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Insurance - Municipal Maintenance Equipment - 2017-11-14ACORO CERTIFICATE OF LIABILITY INSURANCE 11111412N017DD YYYT 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 CONSTIT&E 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 polio lies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms tthhe and Conditions off policy, certain policies may require an endorsement. A statement on this certificate does not Confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Bek Lyon CONTACT NAME: Sentry Customer Service PHONE FAX C No E,01- 800-447-0633 A/CNck 888-533-7827 A EMAIL X ADDRESS: husinessproducto sssic0sentry.cam INSURER(S) AFFORDING COVERAGE NAIC V 12/15/2017 12/15/2018 INSURER A: Sentry Select Insurance Company / 21180 INSURED INSURER B: Municipal Maintenance Equipment Inc 4634 Mayhew Rd INSURER C: INSUREq D Sacramento, CA W827-9700 PRODUCTS - COMP/OP AGO $ 1,500,000 INSUREq E INSURER F: AUTOMOBILE X COVERAGES CERTIFICATE NUMBER: 938354 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 SUGH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBBPOLICY WVD POLICY NUMBER EFF MAD POLICY FXP MSD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Xn OCCUR X 4967776004 12/15/2017 12/15/2018 EACH OCCURRENCE $ 500,000 DAMAGE TO RENTED PREMISES IFaoccumence $100,000 MED EXP (Any one parson) $ 5,000 PERSONAL BADV IIJIURV $500,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ JER F]LOC OTHER: GENERAL AGGREGATE $1,500,000 PRODUCTS - COMP/OP AGO $ 1,500,000 $ A AUTOMOBILE X LIABILITY ANYAlJrO AIWfTO50NLY AUTOSULED HIRED NON -OWNED AUTOS ONLY AUTOS ONLY gg67776005 72/75/2077 12/15/2018 COMBINED SINGLE LIMIT $ 500,000 e a deno BODILY INJURY (Par Person) $ BODILY INJURY (Per accida $ PROPERTY Taccide DAMAGE $ A X X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 4967776006 12/15/2017 12/15/2018 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 9,000,000 DEC) I I RETENTION$ PRODUCTS - COMP/OP AGG $9,000,000 WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUIVE❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, desanbe under DESCRIPTION OF OPERATIONS below N/A I PER OTH- 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 H more space is required) Refer to attached CERTIFICATE HOLDER CANCELLATION Costa Masa Sanh uy District 290 Paulaano Avenue Costa Mesa, CA 92626 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED RRAE/wENENTATIVE ACORD 25 (2016/03) 4967776 Sentry Select Insurance Company 1 00001 0000004948 17319 0 N Page 1 of 2 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 11/14/2017 122F9A21-7150-464F-AE15-482D503EDE6C 002702004434282548849262633100 AC KO O® AGENCY POLICY NUMBER 4967776004 CARRIER Senlry Select Inaurance Cornpany ADDITIONAL REMARKS ADDITIONAL NAIC 21180 THIS ADDITIONAL REMARKS FORM ISASCHEDULE TOACORD FORM, ACORD25 General Liability AGENCY CUSTOMER ID: 7o00( LOC #: — VIARKS SCHEDULE NAMED INSURED Municipal Maintenance Equipment Inc EFFECTIVE DATE: 12/15/2017 Page P of 2 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 THE INSURANCE PROVIDED BY THIS POLICY. UMBRELLA IS EXCESS OVER GENERAL LIABILITY AND AUTO LIABILITY POLICIES. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. 4967776 The ACORD name and logo are registered marks of ACORD 11/14/2017 Sentry Select Insurance Company POLICY NUMBER: 4967776004 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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) Location(s) Of Covered Operations Costa Mesa Sanitary District All Locations Description: ALL JOBS 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, 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. 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. CG 2010 04 13 4967776 Sentry Select Insurance Company 1 00001 0000004949 17319 0 N 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 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 in performing operations for a principal as a part of the same project. © Insurance Services Office, Inc., 2012 SOB13EOD-6242-4686-8EA7-6618360F3339 0027020044342825478692626331490 Page 1 of 2 11/14/2017 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 4967776 11/14/2017 Sentry Select Insurance Company