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Insurance - Sancon Engineering 2016-09-27A.O_ CERTIFICATE OF LIABILITY INSURANCE ­DATF 9/27/20166 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 ocPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, ORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, If SUBROGATION IS WANED, 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 Poms & Associates Insurance Brokers, IIIc.PHONEREar CA License #0814733 5700 Canoga Ave. #400 Woodland Hills CA 91367 _ NAME: Pamela De Guzman (800)578-8802 FAXN ,(818)449-9321 AIC 'MAIL .PDeguzman@pomsassoc.com -INSUREFIR AFFORDING COVERAGE NAICe INSURER A. -Travelers Indemnity Co of Ame 25674 INSURED Sancon Engineering, Inc. 5841 Engineer Drive ,Huntington Beach CA 92649 INSURERB:Homeland Insurance Co. of NY/ 34452 INSURERc:Travelers Indemnit Co. of CT 25682 INSURER D: INSURER E, 1 INSURER F: 0 VCNAGES CEFITIFICATENUMBER:I6-17 ALL 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 10a UBR im POLICY NUMBER POLICY EFF M D,`YYYY1 POLICY EXP MMIDDNYM LIMITS P De Guzman/PDEGUZ GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE Tb R NTED PREMISES Ee arrenca $ 900,000 A CLAIMS -MADE OCCUR X T22-CO-9181R93A-TCT-16 0/1/2016 0/1/2017 MED EXP Any one person $ 5,000 PERSONALS ADV INJURY $ 1,000,000 EDUCTIBLE:$5,000 Per Occ, GENERAL AGGREGATE $ 2,000,000 Prop Drage Liability GENIAGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,000 1-1 POLICY X PRO-TPT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea Me 1,000,000 I L ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS 91BIR93A-16-CNS 0/1/2016 0/1/2017 BODILY INJURY Per accident $ ( ) X NON -OWNED AUTOS HIRED AUTOS Hx PROPERTY DAMAGE Per accident $ X Comp $1000 Coll $1000 $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB CLAIMS -MADE AGGREGATE $ 4,000,000 DED X RETENTION$ 10,00 $ TQ'::-CVP-9181R93A-TIL-16 0/1/2016 0/1/2017 A WORKERS COMPENSATIONX WCSTATI- OTH AND EMPLOYERS' LIABILITY FR E.L EACH ACCIDENT $ 1,000,000 ANY PROPRIETORrPur- 11' -CUi.,� 11c -,EP" 1EM -ER ..., N /A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mniiat-.ry _. .5/ TJ-UB-9181R93A-TIL-16 0/1/2016 0/1/2017 lig, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below B Contractor's Pollution 93-00-26-14-0002 0/1/2016 0/1/2017 EACH CLAIM 2,000,000 LiabilityDEDUCTIBLE: 25,000 EACH AGGREGATE LIMIT 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Re: All Operations It is agreed that the Costa Mesa Sanitary District is named as Additional Insured per the attached endorsement. It is further agreed that said insurance is Primary and that Waiver of Subrogation apply. See attached endorsements. *10 Days Notice of Cancellation Will apply for non-payment of premium. CERTIFICATE HOLDER CANCELLATION Awnu LD (20 i0/0o) IkICr199 nn. , m ©1988-2010 ACORD CORPORATION. All rights reserved. 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 West 19th Street Costa Mesa, CA 92627 �4/v- G AUTHORIZED REPRESENTATIVE 316 P De Guzman/PDEGUZ Awnu LD (20 i0/0o) IkICr199 nn. , m ©1988-2010 ACORD CORPORATION. All rights reserved. Sancon Engineering, Inc. Travelers Property Casualty Company of America COMMERCIAL GENERAL LIABILITY Policy# DT22-CO-9181R93A-TCT-16 EfP: 10-01-2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to Include as an additional insured on this Cover- age 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 quality as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) 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 re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section 111— Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: 1. The preparing approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and II. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily Injury" or "property damage" caused by "your work" and Included in the "products -completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to 'other insurance" available to the additional Insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But the insurance provided to the additional insured by this endorsement still 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 when that person or organization is an additional insured under such 'other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: 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 D2 46 08 05 0 2005 The St. Paul Travelers Companies, Inc Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. How, when and where the 'occurrence" or offense took place; U. The names and addresses of any Injured persons and witnesses; and Ill. 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 connection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and otherwise 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 under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to 'other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the 'bodily injury" and "property damage" oc- curs and the "personal injury" 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 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 COMMERCIAL GENERAL LIABILITY b. "Bodily injury" or "property damage" in- cluded in the "products -completed opera- tions hazard". I. OTHER INSURANCE CONDITION A. COMMERCIAL GENERAL LIABILITY CON- DITIONS (Section IV), paragraph 4. (Other Insurance) is deleted and replaced by the fol- lowing: 4. Other Insurance If valid and collectible "other insurance" is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when b. below applies. If this insur- ance is primary, our obligations are not affected unless any of the "other insurance" is also primary. Then, we will share with all that "other insur- ance" by the method described in c. below. b. Excess Insurance This insurance is excess over any of the "other insurance", whether pri- mary, excess, contingent or on any other basis: (1) That is Fire, Extended Coverage, Builder's Risk, Installation Risk, or similar coverage for "your work"; (2) That is Fire insurance for prem- ises rented to you or temporarily occupied by you with permission of the owner; (3) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or tempo- rarily occupied by you with per- mission of the owner: or (4) If the loss arises out of the main- tenance or use of aircraft, "autos", or watercraft to the ex- tent not subject to Exclusion g. of Section I — Coverage A — Bodily Injury And Property Damage Li- ability; or insured under any other policy, including any umbrella or excess policy. When this insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" if any provider of "other in- surance" has a duty to defend the in- sured against that "suit". if no pro- vider of "other insurance" defends, we will undertake to do so, but we will be entitled to the insured's rights against all those providers of "other insurance". When this insurance is excess over "other insurance", we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such "other insurance" would pay for the loss in the absence of this in- surance; and (2) The total of all deductible and self-insured amounts under that "other insurance". We will share the remaining loss, if any, with any "other insurance" that is not described in this Excess Insur- ance provision. c. Method Of Sharing If all of the "other insurance" permits contribution by equal shares, we will follow this method also. Under this approach each provider of insurance contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, which- ever comes first. If any of the "other insurance" does not permit contribution by equal shares, we will contribute by limits. Under this method, the share of each provider of insurance is based on the ratio of its applicable limit of insur- ance to the total applicable limits of insurance of all providers of insur- ance. B. The following definition is added to DEFINITIONS (Section V): "Other insurance": (5) That is available to the insured a. Means insurance, or the funding of losses, when the insured is an additional that is provided by, through or on behalf of: Page 4 of 6 Copyright, The Travelers Indemnity Company, 2004 CG D316 07 04 COMMERCIAL GENERAL LIABILITY 2. This insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Rupture, bursting, or operation of pres- sure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from wa- ter; c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 3. Paragraph 6. of LIMITS OF INSURANCE (Section 111) is deleted and replaced by the following: Subject to 5. above, the Damage To Prem- ises Rented To You Limit is the most we will pay under COVERAGE A. for the sum of all damages because of 'property damage" to any one premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: fire; explosion; light- ning; smoke resulting from such fire, explo- sion, or lightning; or water. The Damage To Premises Rented To You Limit will apply to all "property damage" proximately caused by the same 'occurrence", whether such damage results from: fire; explosion; lightning; smoke resulting from such fire, explosion, or light- ning; or water; or any combination of any of these causes. The Damage To Premises Rented To You Limit will be the higher of: a. $300,000; or b. The amount shown on the Declarations for Damage To Premises Rented To You Limit. 4. Paragraph a. of the definition of "insured con- tract' (DEFINITIONS — Section V) is deleted and replaced by the following: a. A contract for a lease of premises. How- ever, that portion of the contract for a lease of premises that indemnifies any person or organization for damage to premises while rented to you, or tempo- rarily occupied by you with permission of the owner, caused by: fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water, is not an "insured contract; 5. This Provision B. does not apply if coverage for Damage To Premises Rented To You of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I — Coverages) is excluded by endorsement. C. BLANKET WAIVER OF SUBROGATION We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: premises owned or occupied by or rented or loaned to you; ongoing operations performed by you or on your behalf, done under a contract with that person or organization; "your work"; or "your products". We waive this right where you have agreed to do so as part of a written contract, executed by you before the "bodily injury" or "property damage" occurs or the 'personal injury" or "advertising injury" offense is committed. D. BLANKET ADDITIONAL INSURED — MANAG- ERS OR LESSORS OF PREMISES WHO IS AN INSURED (Section 11) is amended to include as an insured any person or organization (referred to below as "additional insured") with whom you have agreed in a written contract, exe- cuted before the "bodily injury" or "property dam- age" occurs or the "personal injury" or "advertis- ing injury" offense is committed, to name as an additional insured, but only with respect to liability arising out of the ownership, maintenance or use of that part of any premises leased to you, subject to the following provisions: 1. Limits of Insurance. The limits of insurance afforded to the additional insured shall be the limits which you agreed to provide in the writ- ten contract, or the limits shown on the Decla- rations, whichever are less. 2. The insurance afforded to the additional in- sured does not apply to: a. Any "bodily injury" or 'property damage" that occurs, or "personal injury" or "adver- tising injury" caused by an offense which is committed, after you cease to be a ten- ant in that premises; b. Any premises for which coverage is ex- cluded by endorsement; or c. Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. 3. The insurance afforded to the additional in- sured is excess over any valid and collectible Page 2 of 6 Copyright, The Travelers Indemnity Company, 2004 CG D316 07 04