insurance 19445 & Construction Inc PRODUCTS- COMP /OP Air $ 2,000,000 6281 Beach Blvd. Ste 11306 INSURER C: INSURER D: Buena Park, CA 90621 INSURER E : INSURER F: $ BODILY INJURY (Per person) COVERAGES CERTIFICATE NUMBER: 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSD WYD POLICY NUMBER MMIDDIYI'W MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE X OCCUR AES102644201 05109/2014 0510812015 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 50,00 MEDEXP(Anyoneperson) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER X POLICY F—] PRO- JECT ❑ LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS- COMP /OP Air $ 2,000,000 $ AUrOMOBILELIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINEDSINGLELIMIT (Ed accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ I PROPER TV DAMAGE Par accident $ B X UMBRELLA LIAR EXCESSUAB OCCUR CLAIMS MADE EBU028430240 12/0812014 12/08/2015 EACH OCCURRENCE $ 1,000,000 H AGGREGATE $ 1,000,000 DED I I RETENTION $ $ WORKERS COMPENSATION AM EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEREXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA PER STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTIONOFOPERATIONSILOCA TIONSIVEHCLES (ACORD 101, Additional Remarks Schedule, maybe attached if more apace is required) CERTIFICATE HOLDER CANCELLATION COSTAME 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. 628 W. 19th Street AUTTHHORRIIZZEDRREPRESENTAME Costa Mesa, CA 92627 ACORD 25 (2014/01) OO 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD la- R CERTIFICATE OF LIABILITY INSURANCE �� GATE 8 /2014 12!08/2014 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 pollcy(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: a en Pangelinan Helen Pangelinan Allstate Insurance PHON an, 626 392 3227 RAt N,: 562 278-0261 E-MAIL 12623 Imperial Hwy #207 Santa Fe Springs, CA 90670 INSURERS AFFORDING COVERAGE MAICP INSURER A: 1924 INSURED California Building Evaluation 6281 Beach Blvd, #306 Buena Park, CA 90621 INSURER B: $ INSURER C: S INSURER O: INSURER E S INSURER F: LIMIT APPLIES PER: PRO- LOO JECT F71 PRODUCTS - COMPPOP AGO COVERAGES CERTIFICATE NUMBER: 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. LTNR TYPE OF INSURANCE POLICY NUMBER 1WDpryYYV PODp�P LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CWIMSMADE OOCCUR F- F- EACH OCCURRENCE S PREMISES aaxunerca S MED UP me pesont $ PERSONAL 6 ADV INJURY S GENERAL AGGREGATE S GENL AGGREGATE POLICY LIMIT APPLIES PER: PRO- LOO JECT F71 PRODUCTS - COMPPOP AGO S S A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON- HIRED AUTOS AAUTOWNED I x �-- ! r 64811933601 11/07/201 11/071201 E ECOWINEEDISMGLE LIMIT Ai .000 OOD SOOILY INJURY (Pta pRaoDt S BODILY INJURY (PR e¢idwW Par accKhaco S S UMBRELLA UM EXCESS LIAR OCCUR CLAIMS-MADE EACH OCCURRENCE S AGGREGATE Z DED RETENTIONS S WORKERS COMPENSATION LIABILY AND EMPLOYERS' IT ANY PROPRIETORPARTNERiERECUTIVE YIN OFFICE'MEMBER EXCLUDED? ❑MIA (Mindalary In NH) Il yea, deeaihe undm )F OPERATIONS below WC 5r ATU 0714 E. L EACH ACCIDENT S E. L. DISEASE - EA EMPLOYEE $ EL DISEASE - POLICYLIAR S rr 1 1 DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES (Attach ACORD 101, AddhWmN Remarks Schedule, N rn ro space 4 re*drad) The following is herby named as additional Insured Costa Mesa Sanitary District 628 W. 19th Street Costa Mesa, CA 92627 ACORD 25 (2010105) IM111"HSRt111-M 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 REPRESENTATWE The ACORD name and logo are registered marks of ACORD Clear Ali POLICY NUMBER: AES1026442 01 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations ALL PERSONS OR ORGANIZATIONS WHERE WRITTEN CONTRACT WITH THE NAMED INSURED REQUIRES ADDITIONAL INSURED COMPLETED OPERATIONS. THIS FORM DOES NOT APPLY TO YOUR WORK ON "RESIDENTIAL PROPERTY" Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by 'your work" at the location designated and described in the sche- dule of this endorsement performed for that addi- tional insured and included in the "products - completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc, 2004 Page 1 of 1 ❑ COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or or- ganization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an addi- tional insured on your policy. Such person or or- ganization is an additional insured only with re- spect 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. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are com- pleted. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the render- ing of, or the failure to render, any professional architectural, engineering or surveying servic- es, including: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opi- nions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sureds) at the location of the covered operations has been completed, or b. 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 subcontrac- tor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 71