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Insurance - Vortex Industries 2021-06-28AC"RU° CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 6/28/2021 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(les) 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 CONTACT Arthur J. Gallagher & CompanyFAX Arthur J. Gallagher & Co. Insurance Brokers of CA Inc. LIC #0726293 PHONE A/C No Ext): 949-349-9800 A/C No): 818-539-2301 A DRIESS: 18201 Von Karman Ave Suite 200 INSURER(S) AFFORDING COVERAGE NAIC # Irvine CA 92612 INSURER A: Old Republic Insurance Com any 24147 OTHER: INSURED VORTIND-01 INSURER B: Vortex Industries, Inc. I ANY AUTO Vortex Colorado, Inc. INSURER C: j INSURER D: 20 Odyssey Irvine CA 92618 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 974811163 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 TYPE OF INSURANCE ADDL SUER LTR D POLICY NUMBER POLICY EFF POLICY EXP MM/DD/YYYY MM/DD/YYYY LIMITS A i)( !COMMERCIAL GENERAL LIABILITYY 1 MWZY30779921 7/1/2021 7/1/2022 EACH OCCURRENCE $1,000,000 CLAIMS-MADEX OCCUR � � � DAMAGE TO RENTED j i PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 I T —— I � PERSONAL &ADV INJURY $ 1,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER: j I GENERAL AGGREGATE $ 2,000,000 POLICY JELOC i PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: j i Ultimate Gen Agg $ 10,000,000 A AUTOMOBILE LIABILITY Y j MWTB30780021 7/1/2021 7/1/2022 COMBINED SINGLE LIMIT $1,000,000 Ea accident) (Ea I ANY AUTO INJURY (Per person) $ OWNED SCHEDULED — BODILY INJURY (Per accident) ! $ T AUTOS ONLY AUTOS X HIREDX NON -OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY j (Per accident) Comp/Coll Ded $ 2501$500 UMBRELLA UAB OCCUR iEACH OCCURRENCE $ j EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED( TER ENTION $ i$ A WORKERS COMPENSATIONY MWC30779821 7/1/2021 7/1/2022 (X PER OTH- (STATUTE ER AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED?N / A (Mandatory in NH) ! E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT i $ 1,000,000 I I ! I I i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is included as additional insured/primary non-contributory on the general liability policy, per the attached forms CG20101219, CG20371219 and CG20011219. Waiver of subrogation applies to the certificate holder on the workers compensation, per the attached form WC0403060484. RE: Work performed by the named insured as required per written contract with respects to Costa Mesa Sanitary District. Certificate Holder(s) Continued: Costa Mesa Sanitary District, its directors, officials, officers, employees, agents and volunteers. CERTIFICATE HOLDER CANCELLATION t� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN /�-v l ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District 290 Paularino Avenue Costa Mesa CA 92626 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: MWZY30779921 COMMERCIAL GENERAL LIABILITY CG 20 11 1219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. m RDDITIONAL INSURED - MANAGERS OB LESSORS OF PREMISES I This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises (Part Leased To You): Where required by written contract Name Of Person(s) Or Organization( s) (Additional Insured): Where required by written contract Additional Premium: $ Included Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — 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 you or those acting on your behalf in connection with the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1- Any "occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule. 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 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 2011 12 19 0 Insurance Services Office, Inc., 2018 Page I of I MWZY 307799 20 Vortex Industries, Inc. 07/0112020 - 07/01/2021 POLICY NUMBER: MWZY30779921 THIS ENDORSEMENT CHANGES THE POLICY. P COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 E READ IT CAREFULLY. ,'I 1 0 'k 1* 0 0 S, LESSEES OR A I PERSON OR ik This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name Of Additional Insured Person(s) -Or Organization(s)_ i i Loca ions ) Of Covered Operations All persons and organizations as required by Mitten contract or - The locations as pecified in the written contracts or agreements agreement information required to Complete this Schedule, if not shown above, will e -shown in the Declarations. A. Section 11 — 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 B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insu "'property 1. All i equips work, M* comp 2. That injury RMT 2. If coverage provided to the additional insured is pnnc 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 12 19 0 Insurance Services Office, Inc., MWZY 307799 20 Vortex Industries, Inc. 07/0 ince does not apply to "bodily injury" or lamage" occurring after: ork, including materials, parts or ient furnished in connection with such on the project (other than service, iance or repairs) to be performed by or ialf of the additional insured(s) at the i of the covered operations has been ted; or :)rtion of "your work" out of which the )r damage arises has been put to its d use by any person or organization ian another contractor or subcontractor �d in performing operations for a it as a part of the same project. 111 - 07/01/2021 Page I of 2 C. With respect to the insurance afforded to these 2. AvailE additional insureds, the following is added to insurz Section III — Limits Of Insurance: whicheve If coverage provided to the additional insured is This er required by a contract or agreement, the most we applicably will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 le under the applicable limits of ce; is less. !dorsement shall not increase the .L limits of insurance. 0 Insurance Services Office, Inc., 20118 MWZY 307799 20 Vortex Industries, Inc. 07/01/2b2( - 07/01/2021 CG 20 10 12 19 POLICY NUMBER: MWZY30779921 THIS ENDORSEMENT CHANGES THE POLICY. PL COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 E READ IT CAREFULLY. ADDITIONAL INSURED - OWNEif CONTRACTORS - COMPLETE1 0 Ap=44 L This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE P SCHEDULE Name Of Additional Insured Person(s) Or ^- Location And All persons and organizations as required by written contract The locations as s or agreement agreements Information required to complete this Schedule, if not shown above. will A. Section 11 - 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". However: I. 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 37 12 19 Iption Of Completed in the-w-ritten contracts or shown in the Declarations. B. 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; whichever *less, This end rs ement shall not increase the i its ts of insurance. C Insurance Services Office, Inc., 201 MWZY 307799 20 Vortex Industries, Inc. 07/01/200 - 07/01/2021 Page I of I POLICY NUMBER: MWC30779821 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 0484) 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 0 % of the California workers' compensation premium otherwise due on such remuneration. PERSON OR ORGANIZATION AS REQUIRED PER CONTRACT SPECIFICATIONS TO THE EXTENT ALLOWABLE BY LAW SCHEDULE JOB DESCRIPTION ON FILE WITH COMPANY 1998 by the Workers! Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers! Compensation Insurance Forms Manual 1999. INSURED COPY