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Insurance - Municipal Maintenance Equipment - 2017-01-17A� " DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 01/17/2017 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUYE A CONTRACT BETWEEN THE SSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(iss) 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 conYer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Sentry Customer Service Sentry Insurance Company 1800 North Point Drive PHONE FAX o Est), 80OA78-6879 C No), 888-533-7827 EMAIL ADDRESS: business roducts esdo sent .cem Stevens Point, WI 54481 INSURER(S) AFFORDING COVERAGE NAIC M X INSURER A: SENTRY SELECT INSURANCE COMPANY 21180 49-67776-12 INSURED INSURER B : MUNICIPAL MAINTENANCE EQUIPMENT INC INSURER C; INSURER 0: 2360 HARVARD ST SACRAMENTO, CA 95815 INSURER E : INSURERF: PRODUCTS-COMP/OP AGG $ 1,500,000 COVERAGES CERTIFICATE NUMBER: 0116 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 AODL INSR SUBR WVD POLICYNUMBER POLICY EFF MM DOIMMIDDNYYYI POLICY EXP LIMITS A X COMMERCIALGENERAL LIABILITY CLAIMS -MADE OCCUR X 49-67776-12 12/15/2016 12/15/201] EACH OCCURRENCE $500.000 DAMAGE TO RENTED PREMISES Ea occurrenceS 100,000 MED EXP (Any one person) $ 5,000 PERSONAL B ADV INJURY $500,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PRO LOC OTHER: GENERAL AGGREGATE $1,500,000 PRODUCTS-COMP/OP AGG $ 1,500,000 $ A AUTOMOBILE LIABILITY X ANY AUTO SCHEDULED AUTO HIRED AUTOS NON -OWNED AUTOS 49-67776-12 17J15/2016 12/15/2017 E eBcNl En'tSINGLE LIMIT $ 500,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Peracaldent A X UMBRELLA LIAB X EXCESS UAB X OCCUR CLAIMS -MADE 49-67776-12 IV15/2016 12/15/2017 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 9,000,000 DED I I RETENTION$ PRODUCTS - COMP/OP $9,000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) I(yes, describe under DESCRIPTION OF OPERATIONS below NIA OAGG STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Refer to attached CERTIFICATE HOLDER CANCELLATION COSTA MESA SANITARY DISTRICT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 290 PAULARINO AVENUE���/� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COSTA MESA, CA 92626 (J, \ ,V�:j/ ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) 4967776 0116 Page 1 of 2 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 01/17/2017 1 00001 0000000000 17017 0 N 7447DO7G73CB4ABS A717-BO6AOCCFEBCF ACOR" kk.� AGENCY CUSTOMER ID: LOC #: — ADDITIONAL REMARKS SCHEDULE Page P of 2 AGENCY NAMED INSURED Sentry Insurance Company MUNICIPAL MAINTENANCE EQUIPMENT INC POLICY NUMBER 49-67776-12 CARRIER NAIC CODE EFFECTIVE DATE: 12/15/2016 ADDITIONAL REMARKS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, COSTA MESA SANITARY DISTRICT, THEIR ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS, AND EMPLOYEES AS ADDITIONAL INSURED- PERSUANT TO ATTACHED ENDORSEMENT.ANY OTHER INSURANCE MAINTAINED BY THE COSTA MESA SANITARY DISTRICT SHALL BE EXCESS & NON-CONTRIBUTORING WITH "CONTINUED ON CERT #188 "1 OF 2 ACORD 101 (2008101) 4967776 © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 01/17/2017 COMMERCIAL GENERAL LIABILI ., 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) I LOCATION(S) OF COVERED OPERATIONS +----------------------------------+--------------- + 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", "property damage" or personal and advertising injury" caused, in whole or in part, y: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance ofyyour ongoing operations for the additional insured(s) at the locations) designated above. 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 additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CG 20 10 04 13 Copyright, Insurance Services Office, Inc. 2012 MUN 49-67776-12 40 161 11-02-16 PAGE 001 OF 002 irieaac 02190 o COMMERCIAL GENERAL LIABILITY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - CONTINUED 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged inperforming operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III - 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 10 04 13 Copyright, Insurance Services Office, Inc., 2012 MUN 49-67776-12 40 161 11-02-16 PAGE 002 OF 002 02191 O1TI& G CNS0116 SENTRY SELECT INSURANCE COMPANY THE SENTRY PLAN STEVENS POINT WISCONSIN POLICY (A PARTICIPATING STOCK COMPANY) A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES GENERAL LIABILITY DECLARATIONS NAME INSURED: MUNICIPAL MAINTENANCE EQUIPMENT INC ADDITIONAL INSURED SCHEDULE POLICY NUMBER 49-67776-12 The following information is required to complete the accompanying additional insured endorsement which forms a part of the Named Insured's COMMERCIAL GENERAL LIABILITY COVERAGE PART. ADDITIONAL INSURED ENDORSEMENT COSTA MESA SANITARY DISTRICT CG 20 10 04 13 290 PAULARINO AVENUE COSTA MESA, CA 92626 (CERTIFICATE NUMBER 0116) LOCATIONS) OF COVERED OPERATIONS ALL LOCATIONS CG 89 01 11 85 (MECH) MUN 49-67776-12 40 161 01-17-2017 (000 0116) FOR ENDORSEMENT TEXT EFFECTIVE FROM DECEMBER 15, 2016 TO DECEMBER 15, 2017 IL 02 70 09 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/ COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Paragraphs 2. and 3. of the CANCELLATION Common Policy Condition are replaced by the following: 2. ALL POLICIES IN EFFECT FOR 60 DAYS OR LESS If this policy has been in effect for 60 days or less, and is not a renewal of a policy we have previously issued, we may cancel this policy by mailing or delivering to the first Named Insured, at the mailing address shown in the policy and to the producer of record, advance written notice of cancellation, stating the reason for cancellation, at least: a. 10 days before the effective date of cancellation if we cancel for: (1) Nonpayment of premium; or (2) Discovery of fraud by: (a) Any insured or his or her representative in obtaining this insurance; or (b) You or your representative in pursuing a claim under this policy. b. 30 days before the effective date of cancellation if we cancel for any other reason. 3. ALL POLICIES IN EFFECT FOR MORE THAN 60 DAYS a. If this policy has been in effect for more than 60 days, or is a renewal of a policy we issued, we may cancel this policy only upon the occurrence, after the effective date of the policy, of one or more of the following: (1) Nonpayment of premium, including payment due on a prior policy we issued and due during the current policy term covering the same risks. IL 02 70 09 12 Copyright, Insurance Services Office, Inc., 2012 MUN 49-67776-12 40 161 01-11-17 PAGE 001 of 005 oirieaac 04758 CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL - CONTINUED (2) Discovery of fraud or material misrepresentation by: (a) Any insured or his or her representative in obtaining this insurance; or (b) You or your representative in pursuing a claim under this policy. (3) A judgment by a court or an administrative tribunal that you have violated a California or Federal law, having as one of its necessary elements an act which materially increases any of the risks insured against. (4) Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards, by you or your representative, which materially increase any of the risks insured against. (5) Failure by you or your representative to implement reasonable loss control requirements, agreed to by you as a condition of policy issuance, or which were conditions precedent to our use of a particular rate or rating plan, if that failure materially increases any of the risks insured against. (6) A determination by the Commissioner of Insurance that the: (a) Loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial integrity or solvency; or (b) Continuation of the policy coverage would: (i) Place us in violation of California law or the laws of the state where we are domiciled; or (ii) Threaten our solvency. (7) A change by you or your representative in the activities or property of the commercial or industrial enterprise, which results in a materially added, increased or changed risk, unless the added, increased or changed risk is included in the policy. b. We will mail or deliver advance written notice of cancella- tion, stating the reason for cancellation, to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, at least: (1) 10 days before the effective date of cancellation if we cancel for nonpayment of premium or discovery of fraud; or IL 02 70 09 12 Copyright, Insurance Services Office, Inc., 2012 MUN 49-67776-12 40 161 01-11-17 PAGE 002 of 005 oirieoac 04759 CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL - CONTINUED (2) 30 days before the effective date of cancellation if we cancel for any other reason listed in Paragraph 3.a. B. The following provision is added to the CANCELLATION Common Policy Condition: 7. RESIDENTIAL PROPERTY This provision applies to coverage on real property which is used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants household personal property in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part - Farm Property - Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a. If such coverage has been in effect for 60 days or less, and is not a renewal of coverage we previously issued, we may cancel this coverage for any reason, except as provided in b. and c. below. b. We may not cancel this policy solely because the first Named Insured has: (1) Accepted an offer of earthquake coverage; or (2) Cancelled or did not renew a policy issued by the California Earthquake Authority (CEA) that included an earthquake policy premium surcharge. However, we shall cancel this policy if the first Named Insured has accepted a new or renewal policy issued by the CEA that includes an earthquake policy premium surcharge but flails to pay the earthquake policy premium surcharge authorized by the CEA. C. We may not cancel such coverage solely because corrosive soil conditions exist on the premises. This restriction (c.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1) Commercial Property Coverage Part - Causes of Loss - Special Form; or (2) Farm Coverage Part - Causes Of Loss Form - Farm Property, Paragraph D. Covered Causes Of Loss - Special. C. The following is added and supersedes any provisions to the contrary: IL 02 70 09 12 Copyright, Insurance Services Office, Inc., 2012 MUN 49-67776-12 40 161 01-11-17 PAGE 003 of 005 04760 01T1WRG CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL - CONTINUED NONRENEWAL 1. Subject to the provisions of Paragraphs C.2. and C.3. below, if we elect not to renew this policy, we will mail or deliver written notice, stating the reason for nonrenewal, to the first Named Insured shown in the Declarations and to the producer of record, at least 60 days, but not more than 120 days, before the expiration or anniversary date. We will mail or deliver our notice to the first Named insured, and to the producer of record, at the mailing address shown in the policy. 2. RESIDENTIAL PROPERTY This provision applies to coverage on real property used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants household property contained in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part - Farm Property - Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a. We may elect not to renew such coverage for any reason, except as provided in b., c. and d. below, b. We will not refuse to renew such coverage solely because the first Named Insured has accepted an offer of earthquake coverage. However, the following applies only to insurers who are associate participating insurers as established by Cal. Ins. Code Section 10089.16. We may elect not to renew such coverage after the first Named Insured has accepted an offer of earthquake coverage, if one or more of the following reasons applies: (1) The nonrenewal is based on sound underwriting principles that relate to the coverages provided by this policy and that are consistent with the approved rating plan and related documents filed with the Department of Insurance as required by existing law; (2) The Commissioner of Insurance finds that the exposure to potential losses will threaten our solvency or place us in a hazardous condition. A hazardous condition includes, but is not limited to, a condition in which we make claims payments for losses resulting from an earthquake that occurred within the preceding two years and that required a reduction in policyholder surplus of at least 25% for payment of those claims; or IL 02 70 09 12 Copyright, Insurance Services Office, Inc., 2012 MUN 49-67776-12 40 161 01-11-17 PAGE 004 of 005 01T180RG 04761 CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL - CONTINUED (3) We have: (a) Lost or experienced a substantial reduction in the availability or scope of reinsurance coverage; or (b) Experienced a substantial increase in the premium charged for reinsurance coverage of our residential property insurance policies; and the Commissioner has approved a plan for the nonrenewals that is fair and equitable, and that is responsive to the changes in our reinsurance position. C. We will not refuse to renew such coverage solely because the first Named Insured has cancelled or did not renew a policy, issued by the California Earthquake Authority, that included an earthquake policy premium surcharge. d. We will not refuse to renew such coverage solely because corrosive soil conditions exist on the premises. This restriction (d.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1) Commercial Property Coverage Part - Causes Of Loss - Special Form; or (2) Farm Coverage Part - Causes Of Loss Form - Farm Property, Paragraph D. Covered Causes Of Loss - Special. 3. We are not required to send notice of nonrenewal in the following situations: a. If the transfer or renewal of apolicy, without any changes in terms, conditions, or rates, is between us and a member of our insurance group. b. If the policy has been extended for 90 days or less, provided that notice has been given in accordance with Paragraph C.1. C. If you have obtained replacement coverage or if the first Named Insured has agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. d. If the policy is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. e. If the first Named Insured requests a change in the terms or conditions or risks covered by the policy within 60 days of the end of the policy period. f. If we have made a written offer to the first Named Insured, in accordance with the timeframes shown in Paragraph C.1., to renew the policy under changed terms or conditions or at an increased premium rate, when the increase exceeds 25%. IL 02 70 09 12 Copyright, Insurance Services Office, Inc., 2012 MUN 49-67776-12 40 161 01-11-17 PAGE 005 of 005 04762 01T180RG