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Insurance - Emergency Power Controls 2016-09-28EMERG-1 OP ID: SN '4� R� CERTIFICATE OF LIABILITY INSURANCE D09/28ATE /2016 Y) 09/28/2016 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 Fullerton Insurance Service CDI #0596796 P.O.Box4054 Fullerton, CA 92834-4054 CONTACT NAME: Commercial Lines Dept. A/c° No Ell, 714-577-5800 1 VC Not: 714-447-0011 AoualE ss:rec fullertoninsurance.com INSURERS AFFORDING COVERAGE NAICR Jimmy Williams INSURER A:San tinellnsurance Co. 11000 BCSF0035658 INSURED Emergency Power Controls, Inc. P.O. Box 545 Yorba Linda, CA 92886 INSURER B: Scottsdale Insurance 1 41297 NsuRERc: National Union Fire Ins. of PA / 19445 INSURER D: California Auto Insurance Co. 38342 INSURER E: INSURER F, COVERAGES CERTIFICATE NUMBER: RFVISInN NDIUlRFR- 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. INSRrypE LTR OF INSURANCE ADDL UB POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X BCSF0035658 10/01/2016 10/01/2017 EACH OCCURRENCE $ 1,000,00 PRREMISES Ea omunence $ 100,00 MED EXP (Any one person) $ Exclude PERSONAL &ADV INJURY It 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY XJE� EILOC GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,00 Emp Ben. $ 1,000,00 OTHER: AUTOMOBILE LIABILITY COMacutleBINED SINGLE LIMIT Ea nl $ 1,000,00 X BODILY INJURY (Per person) $ D ANY AUTO BA040000009528 10/01/2016 10/01/2017 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) X HIRED AUTOS X NON -OWNED pIJTOaII PROPERTY DAMAGE $ Per accident X $500 Comp X $SOOC $ UMBRELLA LMBX OCCUR EACH OCCURRENCE $ 6,000,00 C X EXCESS LUI6 CLAIMS -MADE EBU080744713 10/01/2016 10101/2017 AGGREGATE $ 6,000,00 DED RETENTION$ Prod/Comp $ 6,000,00 A WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? Ffl N/A X 72WECGA8053 10/01/2016 10/0112017 PER TH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E. L. DISEASE -EA EMPLOYEE $ 1,000,00 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS be. E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The District, its directors, officials, officers, employees, agents and volunteers are named as additional insureds as respects to the general liability policy limits per endorsements CG2033 andCG2037 attached to the policy with coverage primary. (continued on page 2) CERTIFICATE HOLDER CANCELLATION COSTAME SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa SanitaryDistrict 628 W 19th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa, CA 92627Ilh 71Y AUTHORIZED REPRESENTATIVE ✓Ili/ j ACORD 25 (2014/01) ©1988.2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: BCS0035658 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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) Or Organization(s) Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION ALL LOCATIONS WHEN YOU AND SUCH PERSON OR ORGANIZATION HAVE AGREED IN WRITING IN A CONTRACT OR AGREEMENT, EXECUTED PRIOR TO THE "OCCURRENCE" TO WHICH THIS INSURANCE APPLIES, THAT SUCH PERSON OR ORGANIZATION BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY 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 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 damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the 'products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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. B. With respect to the insurance afforded to these additional insureds, the following is added to Section 111 — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 NOTEPAD: HOLDER CODE COSTAME EMERG-1 INSURED -S NAME Emergency Power Controls, Inc. OP ID: SN waiver of subrogation also applies as re sppacts to the workers mpensation policy per endorsement WC040306 attached to the policy. PAGE 2 Ddfe 09/28/2016 it THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 72 WEC GA8053 Endorsement Number: Effective Date: 10/01/16 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: EMERGENCY POWER CONTROLS PO BOX 545 YORBA LINDA, CA 92885 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be premium otherwise due on such remuneration. Person or Organization ANY PERSON OR ORGANIZATION WRITTEN CONTRACT OR AGREEMENT RIGHTS FROM US." CITY OF LOS ANGELES, A MUNICIPAL CORPORATION AND CBRE, INC 201 NORTH FIGUEROA STREET STE 1460 LOS ANGELES, CA 90012 SCHEDULE 5 % of the California workers' compensation Job Description FROM WHOM YOU ARE REQUIRED BY TO OBTAIN THIS WAIVER OF ELECTRICAL Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 08/22/16 Policy Expiration Date: 10/01/17 COMMERCIAL 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 include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in acontract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect 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. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations forthat additional insured are completed. CG 20 33 0413 B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. © Insurance Services Office, Inc., 2012 Insured Copy Page 1 of 2