Loading...
Insurance - Golden Bell Products, Inc. 2021-09-23AC"R®r CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 09/23/2021 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain polic' require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ,]V PRODUCER Van Beurden Ins. Serv, Inc. - Kingsburg E CONTACT NAME: Recia Shelton - ---- - — ----,----------------- T_____— PHONE FAX PO Box 67 2 7 2021 A/C No Ext: (559) 897-2975 ___J1A/C,Noj; (559) 897-4070_-- E-MAIL Kingsburg CA 93631 ADDRESS:— INSURER(S) AFFORDING COVERAGE ! NAIC # hosts 11�Iesa `�ai!ltary - _ -I-------- Evanston Insurance Company__ 35378 - � -__-___ —_ DistriCtINISURERA: INSURED (714) 630-3861 - _ Golden Bell Products, Inc. INSURERS: --- ----- ------------- INSURER C : - -- — - - P.O. Box 366 --------- - -- ---- ------ --- INSURER D : INSURERE: --- Atwood CA 92811 - --- ----- INSURER F : aRWiv.4.'C_L1"00% , 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 -- ADDL.;SUBR'-- TYPE OF INSURANCE N D WVD --_--_-v POLICY NUMBER POLICY EFF POLICY EXP MM/DD/YYYY i MM/DDlYYYY ----------------- -- - -- LIMITS A X COMMERCIAL GENERAL LIABILITY j EACH OCCURRENCE_ 1 $ 1, 000,000 t 1_- CLAIMS MADE M OCCUR � MKLV5ENV103230 _ DAMAGE TO RENTED 10/25/2021, 10/25/2022; PREMISES (Ea occurrence) i $ 50,000 X.I Incid. Prof . Services - ! MED EXP (Any one person) $ 5,000 XI $10, 000 SIR L_ --- _-- ---- -- - -- j ! PERSONAL INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: --.. XPRO _ I GENERAL AGGREGATE -- 1 $ 2,000,000 y POLICY JECT _-_-- _, LOC ( PRODUCTS COMP/OP AGG ! $ 2, 000, 000 'OTHER: ( I j � t-$ -----_ AUTOMOBILE LIABILITY !I COMBINED SINGLE LIMIT $ �_La accidentl - - ANY AUTO i ! BODILY INJURY (Per person) $ ' � ALL OWNED SCHEDULED _ AUTOS AUTOS BODILY INJURY (Per accident) I $ HIRED AUTOS NON -OWNED I �- i _� AUTOS i j PROPERTY DAMAGE -� - - Per accident $ M-- ---� ----- ---- A UMBRELLA LIAB X OCCUR -"t MKLV5EFX100835 10/25/2021110/25/20221 EACH OCCURRENCE $ 2,000,000 G---- X EXCESS LIAB -------------_. -- L—_ - CLAIMS-MADE ! I AGGREGATE i$ 2,000,000 DED 1 X` RETENTION $ 10,0001j I$ WORKERS COMPENSATION ! AND EMPLOYERS' LIABILITY ( I PER 1OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N I OFFICER/MEMBER EXCLUDED? N / A _LSTATUTE_ __-� r -- -- I I E L. EACH ACCIDENT $ (Mandatory in NH) If _ F.L. DISEASE - EA EMPLOYE $ - - - yes, describe under I DESCRIPTION OF OPERATIONS below ( I- ------- - - ------------- I E.L. DISEASE - POLICY LIMIT 1 $ _ A Cont. Pollution L'iab. MKLV5ENV103230 i10/25/2021;10/25/2022;$25,000 SIR $2M Agg/1M Oc A Environ. Impairment Liab. ( MKLV5ENV103230 ! 110/25/2021!10/25/2022!$25,000 SIR S2M Agg/lM Oc 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. Ur-K I It-IUA I t MULUtK CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE f I ( THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa Sanitary District �� ACCORDANCE WITH THE POLICY PROVISIONS. - 290 Paularino Avenue AUTHORIZED REPRESENTATIVE Costa Mesa CA 92626 `%'' ✓ /~'L © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY POLICY NUMBER: MKLV5ENV103230 MARKED 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 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", "property damage", or "personal and advertising injury" occurring after: 1. All work o,n 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 05 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. POLICY NUMBER: -MKLV5ENV103230 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. err • - � � �- MAI fo- • - �� 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 Organization(s) Location And Description Of Completed Operations As required by written contract signed by both parties N/A and executed prior to commencement of operations. 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: 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 Page 1 of 1 CG 20 37 04 13 ~ ^ . ENVIRONMENTAL POLICY NUMBER: MKLV5ENV1O323O : ����������7����� INSURANCE �������������� u�o�u�m��� ~~ � ~ ~^ ~~� ^ �� ^ ` ^^ �~~~~^ ^^ ^^ ~~~�� COMPANY ^ ^^ ~ ^ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ |TCAREFULLY. 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 |aadded tothe Other Insurance condition: Qther|nnurenoe This insurance will be primary and not contributory with any other insurance available to any person or organization under any other third party UabUKx policy if required by a written oontnact, signed by both parties and executed prior to the commencement ofoperations or"your vvork". All other terms and conditions remain unchanged, K8EB2BS1 08 19 Includes copyrighted material of Insurance 8nnvi000 Office, Inc., Page 1 of ENVIRONMENTAL POLICY NUMBER: MKlV5ENV103230 MARKED 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: Z 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. MEET 2592 08 19 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission.