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Insurance - Municipal Maintenance Equipment, Inc. 2019-09-18AC7"RL3 DATE {MM/DD)YYYY) 40,,,,..- CERTIFICATE OF LIABILITY INSURANCE 09/18/2019 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, thelicy{'les must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, policy, subject to the terms and conditions of the 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 Kane Bailey CONTACT NAME: Sentry Customer Service PHONE FAX C No Ext): 800-473-6879 A/C No • 800-514-7191 EMAIL ADDRESS: businessproducts_direot@sontry.com INSURER(S) AFFORDING COVERAGE NAIC # X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE E OCCUR INSURER A: Sentry Select Insurance Company 21180 INSURED Municipal Maintenance Equipment Inc 4634 Mayhew Rd INSURER 13: INSURER C : Sacramento, CA 95827-9700 INSURER D DAMAGE TO RENTED PREMISES a occurrence $ 100,000 INSURER E: A INSURER F: AIANILIP1C■1:MVi171a: 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 ADDL INSR SUER WVD POLICY NUMBER POLICY EFF M/DD POLICY EXP M/DD LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE E OCCUR EACH OCCURRENCE $ 500,000 DAMAGE TO RENTED PREMISES a occurrence $ 100,000 MED EXP (Any one person) $ 5,000 A X 4967776004 12/15/2019 12/15/2020 PERSONAL i£ ADV INJURY $ 500,000 GEN'LAGGREGATE LIMIT APPLIES PER: X POLICY F� JECT F LOC GENERAL AGGREGATE $ 1,500,000 PRODUCTS - COMP/OP AGG $ 1,504,400 OTHER: $ FAUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 500,000 a accident A X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS 4967776005 12!15/2019 12/15!2020 BODILY INJURY {Per person} $ BODILY INJURY {Per accident} $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY(Per PROPERTY DAMAGE accident $ A X X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE 4967776006 12/15/2019 12/15/2020 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? N / A PER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Refer to attached ��.. • .. •.+... , .vwa-rte %-ANGtLLA 1 1UN Costa Mesa Sanitary District SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 290 Paularino Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa, CA 92626-3314 n w ACCORDANCE WITH THE POLICY PROVISIONS. V6 • ` AUTHORIZED REPRESENTATIVE 4967776 Sentry Select Insurance Company 1 00001 0000008088 19261 0 N rage '1 of z Oc 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 09/18/2019 B9505AA1-EC70-40BF-8860-6CC78166 8571 0027020044352077003592626331490 AGENCY CUSTOMER ID: W000c3697 AC CPR L> LOC #: 40 -�' ADDITIONAL REMARKS SCHEDULE AGENCY NAMEDINSURED Kane Bailey Municipal Maintenance Equipment Inc POLICY NUMBER 4967776004 CARRIER NAIC CODE Sentry Select Insurance Company 21180 EFFECTIVE DATE: 12/15/2019 ADDITIONAL. REMARKS 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) © 2008 ACORD CORPORATION. All rights reserved. 4967776 The ACORD name and logo are registered marks of ACORD 09/18/2019 Sentry Select Insurance Company 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 Description: ALL JOBS 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; or 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 20 10 04 13 4967776 Sentry Select Insurance Company 1 00001 0000008089 19261 0 N 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" 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. U Insurance Services Office, Inc., 2012 9919D9F8-7D6A-462F-B DA5-DEOF51413BD0 0027020044352076982092626331490 Page 1 of 2 09/18/2019 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 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 0 Insurance Services Office, Inc., 2012 CG 2010 04 13 4967776 09/18/2019 Sentry Select Insurance Company