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Insurance - Teaman, Ramirez & Smith 2019-03-26TEAMRAM-n1 KADCOCK COVERAGES CERTIFICATE NUMBER: 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 DATE '�coRo CERTIFICATE OF LIABILITY INSURANCE `----''' (MM/ INSR TYPE OF INSURANCE LTR 03/26/22019019Y) 03 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 License # OC36861 CONTACT Karen M Adcock NAME - Inland Empire-Alliant Insurance Services, Inc. PHc°,NN (909) 886-9861 (Alc, No):(909) 886-2013 ,Ext): 735 Carnegie Dr Ste 200 E-MAIL KAdcock@alliant.com San Bernardino, CA 92408 ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Travelers Casualty and Surety Company of America 31194 INSURED INSURER B: Travelers Property Casualty Company of America 5674 Teaman, Ramirez & Smith, Inc. INSURER C: Oak River Insurance Company ✓ 34630 4201 Brockton Ave 100 1 INSURER D: Navigators Insurance Company / 42307 Riverside, CA 92501 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE LTR ADDL SUBRI POLICY NUMBER INSD WVD 1 POLICY EFF POLICY EXP MM/DD/YYYY MM/DD/YYYY LIMITS A2,000,000 'COMMERCIAL GENERAL LIABILITY CLAIMS -MADE L " OCCUR 6801393XO6A 01/10/2019 01/10/2020 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED 300,000 PREMI E Ea occurrence $ MED EXP An one erson $ 5'000 _ I PERSONAL & ADV INJURY $ 2'000,000 GENERAL AGGREGATE $ 4'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY L-_] JECT [::], LOC i ( PRODUCTS - COMP/OP AGG $ 4,000,000 $ OTHER: _ ACOMBINED 1 AUTOMOBILE LIABILITY SINGLE LIMIT 2000000 Ea accident $ ' ' BODILY INJURY Per erson ( $ u ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS ��X I HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY 6801393XO6A j 1 01/10/2019 01/10/2020 BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ $ B X UMBRELLA LIAR ' EXCESS LIAB X IOCCUR CLAIMS -MADE �CUP1530X948 01/10/2019 01/10/2020 EACH OCCURRENCE is 1'000'000 AGGREGATE $ 1'000'000 DED X RETENTION $ 10,000 Prod/Co Agg $ 1,000,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE .-; j OFFICER/MEMBER EXCLUDED? �� (Mandatory in NH) ! TEWC016603 N / A 04/01 /2019 1 04/01 /2020 1 X STATUTE EORH E.L. EACH ACCIDENT $ 1, 000,000 1,000,000 E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below 1,000,000 E.L. DISEASE - POLICY LIMIT $ D Professional Liab ' I i CEI9APLOA3Y281V I 01/01/2019 01/01/2020 j I Each Claim 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Operations pertaining to the named insured for certificate holder. Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees are Additional Insured with Primary/Non-contributory on general liability per endorsement attached. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District rY 290 Paularino Ave Costa Mesa, CA 92626 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 10== 04=== 0"Wam"M 4n_ nmrwrnr POLICY NUMBER: 680-1393X06A-19-42 .............. This endorsement modifies insurance provided under the following, COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. The following listing is a general coverage description only, Limitations and exclusions may apply to these coverages, Read all the PRO- VISIONSof this endorsement carefully to determine rights,, duties, and what is and is not covered. A, Broadened Named Insured & Damage To Premises Rented To You Extension * Perils of fire, explosion, lightning, smoke, water - Limit increased to $300,000 C. Blanket Waiver of Subrogation D. Blanket Additional Insured— Managers or Lessors of Premises E. Blanket Additional Insured — Lessor of leased Equipment F, Incidental Medical Malpractice G. Personal Injury —Assumed by Contract K Extension of Coverage — Bodily Injury PROVISIONS A BROADENED NAMED INSURED 1, The Named. Insured in Item t of the Declara- tions is as follows-, The person or organization named it) Itern 1. of the Declarations and any organization, other than a partnership or joint venture, over which you maintain ownership or majority in- terest on the effective date of the policy, However, coverage for any such organization will cease as of the date during the policy pe- riDd that you no longer maintain ownership of, or majority interest in, such organization, I WHO IS AN INSURED (Section 4) Item 4.a. is deleted and replaced by the following: a Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the E olicy period, whichever is earlier, unless reported in writing to us Mthin 180 days - 3. This Provision A does not apply to any per- son or organization for which coverage is ex- cluded by endorsement. a DAMAGE TO PREMSES RENTED 70 YOU EXTENSION 1. The last paragraph of COVERAGE A, BOD- ILY INJURY AND PROPERTY DAMAGE Ll - ABILITY (Section I — Coverages) is deleted and replaced by the following - Exclusions a through n, do not apply lo dam- age to premises while rented to you, or tem- porarily occupied by you with permission of the ovvner, used by: a Fire,, b Explosion, - c. Lightning-, dr Smoke resulting from such fire, explosion, or lightning-, or e. Water, A separate limit of insurance applies to this coverage as described in LIMITS OF INSUR_ ANCE (Section 110. Z This insurance does not apply to damage to' premises while rented to you, or temporarily CG DI 86 11 03 Copyright, The Travelers Indemnity Company, 2003 Page I of 5 020955 occupied by you with permission of the owner, caused by, a. Rupture, bursting, or operation of pres- sure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from wa- ter: c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 3. Part 6. of LIMITS OF INSURANCE (Section 110 is deleted and replaced by the following: Subject to 5. above, the Damage To Prem- ises Rented To You Limit is the most �Ae will pay under COVERAGE A for damages be- cause of "property damage" to any om prem- ises while rented to you, or temporarily occu- pied by you with permission of the owner, caused by fire, explosion, lightning, smoke resulting from such fire, explosion, or light- ning, or water. The Damage To Premises Rented To You Limit will apply to all damage proximately caused by the same "occur- rence', whether such damage results from fire, explosion, lightning, smoke resulting from such fire, explosion, or lightning, or water, or any combination of any of these, The Damage To Premises Rented To You Limit will be the higher of, a. $300,000; or b. The amount shown on the Declarations for Damage To Premises Rented To You Limit, 4. Under DEFINITIONS (Section V), Paragraph a. of R of "insured contract" is amended so that it does not include that por- tion of the contract for a lease of premises that indemnifies any person or organization for damage to premises while rented to you, or temporarily occupied by you with permis- sion of the owner, caused by-, a. Fire; b. Explosion, c. Lightning; E. Smoke resulting from such fire, explosion, or lightning, or COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I — Coverages) is excluded by endorsement, C� BLANKET WAIVER OFSUBROGATION We waive any right of recovery v* may have against any person or organization because d payments we make for injury or damage arising out of premises owned or occupied by or rented or loaned to you; ongoing operations performed by you or on your behalf, done under a contract with that person or organization; '*your work-; or ,V your products", We waive this dght where you have agreed to do so as part of a written contract, executed by you prior to loss, D. BLANKET .ii fflONAL INSURED — MANAG- ERS OR LESSORS OF PREMISES '0110 IS AN INSURED (Section 1) is amended to incluRe as an insured any person or organization (referred to below as "additional insured�) with whom you have agreed in a written contract, exe- cuted prior to loss, to name as an additional sured, but only with respect to liability adsing, out' of the ownership, maintenance or use of that part of any premises leased to you-, subject to the fol- lowing provisions'. 1. Limits of Insurance, The limits of insurance afforded to the additional insured shall be the limits which you agreed to provide, or the its Shown on the Declarations, whichever is less. Z The insurance afforded to the additional in- sured does not apply to: a. Any "occurrence" that takes place after you cease to be a tenant in that premises, b. Any premises for which coverage is ex- cluded by endorsement, or c. Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured, 3. The insurance afforded to the additional in- sured is excess over any valid and collectible insurance available to such additional in- sured, unless you have agreed in a written contract for this insurance to apply on a pri- mary or contributory basis, E BLANKET ADDITIONAL INSURED — LESSOR OF LEASED EQUIPMENT e. VTater. WHO IS AN INSURED (Section 4) is amended -W. S. This Provision & does not apply f coverage include as an insured any person or organization for Damage To Premises Rented To You of (referred to below as "additional insured") with Page 2 of 5 Copyright, The Travelers Indemnity Company, 2003 CGDISSI103 *NOON"* cv� �4_Awxwmw "imeft whom you have agreed in. a written contract, exe- cuted prior to loss, to name as an additional in- sured, but only with respect to their liability arising 3. ,*ut of the maintenance, operation of use by you of equipment leased to you by such additional in- sured, subject to the follo*ng provns- 1. Limits of Insurance. The limits of insurance afforded to the additional insured shall be the limits which you agreed b provide, or the its shown on the Declarations, whichever is less - Z The insurance afforded to the additional in- sured does not apply to, a. Any "occurrence" that takes place after the equipment lease expires-, or b. nBtidily injury" or "property damage" aris- ing out of the sole negligence of such ad- ditional insured, I The insurance afforded to the additional in- sured is excess over any valid and collectible insurance available lo such additional in- sured, unless you have agreed in a written contract for this insurance to apply on a rnary or contributory basis, INCIDENTAL MEDICAL MALPRACTICE A The definition of "bodily injury" in DEFINI- TIONS (Section V) is amended to include cidental Medical Malpractice Injury", 2. The following definition is added to DEFINI- TIONS (Section V)-. "Incidental medical malpractice injury" means bodily injury, mental anguish, sickness or diS,_ ease sustained by a person, including death resulting from any cf these at any time, aris- ing out of the rendering of, or f allure to ren- der, the f ollowing services, a Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages, b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances; or G. First aid, d "Good Samaritan services". As used in this Proon F., "Good Samaritan ser- vices" are those medical services ren- dered or provided in an emergency and 9 for which no remuneration is demanded or received, Paragraph 2.a.(1)(d) of WHO IS AN IN- SURED (Section 10 does not apply to any registered nurse, licensed practical nurse, emergency medical technician or paramedic employed by you, but only while performing the services described in paragraph 2- above and while acting within the scope of their em- ployment by you. Any "employees" rendering "Good Samaritan services" will be deemed to be acting within the scope of their employ - merit by you. The following exclusion is added to paragraph Z Exclusions of COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABIL- ITY (Section I— Coverages): (This insurance does not apply to:) Liability arising out of the willful violation of a penal statute of ordinance relating to the sale of pharmaceuticals by or with the knowledge or consent of the insured, f For the purposes of determining the applica- ble limits of insurance, any act or ornission, together with all related acts or omissions in the furnishing of the services described in paragraph Z above to any one person, will be considered one "Occurrence", This Provision F. does not apply if you are in the business or occupation OF providing any of the services described in paragraph Z above. 7. The insurance provided by this Provision F. shall be excess over any other valid and col- lectible insurance available 10 the insured, whether primary, excess, contingent or on any other basis, except for insurance pur- chased specifically by you to be excess of this policy, PERSONAL INJURY — ASSUMED BY CON- TRACT 1. The Contractual Liability Exclusion in Part Exclusions of COVERAGE B, PER- SONAL AND ADVERTISING INJURY LIABIL- ITY (Section I — Coverages) is deleted and replaced by the following: (This insurance does not apply to) Contractual Liability "Advertising injury" for which the insured has assumed liability in a contract or agreement, This exclusion does not apply to liability for, CG DI 8611 03 Copyright, The Travelers Indemnity Company, 2003 Page 3 of 5 020M • Page 4 of 5 Copyright, The Travelers Indemnity Company, 2003 CGD1861103 2. in Pail d the amount we will pay for loss of earnings is increased to $500 a day. M KNOWLEDGE. AND NOTICE OF OCCUR- RENCE OR OFFENSE 1. The following is added to COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV), paragraph Z (Duties In The Event of Oc- currence, Offense, Claim or 80)1 Notice of an "occurrence" or of an offense which may result in a claim under this insur- ance shall he given as soon as practicable af- ter knowledge of the "occurrence" Of Offeflse has been reported to any insured listed under Paragraph 1. of Section 11 - Who Is An In- sured or an 'ernployee*' (such as an insur- ance, loss control or hsk manager or adminis- trator) designated by you to give such notice, Knowledge by other "employee(s)" of an currence" or of an offense does not imply that you also have such knovAedge. 2. Notice Shall be deemed prompt I given in good faith as soon as practicable to your workers' compensation insurer, This applies only if you subsequently give notice to us as soon as practicable after any insured listed under Paragraph 1. of Section 11- Who Is An Insured or an "employee" (such as an insur. arice, loss control or risk manager or adminis. trator) designated by you to give Such notice discovers that the "occurrence", offense or claim may involve this policy 3. However, this Provision M. does not apply as respect$ the specific numbef, el days within which you are required to notify us in writing of the abrupt commencement of a discharge, release or escape of "pollutants" which causes "bodily injury" of -property damage which may otherwrise be covered under this policy, The following is added to COMMERCIAL GEN. FERAL LIABILITY CONDITIONS (Section paragraph 6, (Representations). The unintentional omission of, Of unintentional error in, any information provided by you shall not prejudice your rights under this -insurance, How- ever, this Provision N. does not affect our right to collect additional premium cc to exercise our right of cancellation or nonrenewal in accordance vAth applicable State insurance laws, codes or reguW tions, 0. REASONABLE FORCE - BODILY INJURY OR PROPERTY DAMIAGP_ The Expected Or Intended Injury Exclusion in Part 2., Exclusions of COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I - Coverages) is -deleted and replaced by the follov-Airig, (This insurance does not apply to:) Expected or Intended Injury or Damage **Bodfly injury" or "property damage" expected or intended from the standpoint of the insured, This exclusion does not apply to "bodily injury" or "property damage" resulting from the we of rea- sonable force to protect persons or property. CG D1 86 11 03 Copyright, The Travelers Indemnity Company, 2003 Page 5 of 5 0209S7 POLICY NUMBER: 68O-l393XU6A-19-42 This endorsement modifies insurance provided under the followini!j . COMMERCIAL GENERAL LIABILITY COVERAGE PAR PROVISIONS COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV), Paragraph 4, (Other Insurance), is amended as follows: 1. The following is added to Paragraph a Primary However, if you specifically agree in a written con- tract or written agreement that the insurance pro- vided to an additional insured under this Coverage Part must apply on a primary basis, or a primary and non-contributory basis, this insur- ance is primary to other insurance that is avail- able to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided The "bodily injury" or "property damage" for which coverage is sought occurs: and b. The "personal injury" or -advertising injury" which coverage is sought arises out of an fense committed subsequent to the signing and execution of th- contract or agreement by you. Z The first Subparagraph (2) of Paragraph h cess Insurance regarding any other primary i surance available to you is deleted. I The following is added to Paragraph h Exces Insurance, as an additional subparagraph und Subparagraph (1): That is available lo the insured when the insureis is added as an additional insured under any oth policy, including any umbrella or excess policy. CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc, All rights reserved. Page I of 1