Insurance - Jimni Systems, Inc. - 2021-04-06Ac�oRo® CERTIFICATE OF LIABILITY INSURANCE
DATE (MWDD/YYYY)
4/6/2021
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
Bowermaster & Associates
10805 Holder St
Ste 350
NAME: Llzette Orozco
rMUNM714-733-6200 FAX
(A/C, No, Ext): A/C, No):
ADDRESS: lorozco@bowermaster.com
Cypress CA 90630
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Admiral Insurance Company
24856
INSURED SOCPAC-002
Jimni Systems, Inc.
11161 Jeffrey Rd
Irvine CA 92602
INSURER B : Praetorian Insurance Company
37257
INSURER C : AmGuard
42390
INSURER D : Travelers Casualty & Surety Company
24066
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 687403904 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
IANSD
WVD
POLICY NUMBER
(MWDDNYYY)
(MWDDNYYY)
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCUR
Y
FEIECC21334-06
4/1/2021
4/1/2022
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 50,000
MED EXP (Any one person)
$ 5,000
AGGREGATE LIMIT APPLIES PER:
POLICY 11 I ( ' LOC
I JE1CT ECT l�
OTHER:
PERSONAL & ADV INJURY
$ 2,000,000
GEN'L
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS -COMP/OP AGG
$ 2,000,000
$
C
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED X SCHEDULED
AUTOS ONLY AUTOS
HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
JIAU265871
4/1/2021
4/1/2022
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
A
UMBRELLA LIAR
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
FEIEXS21335-06
4/1/2021
4/1/2022
EACH OCCURRENCE
$ 5,000,000
X
AGGREGATE
$ 5,000,000
DED RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/N
ANYPROPRIETOR/PARTNER/EXECUTIVE M
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yyes describe under
DESCRIPTION OF OPERATIONS below
N / A
Y
EQB0102429
4/1/2021
4/1/2022
XPE
STATUTE ERH
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
D
Crime
106875312
2/15/2019
2/15/2022
Retention:1,000
50,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Project: 23rd, Mendoza, Adams, Iowa, Gisler, South Coast Plaza
DISTRICT, its directors, officials, officers, employees, agents, and volunteers shall be covered are Additional Insured as respects to General Liability; coverage
is Primary and non-contributing, per attached forms. Waiver of Subrogation applies to Workers Compensation per attached endorsement form.
CERTIFICATE HOLDER CANCELLATION
�' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Costa Mesa Sanitation District
290 Paularino Avenue
Costa Mesa CA 92626 AU HOR ZED REPRESENTATIVE
WE
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06
(Ed. 04-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA
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. (This agreement applies only to the extent that you perform work
under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work
described in the Schedule.
The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on
such remuneration.
Schedule
Any person or organization for which you have agreed to waive your rights of recovery in
written contract, provided such contract was executed prior to date of loss.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective 0 4/ 01 / 2 0 21 Policy No. EQB 010 2 4 2 9 Endorsement No. 000
Insured JIMNI SYSTEMS INC
Insurance Company PRAETORIAN INSURANCE COMPANY
Countersigned By
EQB0102429 20210401 000
Jimni Systems, Inc.
Endorsement Number: 20
Additional Insured - Owners, Lessees or Contractors -
Completed Operations
This endorsement, effective 04/01 /21 attaches to and forms a part of Policy Number
FEIECC21334-06 - This endorsement changes the Policy. Please read it carefully.
In consideration of an additional premium of $Applied this endorsement modifies insurance provided
under the following:
W"TTPnTn .P
Name Of Additional Insured Person(s) Location And Description Of Completed
Or OrLyanization(s): I Operations
Any person(s) or organization(s) whom the Named Insured Those project locations where this
agrees, in a written contract, to name as an additional insured. endorsement is required by contract.
However, this status exists only for the project specified in that
contract.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section ll — 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 and included in the "products -
completed operations hazard".
CG 20 37 07 04 O ISO Properties, Inc., 2004
Jimni Systems, Inc.
Endorsement Number: 19
Additional Insured - Owners, Lessees or
Contractors - Scheduled Person or Organization
This endorsement, effective 4/1/2020 attaches to and forms a part of Policy Number
F FEIECC21334-05 1 This endorsement changes the Policy. Please read it carefully.
In consideration of an additional premium of $Applied, this endorsement modifies insurance provided
under the following:
0 . ,
i
Name Of Additional Insured Person(s)
Or Organization(s): I Location(s) Of Covered Operations
Any person(s) or organization(s) whom the Named Insured
agrees, in a written contract, to name as an additional insured.
However, this status exists only for the project specified in
that contract.
Those project locations where this
endorsement is required by 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:
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 additional exclusions apply:
CG 2010 0413 C ISO Properties, Inc.
FSTz-3-iFUTz-�
Jimni Systems, Inc.
Endorsement Number: 19
This insurance does not apply to "bodily injury" or "property damage"
occurring after:
L 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.
C. With respect to the insurance afforded to these additional insureds, the
following is added to Section III - Limits Oflnsurance:
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:
L Required by the contract or agreement; or
2. Available under the applicable Limits oflnsurance shown in the
Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in
the Declarations.
CG 2010 0413 C ISO Properties, Inc.
Jimni Systems, Inc.
nnM�Y� Endorsement Number: 13
�i78!lR�L C�yV1�M1YY!
Automatic Primary and Non -Contributory
Insurance Endorsement
Designated Work or Project(s)
This endorsement, effective 4/1 /2020 attaches to and forms a part of Policy Number
F FEIECC21334-052 This endorsement changes the Policy. Please read it carefully.
Name of Person or Organization:
Any person(s) or organization(s) whom the Named Insured agrees, in a written
contract, to provide Primary and/or Non-contributory status of this insurance.
However, this status exists only for the project specified in that contract.
In consideration of an additional premium of $Applied and notwithstanding
anything contained in this policy to the contrary, it is hereby agreed that this
policy shall be considered primary to any similar insurance held by third parties
in respect to work performed by you under any written contractual agreement
with such third party. it is further agreed that any other insurance which the
person(s) or organization(s) named in the schedule may have is excess and non-
contributory to this insurance.
ECC-548-0712