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Insurance - Kilbride.Mike 2017-03-14ACC DR • CERTIFICATE OF LIABILITY INSURANCE DATE I7YYI 031144/20112017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI5 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 pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the tonna 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 enclorsement(s). PRODUCER Phala: (7150) 8373626 Fax: (760)6373698 M. L. ADAMS INSURANCE SERVICES 42-280 BEACON HILL, SUITE D-7 PALM DESERT CA 92211-5188 COM( CT M. L. Adams Insurance Services ucO"N (760) 837-3626 FAX �. (760) 837.3898 EMAIL AODaEs . www.mladamsins.com INSURER(S) AFFORDING COVERAGE NAIC# Agency Lk#: 0609232 INSURERA : Colony Insurance CO INSURED MIKE KILBRIDE, LTD, INSURER , State Compensation Insurance Fund INSURERC : Great American E & S Insurance Co i COAST WATER AND POWER P.O. BOX 3341 INSURERD, NEWPORT BEACH CA 92659 INSURERE INSURER F COVERACIFA CERTIFICATE NUMBER: 22747 REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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 P LICIES. LIMITS SHOWN MAY HAVE BEEN REDU ED BY PAID CLAIMS. MR LTR TYPE OF INSURANCE IADDLPNSD SUER MD POLICY NUMBER eowLICrEFi PoucYPXP LIMITS A X COMMERCIAL GENERAL LIABILITY X X 103GLOO15876-00 1080116 10130117 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE EX OCCUR DAMAGETORENTED $ 100,000 PREM1696 BEG ncr rence MED. EXP (Anyone person) $ 5,000 PERSONAL a ADV INJURY S 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERA —AGGREGATE E 2,000,000 POLICY Ffl C JECT LOC E PRODUCTS - COMPIOP AGO S 2,000,000 _ S OTHER: AUTOMOBILE LIABNTY COMBINED SINGLE L1Mn BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTYMMAGE $ f rewdma E C UMBRELLA Use X JOCCUR XS3305768.02 10130/16 10130117 EACH OCCURRENCE $ 2,000,000 AGGREGATE E 2,000,ODO EXCESS OAS El CLAIMS -MADE DED I (RETENTION$ $ B WORKER$ COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR(PARTNERIECECUTWE rYIN OFFICEWMEMSER EXCLUDED? (MaeNtery In NN) —J MIA X 9087110.16 10/01116 10/01/17 X PER 07� STATUTE ER 1,000,000 — – ELEACHACCOENT E 1,000,000 E.L. DISEASE-EAEMPLOYEE $ INCLUDED E.L DISEASE -POLICY LIMIT S INCLUDED 11 yet deuxae umer C."ION OF OPERATIONS!xN DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES IACORO 101, Additional Remarks Schedule, may be attached If more space is required) RE: ALL OPERATIONS THE COSTA MESA SANITARY DISTRICT, IT'S ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSUREDS PER FORM CG 20 12 0413 ATTACHED. PRIMARY WORDING PER FORM CG 20 0104 13 ATTACHED. 30 DAYS NOTICE OF CANCELLATION PER FORM 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 290 PAULARINO AVENUE �7(jt ACCORDANCE WITH THE POLICY PROVISIONS. COSTA MESA, CA 92626 �/ �/ .1 I AUTHORIZED REPRESENTATIVE Attention: rr�l Michael L. (Mike) Adams I ne mi -virtu name ana logo are rlagts[ereo mares el m1 vmu POLICY NUMBER: 103 GL 0015B76-00 103 GL 001687640 COMMERCIAL GENERAL LIABILITY CG 2012040 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: COSTA MESA SANITARY DISTRICT, ITS ELECTED AND APPOINTED OFFICIALS AND run. nvrrc 290 PAULARINO AVE. COSTA MESA CA 92626 Information required to complete this Schedule, 0 not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to include as an additional insured any state or govemmontal agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations perlorned by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional Insured only applies to the extent permitted by law: and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additlonal insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2. This insurance does not apply to: a. `Bodily injury, "property damage" or 'personal and advertising Injury' arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury' or "property damage" Included within the "products -completed operations hazard". B. 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. %a most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreerhumt; 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 20 112 0413 0 Insurance Services Off ice, Inc., 2012 Page 1 of 1 103 GL 0015876-00 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 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 and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution 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 (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 103 GL 0016876-00 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION - DESIGNATED PERSON(S) OR ORGANIZATION(S) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person(s) or Organization(s): COSTA MESA SANITARY DISTRICT The Person(s) or Organization(s) listed or described in the SCHEDULE above have requested that they receive written notice of cancellation when this policy is cancelled by us. It is agreed that should this policy be cancelled before the expiration date thereof, the issuing company will endeavor to mail 30 days written notice (10 days for non-payment of premium) to the additional insured. The notification of cancellation of the policy is solely for the purpose of informing the Person(s) or Organization(s) shown in the SCHEDULE the effective date of cancellation and does not grant, alter, or extend any rights or obligations under this policy. Our failure to provide such notification will not extend any policy cancellation date nor impact or negate any cancellation of the policy. Any provision of this endorsement that is in conflict with a statute or rule is hereby amended to conform to that statute or rule. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U900-0513 Includes copyrighted material of ISO Properties, Inc., Page 1 of 1 with its permission. Great American E & S Insurance Company - Company Profile - Best's Credit Rating Center Page 1 of 3 A.M. Best Rating Services Great American E & S Insurance Company (?j A.M. Best#:003837 NAIC#:37532 FEIN #: 310954439 Mailing Address View Additional Address Information Financial Strength Rating 301 E. Fourth Street A+ (Superior) Cincinnati, OH 45202 A+ — - Supprior United States Assigned to insurance companies that Outlook: have, in our opinion, a superior ability to Web: www.areatamericaninsurance.com meet their ongoing insurance obligations. Phone: 513-369-5000 May 12, 2016 Fax: 513-369-3600 View additional news, reports and products for this company. Based on A.M. Best's analysis, 058317 - American Financial Group. Inc is the AMB Ultimate Parent and identifies the topmost entity of the corporate structure. View a list of ooerating insurance entities in this structure. Best's Credit Ratings Financial Strength Rating View Definition as - Rating: A+ (Superior) Affiliation Code: r (Reinsured) Financial Size Category: XV ($2 Billion or greater) Outlook: Stable Action: Affirmed Effective Date: May 12, 2016 Initial Rating Date: June 30, 1980 Long -Term Issuer Credit Rating View Definition Long -Term: as - Outlook: Stable Action: Affirmed Effective Date: May 12, 2016 Initial Rating Date: June 17, 2005 u Denotes Under Review Best's Rating Best's Credit Rating Analyst Rating Issued by: A.M. Best Rating Services, Inc. Senior Financial Analyst: Gregory Dickerson Director: Jennifer Marshall, CPCU, ARM Disclosure Information View A.M. Best's Rating Disclosure Form LN A.M. Best Affirms Ratings of American Financial Group. Inc. and Most of Its Insurance Subsidiaries ,.,,..p May 12, 2016 Rating History A.M. Best has provided ratings & analysis on this company since 1980. http://www3.ambest.comlratings/entitiesICompanyProfile.aspx?ambnum=3 837&URatingI... 3/14/2017 List of Approved Surplus Line Insurers (LASLI) Page 3 of 7 Empire Indemnity Insurance Company (Oklahoma) 12/01/1995 Endurance American Specialty Insurance Company (Delaware) (Name changed from Traders & Pacific Insurance Company effective 06/08/2006) 02/23/1996 Energy Insurance Mutual Limited (Barbados) 12/17/1997 Evanston Insurance Company (Illinois) 08/11/1995 Everest Indemnity Insurance Company (Delaware) 08/14/1998 Executive Risk Specialty Insurance Company (Connecticut) 09/01/1995 Fair American Select Insurance Company (Delaware) 07/28/2014 Fireman's Fund Insurance Company of Ohio (Ohio) 05/19/1999 First Mercury Insurance Company (Delaware) (Domicile changed from Illinois to Delaware, effective 10/28/2015) 10/16/1997 First Specialty Insurance Corporation (Missouri) 09/01/1995 Gemini Insurance Company (Delaware) 02/23/1998 General Security Indemnity Company of Arizona (Arizona) (Name changed from Fulcrum Insurance Company effective 05/03/2002) 09/01/1995 General Star Indemnity Company (Delaware) (Domicile changed from Connecticut to Delaware, effective 12/31/2012) 08/11/1995 Gotham Insurance Company (New York) 08/04/1995 Great American E&S Insurance Company (Delaware) (Name changed from Agricultural Excess and Surplus Insurance Company, effective 07/27/2000) 06/30/1995 Great American Fidelity Insurance Company (Delaware) (Name changed from American Dynasty Surplus Lines Insurance Company, effective 06/27/2001) 09/01/1995 Great Lakes Insurance SE (Germany) (Domicile changed from UK to Germany and name changed from Great Lakes Reinsurance (UK) SE effective December 30, 2016 (Name changed from Great Lakes Reinsurance (UK) PLC (U.K.) effective 07/28/2015) 12/01/1995 GuideOne National Insurance Company (Iowa) 12/07/2015 Gulf Underwriters Insurance Company (Connecticut) (Domicile changed from Missouri to Connecticut, effective 10/01/2001) 07/07/1995 Back to Top H - L Insurer Date Approved Hallmark Specialty Insurance Company (Oklahoma) 07/01/2011 Health Care Indemnity, Inc. (Colorado) 03/21/2001 Homeland Insurance Company of New York (New York) 09/24/2003 Houston Casualty Company (Texas) 09/01/1995 http://www.insurance.ca.gov/01-consumers/120-company/07-lasli/lasli.cfm 3/14/2017 Colony Insurance Company - Company Profile - Best's Credit Rating Center Page 1 of 3 A.M. Best Rating Services Colony Insurance Company u A.M. Best #: 003283 NAIC #: 39993 FEIN M 541423096 Mailing Address View Additional Address Information Financial Rating P.O. Box 469012 _Saength ;. 13EST San Antonio, TX 78246 A 9WIont United States Assigned to insurance companies that Outlook: have, in our opinion, an excellent ability Web: www.colonvspecialtv.com to meet their ongoing insurance Phone: 804-560-2000 obligations. Fax: 804-560-4820 June 28, 1993 View additional news, reports and products for this company. Based on A.M. Best's analysis, 058448 Amo Group International Holdings, Ltd is the AMB Ultimate Parent and identifies the topmost entity of the corporate structure. View a list of operating insurance entities in this structure. Best's Credit Ratings Financial Strength Rating View Definition a Rating: A (Excellent) Affiliation Code: g (Group) Financial Size Category: XII ($1 Billion to $1.25 Billion) Outlook: Stable Action: Affirmed Effective Date: November 16, 2016 Initial Rating Date: June 28, 1993 Long -Term Issuer Credit Rating View Definition Long -Term: a Outlook: Stable Action: Affirmed Effective Date: November 16, 2016 Initial Rating Date: June 29, 2005 u Denotes Under Review Best's Rating Best's Credit Rating Analyst Rating Issued by: A.M. Best Rating Services, Inc. Senior Financial Analyst: Susan Molineux Director: Jennifer Marshall, CPCU, ARM Disclosure Information KM View A.M. Best's Rating Disclosure Form A.M. Best Affirms Credit Ratings of Argo Group International Holdings. Ltd. and Subsidiaries j November 16, 2016 Rating History A.M. Best has provided ratings & analysis on this company since 1993. http://www3.ambest.comlratingslentitiesICompanyProfile.aspx?ambnum=3283 &URatingI... 3/14/2017 List of Approved Surplus Line Insurers (LASLI) Page 2 of 7 Atain Specialty Insurance Company (Michigan) 09/01/1995 (Name changed from USF Insurance Company effective 08/25/2011) 07/20/2011 (Domicile changed from Pennsylvania to Michigan effective 12/31/2007) 04/12/2012 Atlantic Casualty Insurance Company (North Carolina) 07/16/2009 AXA Corporate Solutions Assurance (France) 08/14/2003 AXIS Specialty Europe SE (Ireland) 06/20/2007 (Name changed from AXIS Specialty Europe Public Limited Company effective 05/15/2008 09/10/2012. Name changed from AXIS Specialty Europe Limited effective 04/26/2012) 04/10/2007 AXIS Surplus Insurance Company(Illinois) 12/15/1995 (Name changed from Sheffield Insurance Corporation effective 06/09/2003) 09/01/1995 Back to Top B - D Insurer Date Approved Berkley Assurance Company (Iowa) 07/20/2011 Berkley Regional Specialty Insurance Company (Delaware) 04/12/2012 Berkshire Hathaway International Insurance Limited (UK) 04/01/2008 The Burlington Insurance Company (Illinois) (Domicile changed from North Carolina to Illinois, effective 12/31/2015) 11/17/1995 Canopius US Insurance, Inc. (Delaware) (Name changed from Omega'US Insurance, Inc. effective 08/20/2012) 07/20/2011 Capitol Specialty Insurance Corporation (Wisconsin) 05/15/2008 Catlin Insurance Company (UK) Limited 04/10/2007 Catlin Specialty Insurance Company (Delaware) (Name changed from Wellington Specialty Insurance Company effective 03/31/2007) 06/14/2006 Century Surety Company (Ohio) 09/01/1995 Chubb Custom Insurance Company (New Jersey) (Domicile changed from Delaware to New Jersey, effective 04/01/2013) 08/04/1995 The Cincinnati Specialty Underwriters Insurance Company (Delaware) 01/31/2011 Colony Insurance Company (Virginia) 09/01/1995 Columbia Casualty Company (Illinois) 07/06/1995 Covington Specialty Insurance Company (New Hampshire) 07/20/2011 Crum & Forster Specialty Insurance Company (Delaware) (Name changed from Transnational Insurance Company effective 12/26/2000. Domicile changed from Arizona to Delaware effective 11/21/2014.) 04/20/1998 CUMIS Specialty Insurance Company, Inc. (Iowa) 05/15/2008 Back to Top E - G Insurer Date Approved http://www.insurance.ca.gov/01-consumers/120-company/07-lasli/lasli.cfm 3/14/2017