Contract - Kasprzyk, Theresa R. - Exhibit B - 2013-02-01COSTA MESA SANITARY DISTRICT
290 Paularino Ave., Costa Mesa, California 92626
(949) 645-8400
To: Consultants/Contractors:
PLEASE GIVE THESE REQUIREMENTS TO YOUR INSURANCE AGENT
The Costa Mesa Sanitary District (CMSD) requires certificates of workers’ compensation, general
liability, automobile, and if necessary, professional errors and omissions insurance before you can
begin work for CMSD. All certificates must contain the following:
Workers’ Compensation – Minimum policy limit requirements are $1,000,000 bodily injury by
disease; and $1,000,000 bodily injury each employee for accident or disease per occurrence. If
you have no employees, you must sign a Declaration of Non-employee Status form available
from the District. In lieu of a certificate of insurance, a certificate of Consent to Self-Insure issued
by the California Director of industrial Relations is also acceptable.
General Liability – Minimum policy limit requirement is $1,000,000 combined single limit
coverage with insurance designated “per occurrence.” Insurance must include coverage for
ongoing operations and completed operations. The insurance carrier providing the commercial
general liability policy must have an AM Best Rating of A- or better and be an admitted carrier in
the State of California or an approved Surplus Line Insurer from California Department of
Insurance.
Automobile Liability – Minimum policy limit requirement is $1,000,000 combined single limit
coverage with insurance designated “per occurrence.” The “Any Auto” box must be checked.
Professional Errors and Omissions (if necessary) – Minimum policy limit that is appropriate
to the profession.
Description of Operations – The following wording must be added to the policy: “All operations:
Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers,
and employees listed as Additional Insured – Pursuant to attached endorsement.”
Change in Coverages – The following wording must be added to the policy by endorsement:
“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.”
Excess and Non-contributing – The following wording must be added to the policy by
endorsement: “Any other insurance maintained by the Costa Mesa Sanitary District shall be
excess and non-contributing with the insurance provided by this policy.”
Additional Insured Endorsement – (for General Liability, Automobile only). This must be a
separate attachment naming the District as additional insured. The endorsement must include
the policy number and the wording of the additional insured must be exact, stating: “The Costa
Mesa Sanitary District, its elected and appointed officials, agents, officers, volunteers and
employees are additional insureds.” ISO Form CG 20 12 07 98, or a comparable equivalent must
be used.