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Insurance - Kinney Construction - 2016-08-17 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 8/17/2016 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 CONTACT Megan Brandt NAME: g Millennium Corporate Solutions LAW).Ext): 818-844-4118 FAX Not:949-679-7240 ADDRESS:License # 0C13480 -MAIL SS:MBrandt@mcsins.com 550 N Brand Blvd #1100 INSURER(S)AFFORDING COVERAGE NAIC# Glendale, CA 91203 INSURER A34t Hawley Insurance Company 37974 INSURED INSURER B West American Insurance Company 44393 James H Kinney Inc INSURERC:Travelers Property Casualty Co 25674 DBA: Kinney Construction INSURER D: 830 W Fletcher Ave INSURER E: Orange, CA 92865 INSURERF: COVERAGES CERTIFICATE NUMBER:16-17 GL AU XS 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR IVSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD(YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR MGL0183512 2/23/2016 2/23/2017 PREMGcTED PREMISEESS((Ea occurrence) $ 50,000 Ea MED EXP(Any one person) _$ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X in 0 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABIUTY CO aBINEDtSINGLE LIMIT $ 1,000,000. (EaX ANY AUTO BAW56377564 2/23/2016 2/23/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS S AUTOS (Per accident) $ C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 9,000,000 EXCESS LIAB CLAIMS-MADE ZUP-61M51919-16-NF 2/23/2016 2/23/2017 AGGREGATE $ 9,000,000 DED X RETENTION$ 0 Excess over GL AL Prod.-Comp/Opd Aggregate $ 9,000,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABIUTY Y 1 N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re: Costa Mesa Sanitary District - Relocation Office Improvements, 290 Paularino Costa Mesa, CA 92626 Costa Mesa Sanitary District and its elected or appointed officers, agents, officials, employees, and volunteers, where required by written contract, are named as additional insured as respects General Liability for ongoing & completed operations with primary wording and waiver of subrogation per forms CG20100413, CG20370413, CG20010413 & CG24040509, auto additional insured with waiver is per form CA88100113 attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 628 W 19th St ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa, CA 92626 AUTHORIZED REPRESENTATIVE William Syrkin/BRANDT ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 rem nm/ ' Policy Number: MGL0183512 Mt. Hawley Insurance Company 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): Location(s) Of Covered Operations: All persons or organizations where required by written contract. 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 in- not be broader than that which you are required dude as an additional insured the person(s)or organi- by the contract or agreement to provide for such zation(s)shown in the Schedule, but only with respect additional insured. to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or B. With respect to the insurance afforded to these in part, by: additional insureds, the following additional exclusions apply: 1. Your acts or omissions; or This insurance does not apply to "bodily injury" or 2. The acts or omissions of those acting on your "property damage" occurring after: behalf; 1. All work, including materials, parts or equipment in the performance of your ongoing operations for the furnished in connection with such work, on the additional insured(s) at the location(s) designated project (other than service, maintenance or re- above. pairs)to be performed by or on behalf of the addi- tional insured(s) at the location of the covered However: operations has been completed; or 1. The insurance afforded to such additional insured 2. That portion of"your work" out of which the injury only applies to the extent permitted by law; and or damage arises has been put to its intended use by any person or organization other than another 2. If coverage provided to the additional insured is contractor or subcontractor engaged in performing required by a contract or agreement, the in- operations for a principal as a part of the same surance afforded to such additional insured will project. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Insured 'Policy Number: MGL0183512 Mt. Hawley Insurance Company 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) Location and Description of or Organization(s) Completed Operations All persons or organizations where required by written contract. 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to Section organization(s) shown in the Schedule, but only with III—Limits Of Insurance: respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the If coverage provided to the additional insured is re- location designated and described in the Schedule of quired by a contract or agreement, the most we will this endorsement performed for that additional insured pay on behalf of the additional insured is the amount and included in the "products-completed operations of insurance: hazard". 1. Required by the contract or agreement; or However: 2. Available under the applicable Limits of Insurance 1. The insurance afforded to such additional insured shown in the Declarations; only applies to the extent permitted by law; and whichever is less. 2. If coverage provided to the additional insured is required by a contract or agreement, the insur- This endorsement shall not increase the applicable ance afforded to such additional insured will not Limits of Insurance shown in the Declarations. not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Insured Policy Number: MGL0183512 Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition (2) You have agreed in writing in a contract or agree- and supersedes any provision to the contrary: ment that this insurance would be primary and would not seek contribution from any other in- Primary And Noncontributory Insurance surance available to the additional insured. This insurance is primary to and will not seek con- ' tribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Insured ' Policy Number: MGL0183512 Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US modifies insurance provided under the following: This endorsement mod es sunce a COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: All persons or organizations where required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or"your work"done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 Insured Policy#BAW56377564 COMMERCIAL AUTO CA 88 10 01 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. COVERAGE INDEX SUBJECT PROVISION NUMBER ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT 3 ACCIDENTAL AIRBAG DEPLOYMENT 12 AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 19 AMENDED FELLOW EMPLOYEE EXCLUSION 5 AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 13 BROAD FORM INSURED 1 BODILY INJURY REDEFINED 22 EMPLOYEES AS INSUREDS (including employee hired auto) 2 EXTENDED CANCELLATION CONDITION 23 EXTRA EXPENSE- BROADENED COVERAGE 10 GLASS REPAIR-WAIVER OF DEDUCTIBLE 15 HIRED AUTO PHYSICAL DAMAGE (including employee hired auto and loss of use) 6 HIRED AUTO COVERAGE TERRITORY 20 LOAN / LEASE GAP 14 PARKED AUTO COLLISION COVERAGE(WAIVER OF DEDUCTIBLE) 16 PERSONAL EFFECTS COVERAGE 11 PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 8 RENTAL REIMBURSEMENT 9 SUPPLEMENTARY PAYMENTS 4 TOWING AND LABOR 7 TWO OR MORE DEDUCTIBLES 17 UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 18 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 20 SECTION II -LIABILITY COVERAGE is amended as follows: 1. BROAD FORM INSURED SECTION II - LIABILITY COVERAGE, paragraph A.1. - WHO IS AN INSURED is amended to include the following as an insured: d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy period. However, "insured" does not include any organization that: (1) Is a partnership or joint venture; or (2) Is an insured under any other automobile policy; or (3) Has exhausted its Limit of Insurance under any other automobile policy. Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of this policy. e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you own more than 50 percent of the voting stock. This automatic coverage is afforded only for 180 days from the date of acquisition or formation. However, coverage under this provision does not apply: (1) If there is similar insurance or a self-insured retention plan available to that organization; @ 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 1 of 7 (2) If the Limits of Insurance of any other insurance policy have been exhausted; or • (3) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, paragraph A.1. - WHO IS AN INSURED is amended to include the following as an insured: f. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow, but only for acts within the scope of their employment by you. Insurance provided by this endorse- ment is excess over any other insurance available to any "employee". g. An "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties re- lated to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II - LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED is amended to include the following as an insured: h. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit 4. SUPPLEMENTARY PAYMENTS SECTION II - LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, para- graphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations ) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the insured at our request, including actual loss of earn- ings up to $500 a day because of time off from work. 5. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provision is added: SECTION II - LIABILITY, exclusion B.5. FELLOW EMPLOYEE does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. SECTION III -PHYSICAL DAMAGE COVERAGE is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION III - PHYSICAL DAMAGE COVERAGE,is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": a. You hire, rent or borrow; or © 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 2 of 7 To the extent possible, notice to us should include: (1) How, when and where the "accident" or "loss" took place; (2) The "insureds" name and address; and (3) The names and addresses of any injured persons and witnesses. 20. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.5., Transfer of Rights of Recovery Against Others to Us, is amended by the addition of the following: If the person or organization has waived those rights before an "accident" or "loss", our rights are waived also. 21. HIRED AUTO COVERAGE TERRITORY SECTION IV - BUSINESS AUTO CONDITIONS, paragraph B.7., Policy Period, Coverage Territory, is amended by the addition of the following: f. For "autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the insured's responsibility to pay for damages is determined in a "suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. SECTION V -DEFINITIONS is amended as follows: 22. BODILY INJURY REDEFINED Under SECTION V-DEFINTIONS, definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. COMMMON POLICY CONDITIONS 23. EXTENDED CANCELLATION CONDITION COMMON POLICY CONDITIONS, paragraph A. - CANCELLATION condition applies except as fol- lows: If we cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply in those states which require more than 60 days prior notice of cancella- tion. @ 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 7 of 7 f 8/19/2016 Mt.Hawley Insurance Company-Company Profile-Best's Credit Rating Center �� . M . st ::�.is!E�! t' " 4°ic A.M.Best I A.M.Best Rating Services I A.M.Best Information Services About I Careers I Events I Support I Contact Rating Search: Search »Advanced Search A Print this Daae Rating Services Home Ratings . Mt. HawleyInsurance Company u >.Recent Rating Activity P Y s Search for a Rating A.M.Best#:002591 NAIC#:37974 FEIN#:371072999 Regional Centers . Domiciliary Address 9025 North Lindbergh Drive Assigned AmniaNNO*Rating Process&Definitions ,, to a Understanding Best's Ratings Peoria,IL fes616insuranceA. .Guide to Bests United States Ratings companies s Financial Strength Rating Guide that have,in our opinion,a »Issuer Cred'R Ratig Guide Web: superior to meet their Phone:309-692-1000 x Issue Rating Guide Fax:309-689-8676 ongoing insurance obligations. a National Scale Rating Guide *Country Risk Information a Market Segment Outlook Based on A.M.Best's analysis,058460-RLI Coro.is the AMB Ultimate Parent and identifies the topmost entity of the corporate Rating Methodology . structure.View a list ofgoeratina insurance entities in this structure. Industry Research c ,i s.Cre,II tea.}this,'. . Industry&Market Centers . Financial Strength Rating View Definition Best's Credit Rating Analyst Contact an Analyst Rating: A+(Superior) Rating Issued by:A.M.Best Rating Services,Inc. Conferences&Events . Affiliation Code: g(Group) Senior Financial Analyst:Edin Imsirovic Awards 8 Recognitions Financial Size Category: XI($750 Million to$1 Billion) Managing Senior Financial Analyst:Jacqalene Lentz,CPA ' Data Submission Center . Outlook: Stable Regulatory Information ,, Action: Affirmed i ss+r „ar,,,,,a@Ynr e: June 04,2015 Effective tDate: June 30,1980 WI Initial Rating View A.M.Bests Rating Disclosure Statement Find a Best's Credit Rating Long-Term Issuer Credit Rating View Definition _ A.M.Best Affirms Ratinas of RLI Corp.,RLI Insurance Enter a Company Name MI Long-Term: aa 'r Co..Mt Hawley Insurance Co.and Contractors Bonding Outlook: Stable ' and Insurance Co, »Advanced Search June 04,2015 Action: Affirmed Effective Date: June 04,2015 0 A.M.Best Rating Services Initial Rating Date: June 27,2005 Contact Information x u Denotes tinder Review Best's Rating fi+trttr.;Ht-,Itpy A.M.Best has provided ratings&analysis on this company since 1980. Financial Strength_ , Long-Tenn Issuer Credit Effective Date Rating Effective Date Rating 6/4/2015 A+ 6/4/2015 aa 6/3/2014 A+ 6/3/2014 aa 6/17/2013 A+ 6/17/2013 aa 6/12/2012 A+ 6/12/2012 aa 6/20/2011 A+ 6/20/2011 aa- AMB Crest Retort -includes Bests Financial Strength Rating and rationale along with comprehensive analytical commentary,detailed business overview and key financial data. Report Revision Date:3/28/2016(represents the latest significant change). =�- Historical Reports are available in AMB Credit Reoort Archive. t Y View additional news.reports and products for this company. 1 Date Title • • http://www3.ambest.com/ratings/entities/SearchResults.aspx?AltSrc=9 1/2 8/19/2016 41.111.0/0011.1070/011.41 Ironshore Insurance Ltd. (Bermuda) 07/20/2011 Ironshore Specialty Insurance Company(Arizona) 10/02/2008 James River Insurance Company (Ohio) 08/04/1995 (Name changed from Fidelity Excess and Surplus Insurance Company effective 07/07/03) Lancashire Insurance Company (UK) Limited (U.K.) 11/17/2010 Lancashire Insurance Company Limited (Bermuda) 11/19/2009 Landmark American Insurance Company (Oklahoma) 09/30/2003 Lexington Insurance Company (Delaware) 07/28/1995 Liberty Mutual Insurance Europe Limited (U.K.) 10/27/1995 (Name changed from Liberty Mutual Insurance Company (U.K.) Limited effective 10/21/03) Liberty Surplus Insurance Corporation (New Hampshire) 12/18/1997 Back to Top M - P Insurer Date Approved The Marine Insurance Company Limited (UK) ! 11/03/1995 Markel International Insurance Company Limited (U.K.) 10/27/1995 (Name changed from Terra Nova Insurance Company Limited, effective 11/04/2002) Maxum Indemnity Company (Delaware) 09/29/1998 (Name changed from Caliber One Indemnity Company, effective 01/02/2003) Mercer Insurance Company (Pennsylvania) 06/10/2016 Mesa Underwriters Specialty Insurance Company (New Jersey) 02/05/2012 (Name changed from Montpelier U.S. Insurance Company, effective 01/01/2012.) (Domicile changed from Oklahoma to New Jersey, effective 01/01/2012) Mitsui Sumitomo Insurance Company (Europe) Limited (U.K.) 06/10/2011 Mount Vernon Fire Insurance Company(Pennsylvania) 04/02/1997 * 10/27/1995 (Domicile changed from Delaware to Kansas, effective 12/20/95. Domicile changed from Kansas to Illinois effective 4/21/1999) NORCAL Specialty Insurance Company (Pennsylvania) 12/23/2013 (Name changed from PMSLIC Insurance Company, effective 12/01/2015) National Fire & Marine Insurance Company(Nebraska) 06/30/1995 Nautilus Insurance Company(Arizona) 08/04/1995 Navigators Specialty Insurance Company(New York) 12/08/1995 (Name changed from NIC Insurance Company effective 01/04/2007) — Noetic Specialty Insurance Company (Vermont) 09/01/1995 (Domicile changed from Illinois to Vermont effective 01/18/2011) (Name changed from Coregis Indemnity Company effective 11/07/2001) I North American Capacity Insurance Company (New Hampshire) 08/11/1995 Northfield Insurance Company(Iowa) 06/30/1995 (Domicile changed from Missouri to Iowa, effective 1/01/2002) North Light Specialty Insurance Company(Illinois) 110/10/2014 Nutmeg Insurance Company (Connecticut) 06/30/1995 Pacific Insurance Company, Ltd. (Connecticut) 09/01/1995 https://www.i nsurance.ca.gov/01-consumers/120-company/07-lasli/lasli.cfm#M P 4/6 8/19/2016 West American Insurance Company-Company Profile-Bests Credit Rating Center A \ 1 . /3 R, tatilL Sr c A.M.Best 1A.M.Best Rating Services A.M.Best Information Services About Careers Events Support Contact Rating Search: Search s Advanced Search 61 Print this Daae Rating Services Home Ratings *Recent Rating Activity West American Insurance Company a Search for a Rating A.M.Best 5:011354 NAIC 5:44393 FEIN 5:310624491 Regional Centers Mailing Address View Additional Address Information Assigned Fineneiet Rows Rating Process&Definitions 175 Berkeley St. to 43:11) Boston,MA 02116 a Understanding Best's Ratings insurance A United States a Guide to Best's Ratings companies a Financial Strength Rating Guide that have,in our opinion,an Web:www.libertvmutualarouo.com a issuer Credit Rating Guide Phone:617-357-9500 excellent ability to meet their *Issue Rating Guide Fax:513-603-3179 ongoing insurance obligations. a National Scale Rating Guide a Country Risk Information a Market Segment Outlook Based on A.M.Best's analysis,051114-Liberty Mutual Holding Company Inc.is the AMB Ultimate Parent and identifies the Rating Methodology ,, topmost entity of the corporate structure.View a list of operating insurance entities in this structure. Industry Research Crrrtht Industry&Market Centers ,, Financial Strength Rating View Definition Best's Credit Rating Analyst Contact an Analyst Rating: A(Excellent) Rating Issued by:A.M.Best Rating Services,Inc. Conferences&Events Affiliation Code: r(Reinsured) Senior Financial Analyst:Michael W.Russo Awards&Recognitions Financial Size Category: XV($2 Billion or greater) Vice President:Michael J.Lagomarsino,CFA,FRM Data Submission Center Outlook: Stable Action: Affirmed Regulatory Information Effective Date: October 08,2015 Initial Rating Date: October 02,1995 View A.M.Best's Rating Disclosure Form Find a Best's Credit Rating Long-Terrn Issuer Credit Rating View Definitionz... A.M.Best Affirms Ratings of Liberty Mutual Holding Enter a Company Name '1 Long-Term: a ; Company Inc.and Its Subsidiaries October 08,2015 Outlook: Stable D Advanced Search Action: Affirmed Effective Date: October 08,2015 ekM.Best Rating Services Initial Rating Date: July 21,2005 Contact Information) u Denotes Vocier Review Best's Rating II A.M.Best has provided ratings&analysis on this company since 1995. Financial Strength Long-Term Issuer Credit Effective Date Rating Effective Date Rating 10/8/2015 A 10/8/2015 a 9/24/2014 A 9/24/2014 a 8/14/2013 A 8/14/2013 a 7/26/2012 A 7/26/2012 a 6/16/2011 A 6/16/2011 a pc,qt AMB redit Reoort -includes Best's Financial Strength Rating and rationale along with comprehensive analytical commentary,detailed business overview and key financial data. Report Revision Date:8/10/2016(represents the latest significant change). Historical Reports are available in AMB Credit Report Archive. View additional news,reports and products for this company. Date Title http://www3.ambest.com/ratings/entities/SearchResults.aspx?AltSrc=9 1/2 I 8/19/2016 Company Profile C.hLFr ORN A DEPARTMENT OF INSURANCE COMPANY PROFILE Company Profile Company Search Company Information Company Search Results WEST AMERICAN INSURANCE COMPANY Company 175 BERKELEY STREET Information BOSTON, MA 02116 Old Company 800-344-0197 Names Agent for Service Old Company Names Effective Date Reference Information NAIC Group List Agent For Service Lines of Business KARISSA LOWRY Workers' 2710 GATEWAY OAKS DRIVE Compensation SUITE 150N Complaint and SACRAMENTO CA 95833 Request for Action/Appeals Reference Information Contact Information Financial Statements PDF's I NAIC #: [4_4393 Annual Statements California Company ID #: 5743-0 Quarterly —_- Statements Date Authorized in California: 04/12/2012 Company Complaint License Status: UNLIMITED-NORMAL Company - -J Performance & Company Type: Property &Casualty Comparison Data _____________ Company State of Domicile: [ JDIANA Enforcement Action — Composite back to top Complaints Studies Additional Info Find A Company NAIC Group List Representative In Your Area View Financial NAIC Group #: 0111 LIBERTY MUT GRP Disclaimer Lines Of Business The company is authorized to transact business within these lines of insurance. For an explanation of any of these terms, please refer to the glossary. AUTOMOBILE BOILER AND MACHINERY BURGLARY COMMON CARRIER LIABILITY CREDIT FIRE LIABILITY MARINE MISCELLANEOUS PLATE GLASS SPRINKLER SURETY https://interactive.web.i nsurance.ca.gov/com panyprofi le/com panyprofi l e?event=com panyProfi le&doF uncti on=getCom panyProfi le&eid=63091 1/2 8/19/2016 Travelers Property Casualty Company of America-Company Profile-Best's Credit Rating Center A . t` . Ik i t A.M.Best I A.M.Best Rating Services I A.M.Best Information Services About I Careers I Events I Support i Contact Rating Search: Search a Advanced Search Print this oaoe Rating Services Home Ratings Recent Rating Activity Travelers Property Casualty Company of America u a Search for a Rating A.M.Best#:004461 NAIC#:25674 FEIN#:362719165 Regional Centers „ Domiciliary Address Rating Process&Definitions „ One Tower Square Hartford,CT 06183 Aossigned itnenail `� 'bunks Understanding Best's Ratings insurance Ari_ - United States s Guide to Best's Ratings companies w Financial Strength Rating Guide Web:www.traveiers.Com that have,in our opinion,a s Issuer Credk Rating Guide Phone:860-277-0111 superior ability to meet their *Issue Rating Guide Fax:860-277-7002 ongoing insurance obligations. e National Scale Rating Guide *Country Risk Information *Market Segment Outlook Based on A.M.Best's analysis,058470-Travelers Comoanies.Inc.is the AMB Ultimate Parent and identifies the topmost entity of Rating Methodology „ the corporate structure.View a list of operating insurance entities in this structure. Industry Research is f+ Industry&Market Centers „ Financial Strength Rating View Definition Best's Credit Rating Analyst Contact an Analyst Rating: A++(Superior) Rating Issued by:A.M.Best Rating Services,Inc. Conferences&Events „ Affiliation Code: g(Group) Senior Financial Analyst:Michael W.Russo Awards&Recognitions Financial Size Category: XV($2 Billion or greater) Assistant Vice President:Jennifer Marshall,CPCU,ARM Data Submission Center „ Outlook: Stable Regulatory Information „ Action: Affirmed Effective Date: July 22,2016 Initial Rating Date: June 30,1972 itti. View A.M.Best's Rating Disclosure Form Find a Best's Credit Rating Long-Term Issuer Credit Rating View Definition AM,Best Affirms Ratings of The Travelers Companies, Enter a Company Name Long-Term: aa+ t inc.and Its Subsidiaries Outlook: Stable July 22,2016 Advanced Search Action: Affirmed Effective Date: July 22,2016 OAM.Best Rating Services Initial Rating Date: April 18,2005 Contact Information m u Denotes Under Review Best's Rating ic.ttr*zey His tct.y A.M.Best has provided ratings&analysis on this company since 1972. Financial Strewth Long-Term Issuer Credit Effective Date Rating Effective Date Rating 7/22/2016 A++ 7/22/2016 aa+ 5/28/2015 A++ 5/28/2015 aa+ 5/23/2014 A++ 5/23/2014 aa+ 5/30/2013 A+ 5/30/2013 as 5/10/2012 A+ 5/10/2012 aa AMB Credit Report -includes Best's Financial Strength Rating and rationale along with comprehensive analytical r commentary,detailed business overview and key financial data. Report Revision Date:7/22/2016(represents the latest significant change). Historical Reports are available in AMB Credit Report Archive. View additional news,reports and products for this company. Date Title http://www3.ambest.com/ratings/entities/CompanyProfile.aspx?ambnum=4461&URatingld=2128297&b1=0&AltSrc=9&PPP=&AltNum=O&Ext User=&Ext_Mis... 1/2 8/19/2016 Company Profile C/, IrO N A DEPARTMENT OF INSURANCE COMPANY PROFILE Company Profile Company Search Company Information Company Search Results TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Company ONE TOWER SQUARE Information HARTFORD, CT 06183 Old Company 866-336-2077 Names Agent for Service Old Company Names Effective Date Reference Information TRAVELERS INDEMNITY COMPANY OF ILLINOIS (THE) 01/12/2005 NAIC Group List Lines of Business Agent For Service Workers' KARISSA LOWRY Compensation 2710 GATEWAY OAKS DRIVE Complaint and SUITE 150N Request for SACRAMENTO CA 95833 Action/Appeals Contact Information Reference Information Financial Statements PDF's Annual Statements NAIC #: [25674 — `u Quarterly !California Company ID #: 2495-0 Statements Company Complaint Date Authorized in California: 04/16/1982 Company Performance & License Status: UNLIMITED-NORMAL Comparison Data Company Type: Property &Casualty Company [CONNECTICUT Enforcement Action State of Domicile: Composite — —� Complaints Studies Additional Info back to top Find A Company Representative In NAIC Group List Your Area View Financial Disclaimer NAIC Group #: 3548 Travelers Grp Lines Of Business The company is authorized to transact business within these lines of insurance. For an explanation of any of these terms, please refer to the glossary. AIRCRAFT AUTOMOBILE BOILER AND MACHINERY BURGLARY • COMMON CARRIER LIABILITY FIRE LIABILITY MARINE MISCELLANEOUS PLATE GLASS SPRINKLER haps://interactive.web.insurance.ca.gov/companyprofile/companyprofile?event=companyProfile&doFunction=getCompanyProfile&eid=6233 1/2 • CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) KORO 8/18/2016 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 SUBROGRATION 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 OnPoint Underwriting Inc. CONTACT NAME:Steven McComb 8390 E Crescent Pkwy, Suite 200 PHONE(NC,No Ext):(360)828-0644 FAX(A/C,NO):(360)828-0699 Greenwood Village, CO 80111 — — EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: ACE American Insurance Company 22667 INSURED INSURER B: M._ Barrett Business Services, Inc.UC/F INSURER C: JAMES H.KINNEY,INC.DBA KINNEY INSURER D: CONSTRUCTION INSURER E: 830 W FLETCHER AVE INSURER F: ORANGE,CA 92865 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 ISSUES OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS T A TH C O LL E TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABIUTY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurence) CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ POLICY ECT ri LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) • ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY(Per person) $ HIRED AUTOS NON-OWNED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB OCCUR AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' RWC 10/01/15 10/01/2016 / WC STATU- OTH- LIABILITY Y/NC48557831 TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE y E.L.EACH ACCIDENT $2,000,000 OFFICER/MEMBER EXCLUDED? ( N/A Covered states: E.L.DISEASE-EA EMPLOYEE $2,000,000 (Mandatory In NH)If yes,describe under CA DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATA THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE Costa Mesa Sanitary District POLICY PROVISIONS. 290 Paularino AUTHORIZED REPRESENTATIVE Costa Mesa CA 92626 Richard Poling c)1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD. AGENCY CUSTOMER ID: LOC:#: ACORN® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Barrett Business Services, Inc. OnPoint Underwriting Inc. 8100 NE Parkway, Suite 200 POLICY NUMBER Vancouver WA 98662 RWC C48557831 CARRIER NAIC CODE ACE American Insurance Company 22667 EFFECTIVE DATE: 10/01/15 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:25 FORM TITLE:Certificate of Liability(01/14) CERTIFICATE HOLDER: Costa Mesa Sanitary District ADDRESS: 290 Paularino Costa Mesa CA 92626 RE: Tenant improvement. ACORD 101 (2008/01) c)1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD. 8/19/2016 Company Profile F RN A DEPARTMENT OF INSURANCE COMPANY PROFILE Company Profile Company Search Company Information Company Search Results ACE AMERICAN INSURANCE COMPANY Company 436 WALNUT STREET Information PHILADELPHIA, PA 19106 Old Company 800-352-4462 Names Agent for Service Old Company Names Effective Date Reference Information ALLIED COMPENSATION INSURANCE COMPANY 04/03/1961 NAIC Group List ALLIED INSURANCE COMPANY 12/14/1977 Lines of Business CIGNA INSURANCE COMPANY 11/01/1999 Workers' INA UNDERWRITERS INSURANCE COMPANY 12/31/1983 Compensation Complaint and Agent For Service Request for Action/Appeals Vivian Imperial Contact Information 818 WEST SEVENTH STREET SUITE 930 Financial Statements LOS ANGELES CA 90017 PDF's Annual Statements Quarterly Reference Information Statements Company Complaint NAIC #: — — 122667 Company California Company ID #: 1325-0 Performance & — ---- Comparison Data (Date Authorized in California: L112/20/1945 Company — Enforcement Action 1License Status: I UNLIMITED-NORMAL Composite L_ Complaints Studies Company Type: Property &Casualty Additional Info (State of Domicile: PENNSYLVANIA Find A Company L Representative In Your Area back to top View Financial Disclaimer NAIC Group List NAIC Group #: 0626 Chubb Ltd Grp Lines Of Business The company is authorized to transact business within these lines of insurance. For an explanation of any of these terms, please refer to the glossary. AIRCRAFT AUTOMOBILE BOILER AND MACHINERY BURGLARY COMMON CARRIER LIABILITY CREDIT DISABILITY FIRE haps://interactive.web.insurance.ca.gov/companyprofile/companyprofile?event=companyProfile&doFunction=getCompanyProfile&eid=3270 1/2 8/19/2016 ACE American Insurance Company-Company Profile-Bests Credit Rating Center I.) lieSt RiiC AM.Best Best I A.M.Best Rating Services I A.M.Best Information Services About I Careers I Events Support I Contact Rating Search: Search »Advanced Search Print this page Rating Services Home Ratings v aRecentRatingActivky ACE American Insurance Company ri) a Search for a Rating A.M.Best 5:002257 NAIC 5:22667 FEIN 5:952371728 Regional Centers v Mailing Address View Additional Address Information Assigned FInsssid Rating Process&Definitions v P.O.Box 1000 . Reale Philadelphia,PA 19106 to *Understanding Best's Ratings insurance United States a Guide to Bests Ratings companies a Financial Strength Rating Guide Web:www.aceusa.com that have,in our opinion,a a Issuer Credit Rating Guide Phone:215-640-1000 superior ability to meet their *Issue Rating Guide ongoing insurance obligations. a National Scale Rating Guide *Country Risk Information Market Segment Outlook Based on A.M.Best's analysis,058303-Chubb Limited is the AMB Ultimate Parent and identifies the topmost entity of the Rating Methodology v corporate structure.View a list of operating insurance entities in this structure. Industry Research <= , 44'4H R44t14'4,, Industry&Market Centers v Financial Strailgth Rating View Definition Best's Credit Rating Analyst Contact an Analyst Rating: A++(Superior) Rating Issued by:AM.Best Rating Services,Inc. Conferences&Events v Affiliation Code: g(Group) Senior Financial Analyst:Darian Ryan Awards&Recognitions Financial Size Category: XV($2 Billion or greater) Assistant Vice President:Jennifer Marshall,CPCU,ARM Data Submission Center v Outlook: Stable Action: Affirmed Regulatory Information Effective Date: June 22,2016 g.Initial Rating Date: June 30,1951 View A.M.Best's Rating Disclosure Form Find a Best's Credit Rating Long-Terri Issuer Credit Rating View Definition AM.Best Removes From Under Review and Affirms Enter a Company Name Long-Term: aa+ Ratings of Chubb Limited and Most of Its Subsidiaries June 22,2016 Outlook: Stable »Advanced Search Action: Affirmed Effective Date: June 22,2016 0A.M.Best Rating Services Initial Rating Date: August 16,2005 Contact Information)1 u Denotes Under Review Best's Rating A.M.Best has provided ratings&analysis on this company since 1951. Financial Strength Long-Term Issuer Credit Effective Date Rating Effective Date Rating 6/22/2016 A++ 6/22/2016 aa+ 7/2/2015 A++u 7/2/2015 aa+u 4/30/2015 A++ 4/30/2015 aa+ 4/11/2014 A++ 4/11/2014 aa+ 6/14/2013 A+ 6/14/2013 aa 6/12/2012 A+ 6/12/2012 aa , , , • The following links provide access to related data records that A.M.Best utilizes to provide financial and analytical data on a consolidated or branch basis. AMB# Company Name Company Description 991291 ACE American Insurance Company(BHB) Represents the Properly/Casualty financials for the Bahrain Branch of this legal entity. 093314 ACE American Insurance Company(KRB) Represents the Property/Casualty financials for the South Korea Branch of this legal entity. AMB Credit Report -includes Best's Financial Strength Rating and rationale along with comprehensive analytical ;. commentary,detailed business overview and key financial data. Report Revision Date:7/14/2016(represents the latest significant change). Historical Reports are available in AMB Credit Report Archive. View additional news.reports and products for this company. f4.4,--------------------------------------------- Date Title http://www3.ambest.com/ratings/entities/CompanyProfi le.aspx?ambnum=2257&U Rati ngld=2128297&131=0&AltSrc=9&PPP=&AltN um=O&Ext_User=&Ext M is... 1/2