Insurance - Municipal Underground Services Inc. 2017-05-12MUNIUND-01 CDELAT
,a►cll..� Ro' CERTIFICATE OF LIABILITY INSURANCE DAM 05/1212017 )
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 have ADDITIONAL INSURED provisions or 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 riahts to the certificate holder in lieu of such endorsement(s).
PRODUCER
Drion Risk Management Insurance Services, Inc.
1800 Quail Street Suite 110
Jewport Beach, U 92660
Bud): (949) 431-2007 ac, No
i-_
cdelatorre@orionrisk.com
INSURERIS) AFFORDING COVERAGE NAICd
INSURERA:Colony Insurance Company_ 39993
INSURED I INSURERB:Employers Mutual Casualty Company 21415
Municipal Underground Services, Inc. INSURER C: _
28511 Breckenridge Drive .INSURER 0.
Laguna Niguel, CA 92677
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 3
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 CONTRACTOR 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 TypE OF INSURANCE ADDLSDBOR POLICY NUMBERFD DDY EFF POLICY EXP LIMITS
A
COMMERCML GENERAL LIABILITY EACH OCCURRENCE $_ 1'000'000
_ _
CLAIMS -MADE OCCUR 103GL000787606 12/29/2016 12/29/2017 DAMAGE TO RENTED 100,000
X PREMISES Me occunencel $
MED EXP An one person)$ 5'000
_
PERSONAL B ADV INJURY $ 1'000'000
I GENT
AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY X PEs: I LOC PRODUCTS-COMP/OPAGG $ 2,000,000
OTHER. $
B
COMBINEDSINGLE LIMIT 1,000,000
AUTOMOBILE LIA6IDTY (Ea amldent) $ _
X�ANY AUTO 4E43249 04118/2017 04/18/2018 BODILY INJURY (Per person) $ _
OWNED SCHEDULED
I AUTOS ONLY AUTOSWWNNEEpp BODILY INJURY (Per accitlent) $
X� ALTOS ONLY ,.X. ATO OfdIY PROPEd.ot) AGE
(Per accitlent) $
$
UMBRELLA LUNG OCCUR EACH OCCURRENCE $
EXCESS UAB CLAIMS -MADE _ AGGREGATE 5 _
DED I I RETENTION$ $
WORKERS COMPENSATION PER STATUTE EORH
AND EMPLOYERS'LIABIUTY YIN - —
iANYPROPRIETORIPARTNERIEXECUTIVENIA EL EACH ACCIDENT S _
UICERIMEMBER EXCLUDED?
ndatory, In NH) EL DISEASE -EA EMPLOYEE 5
_
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K more space is mu.Imd)
The Costa Mesa Sanitary District, it's elected and appointed officials, agents, officers, volunteers and employees are additional insureds subject to the terms
of the attached General Liability endorsement All operations: Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers,
and employees listed as Additional Insured —Pursuant to attached endorsement Any other insurance maintained by the Costa Mesa Sanitary District shall be
excess and non-contributing with the insurance provided by this policy. Said policy shall not terminate, nor shall it be canceled nor the coverage reduced,
until thirty (30) days after written notice is given to the District.
Costa Mesa Sanitary District
290 Paularino Avenue
Costa Mesa, CA 92626 ✓f
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTIIORU^MD REPRESENTATNE
cxe _ b 1a,"
ACORD 25 (2016103) @ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
103 GL 0007876-06
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - ONGOING & COMPLETED
OPERATIONS - PRIMARY & NON-CONTIBUTORY
OTHER INSURANCE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s)
Location(s) And Description Of Operations
All project owners or contractors as required by
As required by written contract EXCEPT
written contract with the named insured except
any contract for Residential or Habitational
any entity or contract involved with residential or
Construction and/or any contract for a
habitational construction
Consolidated (Wrap Up) Insurance Program
A. SECTION II — WHO IS AN INSURED is amended to include as additional insured the person(s) or
organization(s) shown in the SCHEDULE above, but only with respect to:
1. liability for "bodily injury' or "property damage" caused, in whole or in part, "your work" at the
location designated and described in the SCHEDULE above performed for that additional insured
and included in the "products -completed operations hazard".
2. liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole
or in part, by:
a. your acts or omissions; or
b. 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.
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 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.
U462-0116 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2
with its permission.
103 GL 0007876.06
C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is
amended and the following added:
The insurance afforded to the additional insured designated in the SCHEDULE above is primary
insurance and we will not seek contribution from any other insurance available to that additional
insured under your policy provided that:
1. the additional insured designated in the SCHEDULE above 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.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
U462-0116 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 2
with its permission.