Loading...
Insurance - Dependable Graham 2021-05-04ACOR/O�DATE CERTIFICATE OF LIABILITY INSURANCE (MM/DD/YYYY) �. 5/4/2021 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). PRODUCERCONTACT Venture Pacific Insurance Services, Inc. 111 Corporate Drive Suite 200 Ladera Ranch, CA 92694 NAME: Venture Pacific Insurance Services, Inc. A/CNo Ext): 949-297-4900 AfC No): 949-297-4911 E-MAIL ADDRESS: info@vpisrisk.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Valley Fore Insurance Company / CNA 20508 www.venturepacificinsurance.com Lic# OD 10299 INSURED Dependable Graham Air Conditioning, Inc 2952 Century Place INSURER B: Continental Insurance Company/ CNA 35289 INSURER C: INSURER D: Costa Mesa CA 92626 INSURER E: INSURER F: COVFRAGFS CFRTIFICATF NIIMRFR- alr.997AA RFVICICIN NIIMRFR- 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 D POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A `/ COMMERCIAL GENERAL LIABILITY 6075714593 1/1/2021 1/1/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE [Z OCCUR DAMAGES ( RENTED PREMISES Ea occurrence) $ 100,000 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GEN'L PRO - POLICY ✓� JECT [:] LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY 6075714609 1/1/2021 1/1/2022 COMBINED SINGLE LIMIT $ Ea accident 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ B UMBRELLA LIAB �/ OCCUR 6075714612 1/1/2021 1/1/2022 EACH OCCURRENCE $5,000,000 AGGREGATE $ 5,000,000 f EXCESS LIAB CLAIMS -MADE DED RETENTION It $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ A Builder's Risk/Installation Floater 6075714593 1/1/2021 1/1/2022 $50,000 any single location $1000. ded. A Rented/Leased Equip 6075714593 1/1/2021 1/1/2022 $50,000 Limit; $500 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers and employees are additional insured pursuant to attached endorsement. "30 day notice of cancellation *10 day notice for nonpayment of premium CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 290 Paularino Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa CA 92626 .p� r�%a AUTHORIZED REPRESENTATIVE James Barton ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 61522746 I DEPEN-1 1 21-22 GL CAU UMB FLTR I Maureen Philen I 5/4/2021 8:54:39 AM (PDT) I Page 1 of 3 0 CNA CNA PARAMOUNT Changes -Notice of Cancellation or Material Restriction Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART EMPLOYEE BENEFITS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART STOP GAP LIABILITY COVERAGE PART TECHNOLOGY ERRORS AND OMISSIONS LIABILITY COVERAGE PART SPECIAL PROTECTIVE AND HIGHWAY LIABILITY POLICY - NEWYORK DEPARTMENT OF TRANSPORTATION SCHEDULE Number of days notice (other than for nonpayment of premium): 30 Number of days notice for nonpayment of premium: 10 Name of person or organization to whom notice will be sent: THE COSTA MESA SANITARY DISTRICT Address: 290 PAULARINO AVE. COSTA MESA CA 92626 i i nuen[ry appears apove, ine numper OT aays notice Tor nonpayment of premium will be 10 days. It is understood and agreed that in the event of cancellation or any material restrictions in coverage during the policy period, the Insurer also agrees to mail prior written notice of cancellation or material restriction to the person or organization listed in the above Schedule. Such notice will be sent prior to such cancellation in the manner prescribed in the above Schedule. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA74702XX (1-15) Page 1 of 1 VALLEY FORGE INSURANCE COMPANY Insured Name: DEPENDABLE GRAHAM AIR—CONDITIONING i INC Copyrlgtll CNA All Rights Reserved. 61522746 1 DEPEN-1 1 21-22 GL CAU UMB FLTR I Maureen Philen 1 5/4/2021 8:54:39 AM (PDT) ( Page 3 of 3 Policy No: 6075714593 Endorsement No: 32 Effective Date: 01/01/21 OCAIRCO-01 t_At1RFN CERTIFICATE O F LIABILITY INSURANCE DAT5/4/2 D/YYYY) 5/4/2021 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 Goodman Insurance Services, Inc. 27042 Towne Centre Drive, Suite 120 Foothill Ranch, CA 92610 CONTACT NAME: a/cONE Ext): (949) 769-3100 FAX No):(949) 769-3930 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [:] OCCUR INSURER A: Preferred Professional Insurance Comi3any 36234 INSURED INSURER B: INSURER C : Dependable Graham Air Conditioning, Inc. 2952 Century Place Costa Mesa, CA 92626 INSURER D : INSURER E : INSURER F: COVERAGES CERTIFICATE NI]MRFR• QwlclnKI KII InnRcc• 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 WVD POLICY NUMBER POLICY EFF MM/DD/YYYY) POLICY EXP (MM/DDNYYYI LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [:] OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES occurrence) $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FI JE0 F] LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Perperson) $ ANY AUTO OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS HIRED NON ED AUTOS ONLY AUT05 ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB _ CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE �Y / N ANY OFFICER/MEMBER EXCLUDED? ' I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A ON09996-01 7/1/2020 7/1/2021 X PER OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Proof of Insurance Certificate holders continued: Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees CERTIFICATE HOLDER rANC_FI I ATInN ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District �^yQ� 290 Paularino Avenue J/ V THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa, CA 92626 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD