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Insurance - Project 311 - Sewer Manhole Surface Repair Program ACORD CERTIFICATE OF LIABILITY INSURANCE DATEIMMCONYCY' 10/27/2015 PRODUCER LIC 110E28842 1-949-756-4100 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Invensure Insurance Brokers, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 17991 Cowan ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Irvine, CA 92619 nob Parent INSURERS AFFORDING COVERAGE NAICY INSURED .N„a.LI, �_, LIBERTY MUT FIRE INS CO 23035 Engineering, Inc. EDS General - - - -- N. .PFHN LIBERTY INS CORP 92904 1320 E. Sixth St. #100 P P. Corona, CA 92879 ;EHD. - - -- COVERAGES TIIE POLICIES OF INSUnANCE LISTED BELOW I IAV_BEEN ISSUED TO TIIE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITIISTANDINO ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTI ICR DOCUMENT WITII RESPECT i0 WI SCE I TIIIS CERTIFICATE MAY SE ISSUED OR MAY PERTAIN,TIIE INSURANCE AFFORDED BY TIE POLICIES DESCRIBED I IEREIN IS SUBJECT TO ALL TIIE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN N MAY HAVE BEEN REDUCED BY PAID CLAIMSINSR . DPL PPEEFFECTmE I POPLEXPIRATION LTA NERD TYPEDFINSVBANGE POLICVNUMBER OTE LIMITS A GENERALIABILITY 1132-Z91-454286-015 09/28/15 09/28/16A _ AA 51,000,000 X MMFRCInI F _ nIJmHlury • IPPE ESOEv 06-„F„,„ I 5100,000 SSSS __ 1 CLAYAS Jt X 0,, ME'] 666;SOO'S °Excluded X $5,000 Deductible FHSONAI 6 ADV'^UL.,Y '5 1,000,000 OENERIV AOLIFIEFIATC F$2,000,000 GGRICATI IMIT APPUCC PER PRODUOTS COMPIOP AHr •62,000,000 i • Fo_CY I X IcerLI'= I A AUTOMOBILE LIABILITY AS2-291-454286-025 09/28/15 09/28/16 E MI - -- - y1,000,000 Al I wNrPAUTOS, I scH-rwEr LFos "• ' X HIRED Auu-m I'I X NON ....I__A_'._• - i PnOPLmY'DAMAGE GARAGE LIABILITY Am 0 ONI 6 Fek soncpsr_I s Aa os L.. OTHEPONTHAN LY nGS • LI v e UMBR m TH7-293-954286-045 09/28/15 09/28/16 1 ,./ _u NL CL +_9,000,000 SCUP E 1 MS MAP A . ,4,000,000 1 Dr lUCcmr ' • I• S 'iX n[ PtPGU ,, 10,000 IIS A WORKERS COMPENSATION AND NO2-Z91-454286-035 09/28/15 09/28/16 ! X IT L IIA EMPLOYERS'LIABILITY PI • A. *A .,, :,.1,000,000 •• N C B U P' xcs FL DISEASE EA EMPLOYEE 51,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS **Additional insured form CG2037 04 13 a CG2033 09 13 and blanket WC waiver of subrogation # HC040306 9/84 are attached Primary wording LC 24 20 02 13 applies per attached. **Costa Mesa Sanitary District, its directors, officials, officers, employees, agents and volunteers are additional insureds. Project; Sewer Manhole surface Repair Program - Phase II ; Project # 311 EBS Sob #15110 CERTIFICATE HOLDER CANCELLATION-except 10 days notice for non-payment. SHOULD ANY OF 1MEABOVE DESCRIBED POLRIES BECANCELLEO BEFORETHE EXPIRATION Costa Mesa Sanitary District Vb, DATE THEREOF,711E ISSUING INSURER WILL 81141104411401MAIL 30* DAYS WRnTEN `I('41B/1-] NOTICE TO THE CERTIFICATE HOLDER NAMED To ICE LEFT.849V,L929914&4Af4,W31T6iX 628 V.I. 19th St. XXOBBIZK6R#RX8XXIMII5p %9i6RRXXXXOZtl6%pID6ffiAW/XXXXXXIALIPXX892 XxRTRSEYt1=XXXXXXXXXXXXYXXXXXXXXXXXXfXXZXXXXXXXXXXXXXXXYYX Costa Mesa, CA 92627 AUTHORIZEDREPRESENTADVE USA .iii. _ 4 ACORD 25(2001/08)kloper ©ACORD CORPORATION 1988 95328921 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 insuregs), 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. ACORD 25(2001/00) PolicyNo. TB2-Z91-454286-015 COINvERCIAL GENERAL LIABILITY CG 20 33 0413 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 B. With respect to the insurance afforded to these include as an additional insured any person or addtional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract or agreement that such person or organization be 1. 'Bodily injury'. "property damage' or 'personal added as an additional insured on your policy. and advertising injury" arising out of the Such person or organization s an additional rendering of, or the failure to render, any insured only with respect to liability for "bodily professional architectural. engineering or injury', "property damage" or 'personal and surveying services, including: advertising injury"caused, in whole or in part, by: a. The preparing, approving, or fading to 1. Your acts or omissions; or prepare or approve, maps, shop drawings, 2. The acts or omissions of those acting on your opinions. reports, surveys, field orders, behalf: change orders or drawings and specifications;or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. However, the insurance afforded to such additional This exclusion applies even if the claims against insured: any insured allege negligence or other wrongdoing 1. Only applies to the extent permitted by law;and in the supervision, hiring, employment training or 2. Will not be broader than that which you are monitoring of others by that insured, it the required by the contract or agreement to 'occurrence' which caused the "body injury" or provide for such additional insured. "property damage", or the offense which caused the 'personal and advertising injury", involved the A person's or organization's status as an additional rendering of or the failure to render any insured under this endorsement ends when your professional architectural, engineering or surveying operations for that additional insured are services. completed. CG 20 33 0413 ©Insurance Services Office, Inc.,2012 Page 1 of 2 2. 'Bodily injury" or 'property damage occurring C. With respect to the insurance afforded to these after: additional insureds, the following is added to a. All work, including materials. parts or Section III—Limits Of Insurance: equipment furnished in connection with The most we will pay on behalf of the additional such work. on the project (other than insured is the amount of insurance: • service, maintenance or repairs) to be 1. Required by the contract or agreement you performed by or on behalf of the additional have entered into with the additional insured; or insured(s) at the location of the covered operations has been completed; or 2. Available under the applicable Lints of b. That portion of"your work" out of which the Insurance shown in the Declarations: injury or damage arises has been put to its whichever is less. intended use by any person or organization This endorsement shall not increase the applicable other than another contractor or Limits of Insurance shown in the Declarations. subcontractor engaged in performing operations for a principal as a part of the same project. Page 2 of 2 CO Insurance Services Office, Inc..2012 CG 20 33 0413 POLICY NUMBER: TB2-Z91-454286-015 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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 LABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITYCOVERAGE PART A Section II — Who Is An Insured is amended to B. Weh respect to the insurance afforded to these include as an additional insured the person(s) or addibnal insureds, the following is added to organization(s) shown in the Schedule. but only Section III—Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured S "property damage" caused, in whole or in part, by required by a contract or agreement, the most we 'your work" at the location designated and will pay on behalf of the additional insured is the • described in the Schedule of this endorsement amount of assurance: performed for that additional insured and included in the "products-completed operations hazard*. 1. Required by the contract or agreement or However. 2. Available under the applicable Limits of Insurance shown in the Declarations; 1. The insurance afforded to such addhonal • insured only applies to the extent permitted by whichever s less. law;and This endorsement shall not increase the applicable 2. If coverage provided to the addeional insured is Limits of Insurance shown in the Declarations. • required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location Md Description Of Completed Operations Blanket where requied by written contract executed Any prior to a loss or occurrence. Information required to complete this Schedule, if not shown above. wit be shown in the Declarations. CG 20 37 04 13 ®Insurance Services Office, Inc.,2012 Page 1 of 1 Policy Number T82-Z91-454286-015 Issued by Liberty Mutual Fire Ins. Ca THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE AMENDMENT—SCHEDULED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule Person or Organization: All persons with whom you have a written agreement to include them as Additional Insured, which is signed in advance of the'occurrence or offense for which the Additional Insured seeks coverage. If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any other basis for any person or organization shown in the Schedule of this endorsement that qualifies as an additional insured on this policy,this policy will apply solely on the basis required by such written agreement and Paragraph 4. Other Insurance of Section IV- Conditions will not apply. If the applicable written agreement does not specify on what basis the liability Insurance will apply, the provisions of Paragraph 4. Other Insurance of Section IV- Conditions will govern. However, this insurance is excess over any other insurance available to the additional insured for which it is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same"occurrence",claim or"suit'. LC 24 20 02 13 ®2013 Liberty Mutual Insurance.All rights reserved Page 1 of 1 Includes copyrighted material of Insurance Services Office. Inc.,with its permission WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We nil not enforce our right against the person or organization named in the Schedule. (This agreement applies oily to the event that you perform work under a wr ten contract that requires you to obtan this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees wMe engaged in the work described in the Schedule. The additional premum for this endorsement shall be 2.0% of the California workers compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Descrption Where required by contract or written agreement prior to loss and allowed by law. Issued M Liberty Mutual Fire Insurance Company For attachment to Policy No.WC2-Z91-454286-035 Effective Date 9/28115 Premium$ Issued to ESS General Engineering.Inc. WC o!0306 Page 1 of 1 ED:04/1984