Insurance - National Electrical Contractors - 2015-02-26CERTIFICATE OF LIABILITY INSURANCE
2/17/o° 5 "'
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 cartificate holder Is an ADDITIONAL INSURED, the pollcylies) must be andomed. If SUBROGATION IS WAIVED, subject to
the tome and conditions of the policy, certain policies may require an endorsement. A statement on this Certificate does not confer rights to the
certificate hostler in lieu of such encion ennent(s).
PRODUCER
California Southwestern Insurance
License Number 0443354
21 Orchard
Lake Forest CA 92630
NA EA Veronica Vazquez, CISR
PHONE (g4g)472 -6560 Ay:(94 91 588 -8 3<B
nmrii ,wazquezB CSia -ins. com
INSURE s ATFOROING COVERAGE
SAID
INSURER . C.l.mV Insurance Company
UNITS
INSURED
National Electrical Contractors, Inc.
P.O. Box 3098
,Van Nuys CA 91407
INSURERB:United Financial Casualty
INSURER C:
INSURER O:
INSURER E
$ 1,000,000
INSURER F:
COMMERCIAL GENERAL UABILRV
OINMSMADE OOCCUR
COVERAGES CERTIFICATE NUMBERGL 2014 -2015 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.
Meq
TYPE OF INSURANCE
III NUMBER
PO4CY EFF
M
PIXICYE %P
Mm0
UNITS
GENERAL LABIUW
EACH OCCURRENCE
$ 1,000,000
A
COMMERCIAL GENERAL UABILRV
OINMSMADE OOCCUR
01MOD0240600
1 /I0/2014
1/18/2015
ARE I E o
S 100,000
MEDEXP(AJ,mocemon)
1 5,000
PERSONALa AOVINJURY
$ 1,000,000
GENERALAGGREGATE
$ 2,000,000
OF TL ADGRII
LIMIT APPUESPER:
PRI- COMP/OP AGO
$ 2,000,000
E POLICY
PR LOC
$
AUT OMLE LMBIUTY
Ea emINe051NGLE
11000,00
BODILY INJURY (Par person)
$
B
X PNYAIITO
ALL OWNED SCHEDULED
AUTOS AUTOS
35170510
/17/2015
/17/2016
BCDaY INJURY(Por emeem)
$
pgOPERT'DAMAGE
$
XIREO AUT06 NORO WNEO
UMBRELLA UAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS WB
CLAIMSMAOE
DEC RETENTIONS
ID
WORNERS COMPENSATOR
NCSTATLL OT
ANDEMPLOYERS'UABILIV ylN
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DESCRIPTIONOFOPERATIONSI O MONSIV HiaMabmch ACORD 101, Additional MmeMs Schedule, If more since Is nquiW)
Certificate holder ie named as tlditional insured Per attached endorsement U156AD9313.
Costa Mesa Sanitary District
Attn: Mr. Rob Harmers, BE
628 N. 19th Street
Costa Mesa, CA 92627
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTIORQEO REPRESENTATVE
Iteyes /LFR = �%'O°`" r�ai
INS025 ISnl MS, n1 THC aCrinn namn a nrl inn n a ro ronletnwtl —1,. nE anrinn
101 GL 0002406 -00
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES
OR CONTRACTORS - BLANKET COVERAGE
INCLUDING PRIMARY / NON - CONTRIBUTORY
AND WAIVER OF SUBROGATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Additional Insured Person(s) or Organization(s)
I
Additional Insured):
Locations of Covered Operations:
All persons or organizations as required by a written
Locations as required by a written contract or
contract or agreement with the named insured.
agreement with the named insured.
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 for whom you are performing operations when you and such
person or organization have agreed in writing in a contract 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(s) at the location(s)
designated above.
A person's or organization's status as an additional insured under this endorsement ends when your
operations for that additional insured are completed.
B. With respect to the insurance afforded to these additional insureds, the following additional
exclusions apply:
This insurance does not apply to:
Additional Insured Contractual Liability
"bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages
by reason of the assumption of liability in a contract or agreement.
Finished Operations at Work
"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
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.
Negligence of Additional Insured
"bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional
insured(s).
U156A -0313 Includes copyrighted material of ISO Properties, Inc., Page 1 of 2
with its permission.
101 GL 0002406.00
C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is
amended and the following added:
The insurance afforded by this Coverage Part for the additional insured required by a written contract
or agreement with the named insured is primary insurance and we will not seek contribution from any
other insurance available to that additional insured.
D. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer Of Rights Of
Recovery Against Others To Us is amended and the following added:
We waive any rights of recovery we may have against any person or organization because of
payments we make for injury or damage resulting from your ongoing operations or "your work' done
under a contract with that person or organization and included in the 'products- completed operatiors
hazard" if:
a. you agreed to such waiver;
b. the waiver is included as part of a written contractor lease; and
c. such written contract or lease was executed prior to any loss to which this insurance applies.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
U156A -0313 Includes copyrighted material of ISO Properties, Inc., Page 2 of 2
with its permission.
CERTHOLDER COPY
SC
P.O. BOX 8192, PLEASANTON, CA 94588
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 02 -17 -2015 GROUP:
POLICY NUMBER: 8018812 -2014
CERTIFICATE 16 5
CERTIFICATE EXPIRES: 07-01 -2015
07- 01- 2014/07-01-2015
COSTA MESA SANITARY DISTRICT SC
528 W 19TH ST
COSTA MESA CA 92827 -2718
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer.
We will also give you 10 des advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
Authorized Representative President and CEO
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #1800 - WIROONIAN, SOHRAB P,S T - EXCLUDED.
EMPLOYER
NATIONAL ELECTR CONTRACTORS INC AND /OR SC
HAROONIAN, SOHRAB
PO BOX 3098
VAN NUYS CA 91407
[JAM,CSI
REy.7 -20141 PRINTED : 02 -17 -2015