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Insurance - Municipal Underground Services Inc. 2019-04-15MUNIUND-01 DKELLOGG A+COR�7 CERTIFICATE OF LIABILITY INSURANCE �•�--''� DATE(MM/DD/YYYY) 4/15/2019 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 License # OM70471 Orion Risk Management Insurance Services, rou Insurance Agency, LLC 1800 Quail Street, Suite 110 Newport Beach, CA 92660�� 17 CONTACT NAME: PHONE g49 263-8850 FAX 949 263-8860 (A/C, No, Ext): ( (A/C, No):( ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Colony Insurance Company ✓ 39993 2019 INSURED Municipal Underground Servl es, fns �_,tricf, 28511 Breckenridge Drive Laguna Niguel, CA 92677 INSURER B: Employers Mutual Casualty Company/ 21415 INSURER C INSURER D INSURER E INSURER F: X COVFRAnFS CERTIFICATE NUMBER- 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM DD POLICY EXP MM DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 CLAIMS -MADE X OCCUR103GL000787608 X 12/29/2018 12/29/2019 DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ MED EXP (Any oneperson) $ 5'000 PERSONAL & ADV INJURY $ 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000'000 X POLICY PEC LOC PRODUCTS - COMP/OP AGG $ 2'000'000 $ OTHER: B AUTOMOBILE LIABILITY EOMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) $ X ANY AUTO 4E43249-20 4/18/2019 4/18/2020 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER STATUTE ERH ANY PROPRIETOR/PARTNER/EXE(;UTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Costa Mesa Sanitary District, it's elected and appointed officials, agents, officers, volunteers and employees are additional insureds subject to the terms of the attached General Liability endorsement. All operations: Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees listed as Additional Insured — Pursuant to attached endorsement. Any other insurance maintained by the Costa Mesa Sanitary District shall be excess and non-contributing with the insurance provided by this policy. (30) Days Notice of Cancellation; (10) Days for Non -Payment of Premium. 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 Sanita District ry THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 290 Paularino Avenue � Costa Mesa, CA 92626 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. •' •Will• • • •' 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) And Description Of Operations .-San.i a pistrict Pipeline Repair, 2669 Redlands Drive, Costa 628 W. 19th Street Mesa, CA 92627 Costa Mesa, CA 92627 A. SECTION 11 — WHO IS AN INSURED is amended to include as additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to: 1. liability for "bodily injury" or "property damage" caused, in whole or in part, "your work" at the location designated and described in the SCHEDULE above performed for that additional insured and included in the "products -completed operations hazard". 2. liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. your acts or omissions; or b. 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. B. 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. U462-0116 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2 with its permission.