Loading...
Insurance, Municipal Maintenance Equipment 2018-10-25A t>RIf CERTIFICATE OF LIABILITY INSURANCE �,,.• DAT5/2018 D/YYYY} 10/25/2018 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 polic {{i -es) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions o ge policy, certain policies may require an endorsement. A statement on this certificate does not confer nghts to the certificate holder in lieu of such endorsement(s). PRODUCER Brian Eklund CONTACT NAME: Sentry Customer Service PHONE FAX A/C No • 800-473-6879 1 WC,No: 800-514-7191 EMAIL A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Q OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JET LOC OTHER: ADDRESS: busin roducts direct0swA .com INSURER(S) AFFORDING COVERAGE NAIC # 4967776004 INSURER A: Sentry Select Insurance Company 21180 12/15/2019 INSURED INSURER B: Municipal Maintenance Equipment Inc 4634 Mayhew Rd INSURER C: INSURER D: Sacramento, CA 95827-9700 $ INSURER E: INSURER F: 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 SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF M/DD POLICY EXP M/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Q OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JET LOC OTHER: X 4967776004 12/15/2018 12/15/2019 EACH OCCURRENCE $ 500,000 DAMAGE TO RENTED $ 100,000 PREMISES occurrence MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,500,000 PRODUCTS - COMP/OP AGG $ 1,500,000 $ A AUTOMOBILE LIABILITY X ANY AUTO AUTOS ONLY SCHEDULED HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 4967776005 12/15/2018 12/15/2019 COMBINED SINGLE LIMIT $ 500,000 a acrid BODILY INJURY (Per person) $ BODILY INJURY (Per accident} $ PROPERTY DAMAGE (Per accid $ $ A X UMBRELLA LIARX X EXCESS LIAR OCCUR CLAIMS -MADE 4967776006 12/15/2018 12/15/2019 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 9,000,000 DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A PER TH- STATUTE R 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 if more space is required) Refer to attached CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 290 Paularino Ave Costa Mesa, CA 92626-3314 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /v7 �42_2� ACORD 25 (2016/03) 4967776 Sentry Select Insurance Company 1 00001 0000006039 18298 0 N Page i of 2 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 10/25/2018 9945CB5F-E23D-43FF-A391-60CD53B76815 0027020044347265658192626331490 ACS " AGENCY Brian Eklund POLICY NUMBER 4967776004 CARRIER Sentry Select Insurance Company ADDITIONAL REMARKS AGENCY CUSTOMER ID: XXX)=3697 LOC #: ADDITIONAL REMARKS SCHEDULE NAMED INSURED Municipal Maintenance Equipment Inc NAIC CODE 21180 1 EFFECTIVE DATE. 12/15/2018 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: __Certificate of Liability Insurance General Liability Page 2 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) 0 2008 ACORD CORPORATION. All rights reserved. 4967776 The ACORD name and logo are registered marks of ACORD Sentry Select Insurance Company 10125/2018 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 with respect to liability for "bodily injury", "property Description: damage" or "personal and advertising ALL JOBS Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising "property damage" occurring after: injurycaused, in whole or in part, by: 1. Your acts or omissions; or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or law; and subcontractor engaged in performing 2. If coverage provided to the additional insured operations for a principal as a part of the same is required by a contract or agreement, the project. 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 20 10 04 13 4967776 Sentry Select Insurance Company 1 00001 0000006040 18298 0 N Oc Insurance Services Office, Inc., 2012 2D616598-86F9-4D06-8A56-GAA7307EOFBG 0027020044347265671992626331490 Page 1 of 2 1012512018 C. With respect to the insurance afforded to these additional insureds, the following is added to Section 111 - 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 OO Insurance Services Office, Inc., 2012 CG 2010 0413 4967776 Sentry Select Insurance Company 10/25/2018