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Insurance - Professional Pipe Services 2019-02-12a ,4�oRo CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 8/1/2019 2/12/2019 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 Lockton Insurance Brokers,LLC CONTACT CA License #OF15767 PHONE FAX N A/C No): E-MAIL ADDRESS: 725 S. Figueroa Street, 35th fl. Los Angeles CA 90017 8/1/2019 213-689-0065 INSURERS AFFORDING COVERAGE NAIC # INSURER A : Tokio Marine Specialty Insurance Company 23850 INSURED Hoffman Southwest Corp. 1433285 INSURER B : Federal Insurance Compny 20281 dba Professional Pipe Services INSURER C : Starr Indemnity & Liability Company 38318 INSURER D: Branch #63 INSURER E: 23311 Madero Mission Viejo CA 92691 INSURER F CAVFRAGFS H4WH00l CERTIFICATE NUMBER: 1497117? REVISION NUMBER: XXXXXXX 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 OF INSURANCE ADDLTYPE IVSD SUER POLICY NUMBER MM/DDPOLICY EFF MM/DD POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx—] OCCUR Y Y PPK1858511 8/1/2018 8/1/2019 EACH OCCURRENCE $ 1 000 000 DAMAGE TO PREMISES EaEoccurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X l ECOT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY N N 54309479 8/1/2018 8/1/2019 COMBINED SINGLE LIMIT $ Ea accident 2,000,000 BODILY INJURY (Per person) $ XXXXXXX X ANY AUTO BODILY INJURY (Per accident) $ XXXXXXX OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ XXXX���X $XXXXXXX C UMBRELLA LIAR X OCCUR N N 1000585268181 8/1/2018 8/1/2019 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 X EXCESS LIAR CLAIMS -MADE DED I RETENTION $ XXXXXXX B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVEN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) / A Y 54309480 8/1/2018 8/1/2019 PEI-$ X STATUTE EORH E.L. EACH ACCIDENT $ 1 000 000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S) REFERENCED. Certificate Holder(s) is an Additional Insured(s) as per the attached endorsement or policy language. Waiver of subrogation applies as per the attached endorsements or policy language. See Additional Remarks Schedule /'_GRTIGIr_ATF Hni nFR CANCELLATION See Attachments 14873372 Costa Mesa Sanitary District 290 Paularino Ave Costa Mesa CA 92626 —M 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 REPR 000t 7 ACORD 25 (2016/03) ©1988-201TACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CONTINUATION DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS (Use only if more space is required) Costa Mesa Sanitary District, its directors, officials, officers, employees, agents and volunteers are additional insureds on the General Liability, Auto Liability and Excess Liability Policies if required by written contract. Coverage provided to the Additional Insureds shall apply on a Primary / Non -Contributory Basis on the General Liability, Auto Liability and Excess Liability policies if required by written contract. ACORD 25 (2016/03) Certificate Holder ID: 14873372 POLICY NUMBER: PPK1858511 COMMERCIAL GENERAL LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 40116341111to Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations As where required by written contract prior to loss All covered locations 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 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 Attachment Code: D532712 Master ID: 1433285, Certificate ID: 14873372 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" cut 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. © ISO Properties, Inc., 2012 Page 1 of 2 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 CG 20 10 0413 Attachment Code: D532712 Master ID: 1433285, Certificate ID: 14873372 2. Available under the applicable Limits of Insurance shown in the Declarations; © ISO Properties, Inc., 2012 whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 POLICY NUMBER: PPK1858511 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERI AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/ COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization as required by written contract prior to loss. I Information required to complete this Schedule if not shown above will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 C Insurance Services Office, Inc., 2008 Page 1 of 1 Attachment Code: D532715 Master ID: 1433285, Certificate ID: 14873372 Attachment Code: D532852 Master ID: 1433285, Certificate ID: 14873372 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in Schedule. Schedule Where required by written contract in states where applicable. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement 8/1/2018 Policy No: 54309480 Endorsement No.001 Effective Date: Insured: Hoffman Southwest Corp. dba Professional Pipe Services Insurance Federal Insurance Company Company WC 00 03 13 (Ed. 4-84)