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Insurance - Golden Bell Products, Inc. 2020-09-02Ac"R" CERTIFICATE OF LIABILITY INSURANCE `,,,,moi DATE (MM/DD/YYYY) 09/02/2020 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(les) must 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 Van Beurden Ins. Serv, Inc. - Kingsburg PO Box 67 CONTACT Recia Shelton PHONE FAX /C No: (559) 897-4070 A/C No Ext: (559) 897-2975 AIC, E-MAIL X COMMERCIAL GENERAL LIABILITY Kingsburg CA 93631 ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURERA:Evanston Insurance Company 35378 INSURED (714) 630-3861 Golden Bell Products, Inc. INSURER B: MKLV5ENV102559 INSURER C : INSURER D: P.O. Box 366 INSURER E: Atwood CA 92811 INSURER F : COVERAGES CERTIFICATE NUMBER: Cert ID 38937 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 LTR TYPE OF INSURANCE ADDL N SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR MKLV5ENV102559 10/25/2020 10/25/2021 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 51000 X Incid. Prof . Services X $10,000 SIR PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT PRO- LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ Per accident $ A UMBRELLA LIAB X OCCUR MKLV5EFX100624 10/25/2020 10/25/2021 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 X EXCESS LIAB CLAIMS -MADE DED T X RETENTION $ 10,000 $ 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 EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Cont. Pollution Liab. MKLV5ENV102559 10/25/2020 10/25/2021$25,000 SIR $ 1,000,000 A Environ. Impairment Liab. MKLV5ENV102559 10/25/2020 10/25/2021$25,000 SIR $ 11000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Manhole spraying for roaches at various city locations. It is agreed that the Costa Mesa Sanitary District, its elected and appointed officials, officers, agents, and employees are named as additional insureds as respects to General Liability per attached additional insured form only when required by written contract. CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD n o 4� 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District I� �ab (� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 290 Paularino Avenue AUTHORIZED REPRESENTATIVE Costa Mesa CA 92626 t%� ✓ �'/1.�'L ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD n o 4� 1 COMMERCIAL GENERAL LIABILITY III POLICY NUMBER: MKLV5ENV102559 MARKEL" EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. Section II — Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) to whom the insured agrees to provide additional insured status in a written contract, provided such written contract is signed by both parties and executed prior to the commencement of operations, 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. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract br 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", "property damage", or "personal and advertising injury" occurring after: 1. All work on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured at the location of the covered operations, including materials, parts or equipment furnished in connection with such work, 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. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: 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 will not increase the applicable Limits Of Insurance shown in the Declarations. All other terms and conditions remain unchanged. MEGL 1542 0516 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. POLICY NUMBER: MKLV5ENV102559 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 Organizations) Location And Description Of Completed Operations As required by written contract signed by both parties N/A and executed prior to commencement of 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III — Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and 1. Required by the contract or agreement; or included in the "products -completed operations hazard". 2. Available under the applicable Limits of Insurance shown in the Declarations; 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. CO 20 37 04 13 whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. O Insurance Services Office, Inc., 2012 Page 1 of 1 ENVIRONMENTAL POLICY NUMBER: MKLV5ENV102559 MARKET EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following, where indicated by an "X" in the checkbox(es) below: ® COMMERCIAL GENERAL LIABILITY COVERAGE FORM ® CONTRACTOR'S POLLUTION LIABILITY COVERAGE FORM ❑ PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM Please refer to each Coverage Form to determine which terms are defined. Words shown in quotations on this endorsement may or may not be defined in all Coverage Forms. The following is added to the Transfer Of Rights Of Recovery Against Others To Us condition: Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization with whom the Named Insured has agreed, in a written contract executed prior to the "occurrence" or "pollution condition", to waive such rights of recovery because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a written contract with that person or organization. All other terms and conditions remain unchanged. MEEI 2592 08 19 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. ENVIRONMENTAL POLICY NUMBER: MKLV5ENV102559 MARKET EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following, where indicated by an "X" in the checkbox(es) below: ® COMMERCIAL GENERAL LIABILITY COVERAGE FORM ® CONTRACTOR'S POLLUTION LIABILITY COVERAGE FORM ❑ PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM The following is added to the Other Insurance condition: Other Insurance This insurance will be primary and not contributory with any other insurance available to any person or organization under any other third party liability policy if required by a written contract, signed by both parties and executed prior to the commencement of operations or "your work". All other terms and conditions remain unchanged. MEEI 2591 08 19 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission.