Insurance - American Building Janitorial, Inc 2022-01-18AMER114
DATE(
0111812022Y)
12022
CERTIFICATE OF LIABILITY INSURANCE
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 562-595-5355
Driscoll & Assoc Ins Svcs Inc.
CA. License OB99775
CONTACT Kerry M. Driscoll
PHONE 562-595-5355 FAX 562-427-6069
(A/C, No, Ext): (AIC, No)_
_ed__--
A DRESS: drisckerrp@oIIinsur.co_m
P O Box 92526
Long Beach, CA 90809-2526
Kerry M. Driscoll
INSURERS AFFORDING RAGE NAIC #
INSURERA: Nationwide Ins Co
INSURED
American Building Janitorial, Inc
INSURERB : State Compensation Ins Fund 135076
5527 South St.
INSURER C :
INSURER D
Lakewood, CA 90713
INSURER E :
INSURER F :
C()VFRAGFS CFRTIFICATF NIIMRFR- RFVISIC)m 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
SUB
WVD
POLICY NUMBER
POLICY EFF
MMIDD
POLICY EXP
MMIDD
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAINIS-MADE FX� OCCUP
X
ACP 3047104810
04/01/2021
04/01/2022
EACH OCCURRENCE $ 1,000,000
DAMAGETOEa ccurDence7 $ 300,000
IN,1ED ECP {Any one person $ 10,000
PERSONAL & ADJ INJUP'f $ 1,000,000
'L AGGREGATE 1MIT APPLIES PER
- EC�T -'��
('3ENEPAL AGGREGATE � $ 2,000,000
HGEN
PR. -DU .T :OI,rP,'OP A G j $ 2,000,000
OTHER
A
,AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT 1,000,000
Ea accidentti $
eoDILY IrIJUR',' tPer person $
_
ANY AUTO
OUVNED SCHEDULED
AUTO vPdL`% Ali ITOS
ACP 3047104810
04/01/2021
04/01/2022
)DIL'� IN JR`(' Per acc ent' j — _
X
HIDED X NON -OWNED
AUTOS ONLY AUTOS � ONLY
PROPERTY DAMAGE
'Per accident $
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE $
AGGREGATE $
EXCESS LIAB
CLA1IA-'-,-1VADE
DED F1 RETENTIOr-4 $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
YIN
ANY'PROPRIETORIPARTfvER1E E�CUTV',lE
OFFICERfMEMBER EXCLUDED? ��
(Mandatory in NH)
N 1 A
9122194-2022
01/08/2022
01/08/2023
X EATIJTE ER H
E.L. EACH ACCIDENT $ 1,000,000
E L DISEASE - EA. EMPLO`r EE $ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS bp[-(JkN
- ---------- —- ---- -1,000,000
EL DISEASE - POLICY LINAT 1
i
i
i
I
DESCRIPTION OF OPERATIONS I LOCATIONS I 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 listed as additional insured per the
attached endorsement
COSTA-5
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
A THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Costa Mesa Sanitary District ACCORDANCE WITH THE POLICY PROVISIONS.
290 Paularino Ave. I aU�Vr
Costa Mesa, CA 92626 AUTHORIZED REPRESENTATIVE
ACORD 25 (2016103) @ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS ENHANCEMENT PLUS ENDORSEMENT
INCLUDING MEDICAL PAYMENTS
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Lost Key Coverage
1 Under Section |—Coverages, Coverage
Bodily Injury And Property Damage
Liability, coverage is extended to include
the following*.
If m customer's master or grand key`
excluding electronic key oanj is |ost,
damaged or stolen while in your omns,
custody or control we will pay the cost of
replacing the keys, including the master lock
and all keys used in the same lock, the cost
oyadjusting locks toaccept the new keys, or
the coot to replace the |ooks, whichever is
less.
2. Limit of|nsurmnce—Forthepurpoeeofth|s
coverage the most we will pay is $ 10.000
per"occurrenoe"
B. Voluntary Property Damage
1. Section | — Coveregem,CwvemmgeA Bodily
Injury And Property Damage Liability
coverages extendedoinc|udetheYo|lowing:
At your roqueat, we will pay for "property
damage" toproperty ofothers caused byyou
and while inyour possession, do(ngoutofyour
business operotonmandoccurring during the
pohoyper|od.
2. Limit mfInsurance — For the purpose ofthis
coverage the most wewill pay is $1.500per
following -
D. Expanded Property Damage Coverage
I. For the purposes cfthis endorsement on��
Section | — Coverages, Coverage A
Bodily Injury And Property Damage
L|mbUity, 2. Exclusions, Exclusion J.
Damage ToProperty |oamended asfollows:
a. Poragrepha(3). (5), and are deleted
intheir entirety.
b. Paragraph (4) is deleted in its entirety
and replaced with:
(4) Personal property in the cane.
custody, orcontrol oythe insured*
(m) for storage or sale at premises
you own, rent or occupy; or
(b) while being transported by any
aircraft. ''auto" or watercraft
owned oroperated by or rented
tonrloaned toany insured.
c. The coverage provided by this
endorsement does not apply to
"property damage",
(1) Arising out of the disappearance or
loss ofuse ofpersonal property, or
(2) Included in the "products -completed
operations hazard".
2. Limit of Insurance -Tha most we will pay
for loss arising out of any one "occurrence"
ie$5.00O
C. Non -Owned Watercraft 3. Deductitle-Dmobligationtopay fora
Under Section | — Coverages, Coverage A covered loss applies only tnthe amount of
Bodily Injury And Property Damage Liability, loss |nexcess of$25O
2. Exclusions, Exclusion B. Aircraft, Auto Or We will pay the deductible amount io effect
Watercraft Paragraph (2) (m) is replaced with: settlement of any claim or "suit" and, upon
notifioat|onofthi�aotionh�vingbe�nLaken
�m)Le�mth�n51#set/ong�and '
you shall promptly reimburse us for the
deductible aehas been paid byus.
CG 73 23 12 16 Includes copyrighted material ofInsurance Services Office, Inc.: Page of
with its permission,
The insurance is primary to any expanded
property damage coverage provided by o
separate endorsement attached to this
po|icy, and itwill supplant any deductible |n
said endorsement
E. Damage To Premises Rented ToYou
1Under Section |— Coverages, Coverage A
Bodily Injury And Property Damage
Liability, the last paragraph of 2.
Exclusions |sreplaced vvith�
If Damage To Premises Rented To You is
not otherwise exc|udod. Exclusions o.
through n. do not apply to damage by fire,
||Qhtn|nQ, exp|oo|on, mmoke, or sprinkler
leakage to premises while rented to you or
temporarily occupied by you with permission
ofthe owner.
2. Under Section R| — Limits Of Insurance,
Paragraph 8hsreplaced with-
6. Subject to S. above, the Damage To
Pnarnieeo Rented To You Limit is the
most we will pay under Coverage Afor
damages because of "property damage"
to any one pnam|ees, vvh||e rented to
you. or in the case of damage by fire,
lightn|ng, exp|oo|on, smoke or sprinkler
\eakage, while rented to you or
temporarily occupied by you with
permission of the owner. The limit is
increased toS1.0JO.O0]
3. Under Section IV — Commercial General
Liability Conditions, 4. Other Insurance, b.
Excess Insurance (1) (m) (|i) is replaced
with:
(iiii) That is Fire. L|ghtning, Explosion, Smoke
or Sprinkler leakage insurance for
premises rented to you or temporarily
occupied by you with permission of the
owner.
F. Supplementary Payments
Under Section I — Coverages, Supplementary
Payments — Coverages A and B Paragraphs
I.bond I.d. are replaced with:
b. Up to 82.500for coat of bail bonds required
because ofaccidents ortraffic law violations
arising out of the use of any vehicle to which
the Bodily Injury Liability Coverage applies.
VVedonot have tofurnish these bonds.
Page 2 of 6
d. All reasonable expenses incurred by the
insured at our request to assist us in the
investigation or defense of the o{airn or
"suit'.including actual loss ofearnings upto
$5OOaday because oYtime off from work.
G. Newly Formed And Acquired Organizations
Under SECTION 11 — WHO IS AN INSURED
Paragraph 3.m.ioreplaced with:
m. Coverage under this provision is afforded
only until the 180t^ day after you acquire or
form the organization orthe end ofthe policy
period, whichever |oeor|ier�
H. Additional Insured —Auhmrnatim Status When
Required In An Agreement OrContract With
You
Section U —Who Is An Insured is amended to
include:
1 Any pereonNAororganizaton(s)described
|nParagraph m.—d.below with whom you
have agreed in writing in a contract or
written agreement that such person or
organization beadded asonadditional
insured on your policy during the policy
period shown in the Declarations.
2. Any other person or organization you are
required to add as on additional insured
under the contract oragreement described
|nParagraph 1.above.
The person or organization added as an
insured by this endorsement is an insured
only for liability due to:
m. Lessors of Leased Equipmmnt—vvith
respect totheir liability for "bodily injury",
"property damage", or "personal and
advertising in]uryr, caused in whole or|n
part by your maintenance, operad|on, or
use ofequipment leased toyou bysuch
person(s) or organization(s) This
insurance does not apply to any
^ocnurrenne"which takes place after the
equipment lease expires.
However, their status an additional
insured under this policy ends when
their |ease, oontnaci, or agreement with
you for such leased equipment expires.
b. Managers or Lessors of Premises —
with respect to ||ab||ih/ arising out of the
ovvnerahip, nnaintenance, or use ofthat
part of the premises you own, rent,
lease, or occupy.
Includes copyrighted motoria|ofInsurance Services Office, |nu.
with its permission.
AcpmLO3057104810 LmCp 20076 INSURED COPY 47 0002612
This insurance does not apply to�
(1) Any "occurrence" which takes place
after you cease to be a tenant in
that premises,
(2) Structural a|teret|ons, new con-
struction, or demolition operations
performed by or on behalf of the
person ororganization.
However, their status as additional
insured under this policy ends when you
cease tobeatenant ofsuch premises.
c. State or Political Subdivision —
Permits Relating to Premises — with
respect to the following hazards for
which the state or political subdivision
has issued a permit orauthorization in
connection with premises you own, rent,
or control and to which this insurance
(1) The existenoe, maintenance, repair,
oonatruction, erection, or removal of
advertising signs, avvninQs,
canopiea, cellar entranoes, oua|
ho|ea, dMvewayo, nnunho|ea,
manluees, hoist away openings,
sidewalk vou|ts, street bannere, or
decorations and similar exposures-.
or
(2) The oonstruction, ereotion, or
removal oyelevators; or
(3) The ownership maintenance oruse
of any elevators covered by this
insurance.
This insurance does not apply to,
(1) "Bodily injury" or"property damage"
or "persona( or advertising injury"
arising out of operations performed
for the state or municipality; or
(2) "Bodily injury" or "property damage"
included within the ^produots-
cornp|etedoperations hazanj"
Hovvever, such state or political
subdivision's status as additional
insured under this policy ends when the
permit ends,
d Ommers. Lessees. or Contractors —
with respect to liability for "bodily injury",
"property damage''. or ''persona/ and
advertising injury" caused in whole or in
(1) Your acts oromissions; mr
(2) The acts or omissions of those
acting on your behalf, in the
performance of your ongoing
operations performed for that
additional insured, whether the work
is performed by you or on your
behalf.
The insurance does not apply to-
(1) "Bodily injury", "property darnage^,
or "personal and advertising injury"
arising out ofthe rendering oforthe
failure to render any professional
architectural, engineering, or survey
services, including:
(a) The preparing, approvng, or
failing to prepare or approve
maps, shop drawings, opin|ons,
reports, sun/ey, field orders,
change orders, ordrawings and
specifications; or
(b) Bupen/iaory, inopoct|on, archi-
tectural orengineering activities.
This exclusion applies even if
the claims against any insured
allege negligence or other
wrongdoing in the eupew|e/on,
hir|ng, emp|oynnent, training or
monitoring of others by that
inaured, if the "occurrence"
which caused the "bodily injury"
or "property damage^, or the
offense vvMoh caused the
''personal and advertising
irjury''. involved the rendering
of, or failure to nsnder, any
pro[ems|nna|, aruhiteotura|,
enQ|neering, or surveying
services.
(2) "Bodily in]ury'or"property damage"
occurring aDer�
(m) All work, including rnateria|s,
pahs, orequipment furnished |n
connection with such work, on
the project (other than semios,
rna|nhenanoe, or repairs) to be
performed byoronbehalf ofthe
additional insured(s) at the
location of the covered
operations has been completed,
or
Includes copyrighted material of|nsuenceSewicnsOffioe.|nc. Page 3of5
(b) 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 m
part oYthe same project.
However,m person ororganizudon's
status as additional insured under
this policy ends when your
operations for that additional insured
are completed.
With respect to the insurance afforded to
such additional insureds a. —d. described
above, the following is added to Section Y||
—Limits Of Insurance:
If coverage provided to the additional
insured is required by a contract or
agreement, the most vvewill pay onbehalf of
the additional insured is the amount of
insurance:
1. Required bythe contract oragreement;
or
2. Available under the applicable L|rn|1a of
Insurance shown inthe Declarations:
whichever isless.
This endorsement shall not increase the
applicable Limits oYInsurance shown |nthe
Declarations.
However. the insurance afforded to such
additional insureds o.—d.described above,
I. Only applies tothe extent permitted by
law, and
2. Will not be broader than that which you
are required by the contract or
agreement toprovide for such additional
insured.
3. Primary and Noncontributory — Other
Insurance Conditions
The following is added to the Other
Insurance Condition and supersedes any
provisions tothe contrary�
Primary and Noncontributory Insurance
This insurance is primary to and will not
seek contribution from any other insurance
available toanadditional insured under your
policy provided that:
m. The additional insured is a Named
Insured under such other insurance* and
Page 4 of 5
b. You have agreed |nwriting |nacontract
or agreement that this insurance would
be primary and would not seek
contribution from any other insurance
available tothe additional insured.
Employee Bodily Injury ToAnother Employee
Under Section U —Who Is An Insured The
following |eadded bzParagraph 2.a.(1):
Paragraphs 2.a-(1)(m)` (b) and (c) do not apply
to "bodily in]uq/' to a co -"employee" in the
course of the co -"employee's" employment by
you, or to "bodily injury" to a co -"volunteer
vvorker" while performing duties related to the
conduct ofyour business.
J. Broad Form Named Insured
Under Section U —Who Is An Insured The
following |aadded toParagraph 2.:
e. Any bma|neae entity incorporated or
organized under the |ovvo of the United State
of America (including any State theneoD, its
territories or possessions, or Canada
(including any Province thereof) inwhich the
Named Insured shown in the Declarations
ovvns, during the policy period, an interest of
more than fifty percent. If other valid
collectible insurance is ows||eb(e to any
business entity covered by this solely by
reason ofownership bythe Named Insured
shown in the Declarations in excess oYfifty
percent. this insurance is excess over the
other insurance, whether prinnary, excess,
contingent, oronany other basis.
K. Aggregate Limit Per Location
Under Section I|| — Limits Of Insurance the
following |eadded toParagraph 2:
The General Aggregate Limit under Section |||
Limits Of Insurance applies separately to each
of your locations owned by or rented to you or
temporarily occupied by you with the permission
of the owner. For the purposes ofthis provision,
location means premises involving the same or
connecting |ots, or premises whose connection
is interrupted only by o public otreet, roadway,
waterway orrailroad riQht-of-vvay.
L. Aggregate Limit Per Project
Under Section U|— Limits Of Insurance The
following paragraph isadded toParagraph 2:
The General Aggregate Limit under Section |||
Limits Of Insurance applies separately to each
of your construction projects away from
premises owned byorrented toyou.
Includes copyrighted material ofInsurance Services Office, |nc.
with its permission.
m:pmLm3057104810 Lmop 20076 INSURED COPY 47 0002614
M. Medical Payments
Under Section U| — Limits Of Insurance,
Paragraph 7.ioreplaced with:
7. Subject to S. above, the higher of -
a.
Eel
b. The amount shown |n the Declarations
for Medical Expense Limit is the most
we will pay under Coverage C for all
medical expenses because of "bodily
injury" sustained byone person.
This coverage does not apply if Coverage
— N4edinm| Payments is excluded either by
the provisions of any coverage forms
attached tothe policy orbyendorsement.
Knowledge OfAnOccurrence
Under Section QY — Commercial General
Liability Cnnditimnm, the following is added to
2. Duties In The Event Of Occurrence,
Offense, Claim OrSuit:
e. Knowledge of an oocurrence, offemae, claim
or suit by an agent or employee of any
insured shall not in itself constitute
knowledge of the insured unless you, a
partner. if you are a partnership; or an
executive officer or insurance manager` if
you are a corporation receives such notice
ofmnoccurrence, offense, claim orsuit from
the agent oremployee.
f. The requirements in Paragraph b. will not
be considered breached unless there is
knowledge of occurrence as outlined in
Paragraph e.above.
Unintentional Failure To Disclose Hazard
Under Section IV — Commercial General
Liability Cmndit|ons, Condition 6.
Representations the following paragraph is
added�
d. Your failure to dimn|oes all hazards or prior
^000urrences"oroffenses existing asofthe
inception date of the policy shall not
prejudice the coverage afforded by this
policy provided such failure to disclose all
hazards orprior "oocurrences'oroffenses |s
not intentional. This provision does not
affect our right to collect additional premium
or exercise our right of cancellation or non -
renewal.
P. Waiver Of Subrogation
Under Section IV — Commercial General
Liability Conditions, 8. Transfer Of Rights Of
Recovery Against Others To Ws the following
paragraph |sadded:
|frequired bymwritten contract executed prior to
|ose, we waive any right of subrogation we may
have against the contracting person or
organization because of payments we make for
injury or damage arising out of your ongoing
operations or"your work" done under a contract
with that person or organization and included in
the ^produota-comp/etedoperations hazard^
Q. Liberalization
Under Section R/ — Commercial General
Liability Conditions, the following paragraph is
added-
10. Liberalization
If we nav|ae this coverage form to provide more
coverage without additional premium charge,
your policy will automatically provide the
additional coverage as of the day the revision is
effective |nyour state.
R. Broadened Bodily Injury Definition (Mental
Anguish)
Under Section \/ — Definitions Definition 3.
"Bodily Injury" isreplaced with:
3. "Bodily injury" means phye/oe| in]ury,
s|ckness, or disease to a person and if
arising out oYthe foregoing, mental anguish,
mental injury, shook, or hurniUation,
including death at any time resulting
therefrom.
All terms and conditions ofthis policy apply unless modified by this endorsement.
Includes copyrighted matehm|ofInsurance Services Office, /nc.
Page 6 of 5