Loading...
Insurance - Hoffman Southwest Corp. dba Professional Pipe Services Branch #63 - 2020-07-06ACORO0 CCP CERTIFICATE OF LIABILITY INSURANCE 8i1i2020 DATE (MM/DD/YYYY) 7i6i2020 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 CA License #OF15767 777 S. Figueroa Street, 52nd fl. Los Angeles CA 90017 CONTACT NAME: PHONE FAX A/C No Ext : A/C No): E-MAIL ADDRESS: 213-689-0065 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Executive Risk Indemnit Inc. 35181 INSURED Hoffman Southwest Corp. 1429111 dba Professional Pipe Services INSURER B : Federal Insurance Company ✓ 20281 oe INSURER C : Starr Indemnity& Liability Company 38318 INSURER D : Branch #63 23311 Madero Mission Viejo CA 92691 INSURER E : INSURER F COVERAGES HSWHO01 CERTIFICATE NUMBER: 14R73377 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP /Y MM/DDYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y Y 54310144 3/31/2020 3/31/2021 EACH OCCURRENCE $ 2 000 000 DAMAGE TO PREMISES (Ea occu RENTED ) $ 100,000 GEN'L MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 AGGREGATE LIMIT APPLIES PER: POLICY � JEC LOC OTHER: GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP/OP AGG $ 4 000 000 $ B AUTOMOBILE X X LIABILITY ANY AUTO OWNED OS ONLY AUTOSULED HIRED AUTOS ONLY Ix AUTOS ONLY D N N 54309479 3/31/2020 3/31/2021 COMBINED SINGLE LIMIT Ea accident $ 21000,000 BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident) $ XXXXXXX (Per accident)TDAMAGE $ XXXXXXX $ XXXXXXX C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE N N 1000586274201 3/31/2020 3/31/2021 EACH OCCURRENCE $ 10 000 000 AGGREGATE $ 10,000,000 DED RETENTION $ $ XXXXXXX B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NN/A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y 54309480 8/1/2019 8/1/2020 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1000 000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 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 TERNI(S) REFERENCED See Additional Remarks Schedule CERTIFICATE HOLDER CANCELLATION See Attachments 14873372 Costa Mesa Sanitary District 290 Paularino Ave /► r��Y� j J Costa Mesa CA 92626 TO / Y v SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I I AUTHORIZED REPR 7,*t ©1688-201nCGIkD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CONTINUATION DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/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 Insured(s) as per the attached endorsement or policy language. Insurance provided to Additional Insured(s) is primary and non-contributory as per the attached endorsements or policy language. Waiver of subrogation applies as per the attached endorsements or policy language. Cancellation notice applies as per policy language or attached endorsement. ACORD 25 (2016/03) Certificate Holder ID: 14873372 Attachment Code: D535496 Certificate ID: 14873372 Policy Number: Commercial Auto 54309479 16-02-0322 (Ed. 11-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR NON -RENEWAL TO SPECIFIED PERSONS OR ORGANIZATIONS This endorsement modifies the following: COMMON POLICY CONDITIONS SCHEDULE Name(s) and Address(es): ALL PERSONS OR ORGANIZATIONS AS ON FILE WITH US. The following Condition is added: Notice Of Cancellation Or Non -Renewal To Specified Persons Or Organizations 1. If we cancel or non -renew this policy for any reason other than non-payment, we will deliver notice of cancellation or non -renewal to any Person(s) or Organization(s) shown in the Schedule 30 days prior to the effective date of cancellation or non -renewal. 2. If we cancel this policy for non-payment, we will deliver notice of cancellation to any Person(s) or Organization(s) shown in the Schedule 10 days prior to the effective date of cancellation. 3. If notice is mailed, proof of mailing will be sufficient proof of notice. 4. Any failure by us to notify such person(s) or organization(s) will not invalidate such cancellation or non -renewal with respect to any other person(s) organization(s). 16-02-0322 (Ed. 11-15) Included copyrighted material of insurance Services Office, Page 1 of 1 Inc., with its permission. Attachment Code: D535500 Certificate ID: 14873372 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 45 (Ed. 6-11) EARLIER NOTICE OF CANCELLATION OR NONRENEWAL PROVIDED BY US This endorsement, effective on 3/31/2020 at 12,01 A. M. standard time, forms a part of Policy No: 54309480 of the Federal Insurance Company Issued to Hoffman Southwest Corp. Authorized Representative A. Under Condition D. Cancellation of Part Six, the time period is amended as follows: We may cancel this policy by mailing or delivering to you written notice of cancellation at least: 1. TEN (1o) days before the effective date of cancellation if we cancel for non-payment of premium; or 2. SIXTY (6o) days before the effective date of cancellation if we cancel for any other reason. B. Under Part Six - Conditions of the policy, the following is added: Notice Of Nonrenewal When we do not renew this policy, we will mail or deliver to you written notice of the nonrenewal at IeastsIXTY (6o)days before the expiration date. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. wC 99 06 45 (Ed. 6-11) Attachment Code: D532712 Certificate ID: 14873372 POLICY NUMBER: 54310144 COMMERCIAL GENERAL LIABILITY CG20100413 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) Locations Of Covered Operations WHERE REQUIRED BY WRITTEN CONTRACT. ALL LOCATIONS WHERE REQUIRED BY WRITTEN CONTRACT. I 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: 13he 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 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. CG 20 10 04 13 © ISO Properties, Inc., 2012 Page 1 of 2 Attachment Code: D532712 Certificate ID: 14873372 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. CG 20 10 0413 © ISO Properties, Inc., 2012 Page 2 of 2 Attachment Code: D532713 Certificate ID: 14873372 POLICY NUMBER: 54310144 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Oraanization(s) Location(s) Of Covered Operations WHERE REQUIRED BY WRITTEN CONTRACT, ALL LOCATIONS WHERE REQUIRED BY BUT ONLY WHERE THE CONTRACT SPECIFIES WRITTEN CONTRACT. COVERAGE FOR COMPLETED OPERATIONS. 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured(s) and included in the "products -completed operations hazard". 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. A. 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. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Attachment Code: D532717 Certificate ID: 14873372 POLICY NUMBER: 54310144 COMMERCIAL GENERAL LIABILITY 10-02-2461 (Ed. 7-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE FOR SCHEDULED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Additional Insured: Location Of Covered Operations: WHERE REQUIRED BY WRITTEN CONTRACT ALL LOCATIONS (If not entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect only to the Additional Insured and at the Location Of Covered Operations shown in the Schedule, the following is added to SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 4.Other Insurance and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to the Additional Insured with respect to the Location Of Covered Operations shown in the Schedule under this policy provided that: (1) The Additional Insured is a named insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the Additional Insured. 10-02-2461 (Ed. 7-15) Includes copyrighted material o' Insurance Services Office, Inc., with its permission. Attachment Code: D532715 Certificate ID: 14873372 POLICY NUMBER: 54310144 COMMERCIAL GENERAL LIABILITY Form 10-02-1800 (Rev. 09-17) COMMERCIAL GENERAL LIABILITY COVERAGE FORM 8. Transfer Or Waiver Of Rights Of Recovery Against Others To Us We will waive the right of recovery we would otherwise have had against another person or organization, for loss to which this insurance applies, provided the insured has waived their rights of recovery against such person or organization in a contract or agreement that is executed before such loss. To the extent that the insured's rights to recover all or part of any payment made under this Coverage Part have not been waived, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. This condition does not apply to Coverage C. Form 10-02-1800 Includes copyrighted material of ISO Properties, Inc., with its permission Page 1 of 1 (Rev. 09-17 Attachment Code: D532733 Certificate ID: 14873372 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 99 03 04 (Ed. 7- 08) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need to be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 8/1/2019 at 12:01 A. M. standard time, forms a part of Policy No.54309480 of the Federal Insurance Company issued to Hoffman Southwest Corp. Endorsement No. Authorized Representative 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. The additional premium for the blanket waiver offered by this endorsement shall be 0.00 % of total California premium. Schedule Person or Organization WHERE REQUIRED BY WRITTEN CONTRACT. WC 99 03 04 (Ed. 7-08) Job Description