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Insurance - National Plant Services - 2018-03-12'`�R b® CERTIFICATE OF LIABILITY INSURANCE D03/121201e01YYYY) 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(ies) 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER MARSH USA INC. 540 W. MADISON CONTACT AME PHONE FAX N ADDRESS' CHICAGO, IL 60661 Aft chicago.CerlRequest@rnarsh.com INSURERS AFFORDING COVERAGE NAIC# NPS INSURER A: Zurich Amercan Insurance Company � 16535 INSURED NATIONAL PLANT SERVICES, INC. INSURERS: Amencan Zurich Insurance Company 40142 INSURER C 1461 HARBOR AVENUE LONG BEACH, CA 908112741 INSURER D: INSURER E INSURER F: MED EXP (Any oneperson) $ 10,000 COVERAGES CERTIFICATE NUMBER: CHI -008922821-02 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 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. ILTR TYPE OF INSURANCE ADDLSUBR AUTHORIZED REPRESENTATIVE POLICYNUMBER POLICY EFF MMI POLICY EXP (MM/DDfYYY)(I LIMITS A X COMMERCIALGENERALOABILITY GLO 9377201-14 10/3112017 10/31/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE I OCCUR DAMAGE TRENTED 1,000,000 PREMISES Ea occunence $ MED EXP (Any oneperson) $ 10,000 X XCU INCLUDED PERSONAL a ADV INJURY $ 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICYI JECOT LOC PRODUCTS - COMP/OP AGO $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY BAP 9377199-14 10f3112017 10131/2018 COMBINED SINGLE LIMIT $ 2,000,000 Ea accident BODILY INJURY (Per Person) $ X ANY AUTO OWNED SCULED AUTOS ONLYPAITHOES0HIRED - BODILY INJURY(Peraccident) $ NON'WNED AUTOS ONLYAUTOS ONLY PROPERTY DAMAGE$ P r accident UMBRELLALIAS OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTIONS $ 8 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERIMEMBEREXCLUDED? (Mandatory In NH) N/A WC 9377202-14 WC012261902 WI ( ) 10131/2017 1013112018 10/31/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) COSTA MESA SANITARY DISTRICT, THEIR ELECTED AND APPOINTED OFFICIALS, AGENTS, OFFICERS, VOLUNTEERS, AND EMPLOYEES ARE ADDITIONAL INSUREDS UNDER GENERAL LIABILITY AND AUTOMOBILE LIABILITY, BUT ONLY TO THE EXTENT REQUIRED BY THEIR WRITTEN CONTRACT WITH THE NAMED INSURED FOR OPERATIONS PERFORMED BY THE NAMED INSURED. THIS INSURANCE IS PRIMARY AND NON-CONTRIBUTORY OVER ANY EXISTING INSURANCE AND LIMITED TO LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED WHERE REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION COSTA MESA SANITARY DISTRICT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: DBOJARSKI@CMSDCA.GOV THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 290 PAULARINO AVENUE _ / COSTA MESA, CA 92626 'yi3�4 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988.2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Commercial Auto Insurance Endorsement Insurance for this coverage is provided by: 0 ZURICH Policy Number: BAP 9377199-14 Zurich American Insurance Company Renewal of Number: BAP 9377199-13 BLANKET NOTIFICATION TO OTHERS OF CANCELLATION THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE: COMMERCIAL AUTO COVERAGE PART A. IF WE CANCEL THIS COVERAGE PART BY WRITTEN NOTICE TO THE FIRST NAMED INSURED FOR ANY REASON OTHER THAN NONPAYMENT OF PREMIUM, WE WILL DELIVER ELECTRONIC NOTIFICATION THAT SUCH COVERAGE PART HAS BEEN CANCELLED TO EACH PERSON OR ORGANIZATION SHOWN IN A SCHEDULE PROVIDED TO US BY THE FIRST NAMED INSURED. SUCH SCHEDULE: 1. MUST BE INITIALLY PROVIDED TO US WITHIN 15 DAYS: A. AFTER THE BEGINNING OF THE POLICY PERIOD SHOWN IN THE DECLARATIONS; OR B. AFTER THIS ENDORSEMENT HAS BEEN ADDED TO POLICY; 2. MUST CONTAIN THE NAMES AND E-MAIL ADDRESSES OF ONLY THE PERSONS OR ORGANIZATIONS REQUIRING NOTIFICATION THAT SUCH COVERAGE PART HAS BEEN CANCELLED; 3. MUST BE IN AN ELECTRONIC FORMAT THAT IS ACCEPTABLE TO US; AND 4. MUST BE ACCURATE. SUCH SCHEDULE MAY BE UPDATED AND PROVIDED TO US BY THE FIRST NAMED INSURED DURING THE POLICY PERIOD. SUCH UPDATED SCHEDULE MUST COMPLY WITH PARAGRAPHS 2.3. AND 4. ABOVE. B. OUR DELIVERY OF THE ELECTRONIC NOTIFICATION AS DESCRIBED IN PARAGRAPH A. OF THIS ENDORSEMENT WILL BE BASED ON THE MOST RECENT SCHEDULE IN OUR RECORDS AS OF THE DATE THE NOTICE OF CANCELLATION IS MAILED OR DELIVERED TO THE FIRST NAMED INSURED. DELIVERY OF THE NOTIFICATION AS DESCRIBED IN PARAGRAPH A. OF THIS ENDORSEMENT WILL BE COMPLETED AS SOON AS PRACTICABLE AFTER THE EFFECTIVE DATE OF CANCELLATION TO THE FIRST NAMED INSURED. C. PROOF OF EMAILING THE ELECTRONIC NOTIFICATION WILL BE SUFFICIENT PROOF THAT WE HAVE COMPLIED WITH PARAGRAPHS A. AND B. OF THIS ENDORSEMENT. D. OUR DELIVERY OF ELECTRONIC NOTIFICATION DESCRIBED IN PARAGRAPHS A. AND B. OF THIS ENDORSEMENT IS INTENDED AS A COURTESY ONLY. OUR U -CA -388-A(7/94) FAILURE TO PROVIDE SUCH DELIVERY OF ELECTRONIC NOTIFICATION WILL NOT: 1. EXTEND THE COVERAGE PART CANCELLATION DATE; 2. NEGATE THE CANCELLATION; OR 3. PROVIDE ANY ADDITIONAL INSURANCE THAT WOULD NOT HAVE BEEN PROVIDED IN THE ABSENCE OF THIS ENDORSEMENT. E. WE ARE NOT RESPONSIBLE FOR THE ACCURACY, INTEGRITY, TIMELINESS AND VALIDITY OF INFORMATION CONTAINED IN THE SCHEDULE PROVIDED TO US AS DESCRIBED IN PARAGRAPHS A. AND B. OF THIS ENDORSEMENT. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. 0 Blanket Notification to Others of Cancellation ZURICH. Policy Na Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add 1. Prem Return Prem. GLO 9377201-14 1 10/31/2017 10/31/2018 10/31/2017 30060-000 N/A N/A THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. If we cancel this Coverage Part by written notice to the first Named Insured for any reason other than nonpayment of premium, we will deliver electronic notification that such Coverage Part has been cancelled to each person or organization shown in a Schedule provided to us by the First Named Insured. Such Schedule: 1. Must be initially provided to us within 15 days: a. After the beginning of the policy period shown in the Declarations; or b. After this endorsement has been added to policy; 2. Must contain the names and e-mail addresses of only the persons or organizations requiring notification that such Coverage Part has been cancelled; 3. Must be in an electronic format that is acceptable to us; and 4. Must be accurate. Such Schedule may be updated and provided to us by the First Named Insured during the policy period. Such updated Schedule must comply with Paragraphs 2.3. and 4. above. B. Our delivery of the electronic notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured. Delivery of the notification as described in Paragraph A. of this endorsement will be completed as soon as practicable after the effective date of cancellation to the first Named Insured. C. Proof of entailing the electronic notification will be sufficient proof that we have complied with Paragraphs A. and B. of this endorsement. D. Our delivery of electronic notification described in Paragraphs A. and B. of this endorsement is intended as a courtesy only. Our failure to provide such delivery of electronic notification will not: 1. Extend the Coverage Part cancellation date; 2. Negate the cancellation; or 3. Provide any additional insurance that would not have been provided in the absence of this endorsement. E. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the Schedule provided to us as described in Paragraphs A. and B. of this endorsement. All other terms and conditions of this policy remain unchanged. U -GL -1114-A CW (10-02) Page 1 of 1 Includes copyrighted material of Insurance Services Office. Inc., with its permission. Endorsement 0 ZURICH Policy No. Eff. Date of Exp. Date of Pot. Eff. Date of End Producer Add'l Prem Return Prem Pol WC9377202-14 10/31/2017 10/31/2018 10/31/2017 N/A WORKERS COMPENSATION AND EMPLOYERS LIABLITY INSURANCE POLICY Endorsement #: BLANKET NOTICE TO OTHERS OF CANCELLATION THIS ENDORSEMENT IS USED TO ADD THE FOLLOWING TO PART SIX OF THE POLICY. PART SIX - CONDITIONS F. NOTIFICATION TO OTHERS OF CANCELLATION 1. IF WE CANCEL THIS POLICY BY WRITTEN NOTICE TO YOU FOR ANY REASON OTHER THAN NONPAYMENT OF PREMIUM, WE WILL DELIVER ELECTRONIC NOTIFICATION TO EACH PERSON OR ORGANIZATION SHOWN IN A SCHEDULE PROVIDED TO US BY YOU. SUCH SCHEDULE: A. MUST BE INITIALLY PROVIDED TO US WITHIN 15 DAYS: AFTER THE BEGINNING OF THE POLICY PERIOD SHOWN IN THE DECLARATIONS; OR AFTER THIS ENDORSEMENT HAS BEEN ADDED TO POLICY; B. MUST CONTAIN THE NAMES AND E-MAIL ADDRESSES OF ONLY THE PERSONS OR ORGANIZATIONS REQUIRING NOTIFICATION THAT THIS POLICY HAS BEEN CANCELLED; C. MUST BE IN AN ELECTRONIC FORMAT THAT IS ACCEPTABLE TO US; AND D. MUST BE ACCURATE. SUCH SCHEDULE MAY BE UPDATED AND PROVIDED TO US BY YOU DURING THE POLICY PERIOD. SUCH UPDATED SCHEDULE MUST COMPLY WITH PARAGRAPHS B.C. AND D. ABOVE. 2. OUR DELIVERY OF THE ELECTRONIC NOTIFICATION AS DESCRIBED IN PARAGRAPH 1. OF THIS ENDORSEMENT WILL BE BASED ON THE MOST RECENT SCHEDULE IN OUR RECORDS AS OF THE DATE THE NOTICE OF CANCELLATION IS MAILED OR DELIVERED TO YOU. DELIVERY OF THE UWC332A (7/94) Pale I of 2 Endorsement 0 ZURICH NOTIFICATION AS DESCRIBED IN PARAGRAPH 1. OF THIS ENDORSEMENT WILL BE COMPLETED AS SOON AS PRACTICABLE AFTER THE EFFECTIVE DATE OF CANCELLATION TO YOU. 3. PROOF OF EMAILING THE ELECTRONIC NOTIFICATION WILL BE SUFFICIENT PROOF THAT WE HAVE COMPLIED WITH PARAGRAPHS 1. AND 2. OF THIS ENDORSEMENT. 4. OUR DELIVERY OF ELECTRONIC NOTIFICATION DESCRIBED IN PARAGRAPHS 1 AND 2. OF THIS ENDORSEMENT IS INTENDED AS A COURTESY ONLY. OUR FAILURE TO PROVIDE SUCH DELIVERY OF ELECTRONIC NOTIFICATION WILL NOT: A. EXTEND THE POLICY CANCELLATION DATE; B. NEGATE THE CANCELLATION; OR C. PROVIDE ANY ADDITIONAL INSURANCE THAT WOULD NOT HAVE BEEN PROVIDED IN THE ABSENCE OF THIS ENDORSEMENT, 5. WE ARE NOT RESPONSIBLE FOR THE ACCURACY, INTEGRITY, TIMELINESS AND VALIDITY OF INFORMATION CONTAINED IN THE SCHEDULE PROVIDED TO US AS DESCRIBED IN PARAGRAPHS 1. AND 2. OF THIS ENDORSEMENT. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. Countersigned: Authorized Representative UWC332A (7/94) Page 2 of 2 0 Additional Insured —Owners, Lessees Or Contractors — ZURICH Ongoing Operations — Scheduled Policy No. Eff. Date of Pol. I Exp, Date of Pol I Eff. Daze of End. I Producer No. Add'I. Prem Retwn Prem. GLO-9371201-14 10/31/2017 1 10/31/2018 1 10/31/2017 SURVEYOR, WHOM YOU ARE REQUIRED THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part F3e3'I��l�f� Name of Person or Organization: Location and Description of Ongoing Operations: Additional Premium: ANY PERSON OR ORGANIZATION, OTHER ANY LOCATION OR PROJECT, OTHER NIA THAN AN ARCHITECT, ENGINEER, OR THAN A WRAP-UP OR CONSOLIDATED SURVEYOR, WHOM YOU ARE REQUIRED INSURANCE PROGRAM LOCATION OR TO ADD AS AN ADDITIONAL INSURED PROJECT FOR WHICH INSURANCE IS UNDER THIS POLICY UNDER A WRITTEN OTHERWISE SEPARATELY PROVIDED TO CONTRACT OR WRITTEN AGREEMENT YOU BY WRAP-UP OR OTHER EXECUTED PRIOR TO LOSS, EXCEPT CONSOLIDATED INSURANCE PROGRAM. WHERE SUCH REQUIREMENT IS PROHIBITED BY LAW. A. Section II — Who Is An Insured is amended to include as an insured any person or organization shown in the Schedule of this endorsement, but only with respect to liability arising out of your ongoing operations performed for that insured at or from the corresponding location designated and described in the Schedule. However, if you have entered into a construction contract with an additional insured person or organization shown in the Schedule of this endorsement, the insurance afforded to such additional insured only applies to the extent permitted by law. B. With respect to the insurance afforded to any additional insured shown in the Schedule of this endorsement, the following additional exclusion applies: 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 site 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. All other terms and conditions of this policy remain unchanged. U -GL -1465-D CW (12-13) Page 1 of 1 Includes copyrighted material of Insurance Sendces Office, Inc., with its pennission, Additional Insured — Owners, Lessees Or Contractors — Completed Operations — Scheduled ZURICH' Policy No. EfF, Date of Pol. Exp. Date of Pol, Eff. Daze of End. Producer No. Add'I, Prem Return Prem. GLO-9377201-14 10/31/2017 10/31/2018 10/31/2017 INSURANCE PROGRAM LOCATION OR THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE Name of Person or Organization: Location and Description of Completed Operations: Additional Premium: ANY PERSON OR ORGANIZATION, OTHER ANY LOCATION OR PROJECT, OTHER N/A THAN AN ARCHITECT, ENGINEER, OR THAN A WRAP-UP OR CONSOLIDATED SURVEYOR, WHOM YOU ARE REQUIRED INSURANCE PROGRAM LOCATION OR TO ADD AS AN ADDITIONAL INSURED PROJECT FOR WHICH INSURANCE IS UNDER THIS POLICY UNDER A WRITTEN OTHERWISE SEPARATELY PROVIDED TO CONTRACT OR WRITTEN AGREEMENT YOU BY A WRAP-UP OR OTHER EXECUTED PRIOR TO LOSS, EXCEPT CONSOLIDATED INSURANCE PROGRAM. WHERE SUCH REQUIREMENT IS PROHIBITED BY LAW. Section II —Who Is An Insured is amended to include as an insured any person or organization shown in the Schedule of this endorsement, but only with respect to liability arising out of "your work" at or from the corresponding location designated and described in the Schedule performed for that insured and included in the "products -completed operations hazard". However, if you have entered into a construction contract with an additional insured person or organization shown in the Schedule of this endorsement, the insurance afforded to such additional insured only applies to the extent permitted by law. All other terms and conditions of this policy remain unchanged. U -GL -1466-D OW (12-13) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Ino, with its permission.