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Insurance - C & R Drains Inc - 2021-03-25 (2)AcoR" 0CERTIFICATE CERTIFICATE OF LIABILITY INSURANCE �' DATE D/YYYY) /25/2 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 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 Wood Gutmann & Bogart Insurance Brokers 15901 Red Hill Ave., Suite 100 Insurance License #0679263 CONTACT NAME: Melissa I nelis PHONE FAX A/C Eo Et): 714-450-1669 1 JA/C,No): 714-573-1770 E-MAIL ADDRESS: mignelis@wgbib.com INSURER(S) AFFORDING COVERAGE NAIC # Tustin CA 92780 INSURER A: Kinsale Insurance Company INSURED C&RDR-1 C & R Drains, Inc 1525 W. Macarthur Blvd.#11 INSURER B : Westchester Surplus Lines INSURER C: Insurance Company of the Wes4 27847 INSURER D : Nationwide Mutual Ins Co voor Costa Mesa CA 92626 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 2014730249 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 INSD SUBR WV POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 01000649032 4/11/2020 9/10/2021 EACH OCCURRENCE $1,000,000 CLAIMS -MADE �� OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ excluded PERSONAL & ADV INJURY $ 1,000,000 i AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GEN1 POLICY E ECOT- LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: D AUTOMOBILE LIABILITY ACPBA3039887550 9/10/2020 9/10/2021 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY (Peraccident) YDAMAGE $ NON -OWNED HIRED AUTOS Ix AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A WSD505051101 9/10/2020 9/10/2021 X STATUTE OERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Pollution Liability G71117200003 4/11/2020 9/10/2021 Each Pollution Condit $1,000,000 General Aggregate $2,000,000 Deductible $2,500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is named as additional insured per the attached endorsements as required by written contract and subject to the terms & conditions of the policy: GL Additional Insured - Primary and Non- Contributory per Form CG20120509 & CAS50010717 GL 30-day Notice of Cancellation per Form ADF90270418 GL Waiver of Subrogation per Form CAS4008 0110 See Attached... CERTIFICATE HOLDER CANCELLATION -y.,SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE _`��'/o THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District 290 Paularino AUTHORIZED REPRESENTATIVE Costa Mesa CA 92626 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACC)R 116.� AGENCY CUSTOMER ID: C&RDR-1 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Wood Gutmann & Bogart Insurance Brokers NAMED INSURED C & R Drains, Inc 1525 W. Macarthur Blvd.#11 Costa Mesa CA 92626 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE HOLDER VESTING: DISTRICT, its directors, officials, officers, employees, agents, and volunteers ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY TERMINATION NOTICE TO THIRD PARTY Attached To and forming Part of Policy Effective Date of Endorsement Named Insured 0100064903-2 04/11/2020 12:01AM at the Named Insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: $0 $0 This endorsement modifies insurance provided under the following: ALL COVERAGE FORMS The CANCELLATION section of the CONDITIONS section of this Policy are amended by adding the following: SCHEDULE Notice of Policy Termination To: Costa Mesa Sanitary District, 290 Paularino Avenue, Costa Mesa, CA 92626 If we send notice of termination of this policy to the insured, we will also send written notification of such termination to the person or organization shown in the Schedule above at the address shown above. We will mail this notice in accordance with the Cancellation and Nonrenewal terms and conditions of this policy. If notice is mailed, proof of mailing will be sufficient proof of notice. No policy rights are conferred to the person or organization shown in the Schedule above. Failure to provide notice as described in this endorsement shall impose no obligation or liability of any kind upon the Company. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. ADF9027 0418 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100064903-2 04/11/202012:01AM at the Named Insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: $0 $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State or Governmental Agency or Subdivision or Political Subdivision: Costa Mesa Sanitary District, 290 Paularino Avenue, Costa Mesa, CA 92626 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II —Who Is An Insured is amended to include as an 2. This insurance does not apply to: insured any state or governmental agency or subdivision a. "Bodily injury", "property damage" or "personal or political subdivision shown in the Schedule, subject to and advertising injury" arising out of operations the following provisions: performed for the federal government, state or 1. This insurance applies only with respect to operations municipality; or performed by you or on your behalf for which the state b. "Bodily injury" or "property damage" included or governmental agency or subdivision or political within the "products -completed operations subdivision has issued a permit or authorization. hazard". ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CG 2012 05 09 0 Insurance Services Office, Inc., 2008 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SCHEDULE ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100064903-2 04/11/2020 12:01AM at the Named Insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: $0 $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE SCHEDULE Name and Address of Additional Insured Person(s) or Organization(s): Costa Mesa Sanitary District, 290 Paularino Avenue, Costa Mesa, CA 92626 A. SECTION 11- WHO IS AN INSURED is amended to include any person or organization shown in the above Schedule as an Additional Insured but only for the vicarious liability imposed on the Additional Insured provided that such liability is caused by the sole negligent conduct of the Named Insured and is proximately caused by "your work" or "your product" for the Additional Insured. B. The insurance provided to the Additional Insured under this endorsement is limited as follows: 1. The insurance provided to the Additional Insured shall be excess with respect to any other valid and collectible insurance available to the Additional Insured unless the written contract specifically requires that this insurance apply on a primary and non-contributory basis, in which case this insurance shall be primary and non-contributory. 2. In the event the written contract requires Limits of Insurance in excess of the Limits of Insurance provided by this policy, the Limits of Insurance provided by this policy shall apply and not the limits required by the written contract. This endorsement shall not increase the Limits of Insurance stated in the Declarations of this policy. 3. This insurance does not apply to "bodily injury" or "property damage" arising out of "your work or "your product" included in the "products -completed operations hazard" unless you are required to provide such insurance by written contract. If required, then insurance is provided only for "bodily injury" or "property damage" that occurs during the policy period arising out of "your work" or "your product". 4. Where there is no duty to defend the Named Insured, there is no duty to defend the Additional Insured. Where there is no duty to indemnify the Named Insured, there is no duty to indemnify the Additional Insured. 5. This insurance does not apply to "bodily injury" or "property damage" arising out of: a. The sole negligence of the Additional Insured or any employee of the Additional Insured; or b. Any obligation of the Additional Insured to indemnify another because of damages arising out of such injury or damage. C. Duties of the Additional Insured in the event of "occurrence", claim or "suit": 1. The Additional Insured must promptly give notice of an "occurrence", a claim which is made or a "suit", to any other insurer which has insurance for a loss to which this insurance may apply. CAS50010717 Page 1 of 2 2. The Additional Insured must promptly tender the defense of any claim made or "suit " to any other insurer which also issued insurance to the Additional Insured as a Named Insured or to which the Additional Insured may qualify as an Additional Insured for a loss to which this insurance may apply. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS50010717 Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHER TO US Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100064903-2 04/11/2020 12:01AM at the Named Insured C & R Drains Inc address shown on the Declarations Additional Premium: Return Premium: $o $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE SCHEDULE Name of Person or Organization: Costa Mesa Sanitary District, 290 Paularino Avenue, Costa Mesa, CA 92626 SECTION IV — CONDITIONS, 8. Transfer of Rights of Recovery against Others to Us is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of "your work" done under a written contract with that person or organization wherein you have agreed to provide this waiver. This waiver applies only to the person or organization shown in the Schedule above and only to the extent of written agreement. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS4008 0110 Page 1 of 1