Loading...
Insurance - RBH 2016-10-05ACOR& CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/DDNYYY) LTR 1 10/5/2016 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(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 CONT Elizabeth Lee $elect$olutions Insurance Services 925) 1350 Carlback Avenue eli(z866)500-6359 abethl@ppibselect.cm MED EXP (Any one person) $ 5,000 oN Suite 100 INSURERS AFFORDING COVERAGE NAIC9 INSURERA: Travelers Property Casualty Compani 025674 Walnut Creek CA 94596 INSURED INSURER B: The Hanover American Insurance i 36064 Robin B. Banners S Associates, Inc. INSURER C:Atlantic Specialty Insurance/' 27154 234 E. 17th Street INSURERD: Suite 205 NSURERE: Costa Mesa CA 92627 Isu F: COVERAGES CERTIFICATE NUMBER'16/17EO,GL,BA,WC 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. LTR TYPE OF INSURANCE ADD SUB POLICY NUMBER (MMIOD/YYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS-MAD1XIE EACHOCCURRENCE $ 1,000,000 PREMISES Ea occunne $ 300,000A MAGETORENTED MED EXP (Any one person) $ 5,000 X 680 -829111502 -TIL -16 6/1/2016 6/1/2017 PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JET [:] LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGO $ 2,000,000 Hired Nan Owned Auto $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Me accident) $ INCL IN GL BODILY INJURY (Per person) $ AANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS 680-8291NS02-TIL-16 6/1/2016 6/1/2017 BODILY INJURY Per accident $ ( ) X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE $ Peraccident $ UMBRELLA LIA9 OCCUR N/A RRENCE $ $ EXCESS LIAR CLAIMS -MAGE DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y/N PROPRIETORIPARTNEWEXECUTIVE OFFICERMEMBER EXCLUDED?B (Mandatory in NH) IF yes, describe under N/ACIDENT WZF-9012529-05 3/23/2016 3/23/2017E FAGGREGA� OTH- E ERANY $ 1 000 000 -EA EMPLOYE $ 1 000 000 -POLICY LIMIT $ 1-000,000 DESCRIPTION OF OPERATIONS below C PROFESSIONAL LIABILITY DPL5705-16 7/27/2016 7/27/2017 PERCLAIM $1,000,000 AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K more space Is required) Re: As Per Contract or Agreement on File with Insured. Costa Mesa Sanitary District is named as additional insured on the General Liability policy, if required by written contract per the attached endorsement. Costa Mesa Sanitary District 626 W. 19th Street Costa Mesa, CA 92627 ltd (J I� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRESENTATIVE Trevino/CHADIl ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 mmAm I I. All dahts reserved_ POLICY NUMBER 6808291N502TIL16 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to WHO IS AN INSURED (Section II): Any person or organization that you agree in a `contract or agreement requiring insurance" to include as an additional insured on this Coverage Part, but only with respect to liability for "bodily injury", "property damage" or "personal injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing operations; b. In connection with premises owned by or rented to you; or C. In connection with "your work" and included within the "products -completed operations hazard". Such person or organization does not qualify as an additional insured for "bodily injury', "property damage" or "personal injury" for which that person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: B. The following is added to Paragraph a. of 4. Other Insurance. in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): d. This Insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another C. endorsement to this Coverage Part. e.. This insurance does not apply to the rendering of or failure to render any "professional services". The limits of insurance afforded to the additional insured shall be the limits which you agreed in that "contract or agreement requiring insurance' to provide for that additional insured, or the limits shown in the Declarations for this Coverage Part, whichever are less. This endorsement does... not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) for this Coverage Part. However, if you specifically agree in a "contract or agreement requiring insurance" that the insurance provided to an additional insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury' for which coverage is sought arises out of an offense committed; after you have entered into that "contract or agreement requiring insurance". But this insurance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when the insured is an additional insured under any other insurance. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury, "property damage" or "personal Injury' arising out of "your work" performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that person or organization. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insurance" with such person or organization entered into by you before,: and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury' offense is committed. CG D3 81 09 07 © 2007 The Travelers Companies, Inc. Page i of 2 Includes copyrighted material of Insurance Services Office; Inc., with its permission. D. The following definition is added to DEFINITIONS (Section V): 'Contract or agreement requiring insurance" means that part of any contract or agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal injury' is caused by an offense committed: COMMERCIAL GENERAL LIABILITY a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. CG D3 81 09 07 ® 2007 The Travelers Companies, Inc. Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission.