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Insurance - C & R Drains Inc - 2022-05-17ACOR6' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) lllo...• -` 5/17/2022 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 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 NAME: Melissa IgnellS Burnham WGB Insurance Solutions PHONE FAX CA Insurance License OF69771(A/c No Extl: 714-450-1669 (Arc, Not. 714-573-1770_ _ E-MAIL mignelis@Mbib.com 15901 Red Hill Avenue Tustin CA 92750 POLICY JECT LOC — - -- .__..; _ INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Westchester Surplus Lines INSURED C&RDR-1 INSURER B: Middlesex Insurance Company 23434 C & R Drains, Inc -- — 1525 W. Macarthur Blvd.#11 wsuRER c Costa Mesa CA 92626 INSURER D: _ _- AUTOS _ AUTOS INSURER E: NON -OWNED X ;HIRED AUTOS X 'AUTOS INSURER F : COVERAGES CERTIFICATE NUMBER: 696104 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. 290 Paularino INSR ADDL SUER; POLICY EFF : POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY Y : Y A0179402004 9/10/2021 9/10/2022 EACH OCCURRENCE $ 1.000,000 l CLAIMS MADE X OCCUR _--_ DAMAGE TO RENTED PREMISES (Ea occurrence__$ 500,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000.000 PRO POLICY JECT LOC — - -- .__..; PRODUCTS -COMP/OP AGG $ 2.000,000 ---- -�-� -- OTHER: B AUTOMOBILE LIABILITY A0179402001 9/10/2021 9/10/2022 COMBINED SINGLE LIMIT $ (Ea accident) 1.000 000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED i SCHEDULED BODILY INJURY $ _ _- AUTOS _ AUTOS (Per accident) NON -OWNED X ;HIRED AUTOS X 'AUTOS PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ -- EXCESS LIABCLAIMS -MADE � �-- ---- --- _ ------ AGGREGATE $ DED RETENTION $ $ B !WORKERS COMPENSATIONA0179402005 9/10/2021 9/10/2022 X PER OTH- AND EMPLOYERS' LIABILITY Y / N . STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 I OFFICER/MEMBER EXCLUDED? N / A — --- -- j (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under—_ -- DESCRIPTION OF OPERATIONS below j E.L. DISEASE -POLICY LIMIT $ 1,000,000 A j Pollution Liability G71117200004 9/9/2021 9/10/2022 Each Pollution Condit $1,000,000 General Aggregate $2,000,000 Deductible $2.500 DESCRIPTION OF OPERATIONS ! LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is named as additional insured per the attached endorsements as required by written contract and subject to the terms & conditions of the policy: GL Additional Insured - Primary and Non- Contributory per Form CG20120509 & CAS50010717 GL 30 -day Notice of Cancellation per Form ADF90270418 GL Waiver of Subrogation per Form CAS4008 0110 See Attached... CERTIFICATE HOLDER CANCFLLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 61147— Pf� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District 290 Paularino AUTHORIZED REPRESENTATIVE Costa Mesa CA 92626 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: C&RDR-1 LOC #: ACOR" ADDITIONAL REMARKS SCHEDULE i6_� Page 1 of 1 AGENCY Burnham WGB Insurance Solutions NAMED INSURED C & R Drains, Inc 1525 W. Macarthur Blvd.#11 Costa Mesa CA 92626 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE HOLDER VESTING: The Costa Mesa Sanitary District, its elected and appointed officials, agents, officers, volunteers and employees Policy shall not terminate, nor shall it be canceled nor the coverage reduced, until thirty (30) days after written notice is given to the District, except 10 Days for Nonpayment - Endorsements to follow ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: A0179402004 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 Any person or organization you are required to add as All locations and jobs performed that have a written an contract, agreement or permit additional insured under a written contract or agreement in effect prior to any accident, injury, loss or damage 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" 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. CG 20 37 0413 A0179402 Middlesex Insurance Company 1 00001 0000000000 21252 0 N 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 eefdefa4-01 fc-4585-919f-3cdcfbcd712c Page 1 of 1 09/09/2021 POLICY NUMBER: A0179402004 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization you are required to add as All locations per written contract, agreement or permit an Description: additional insured under a written contract or All jobs performed that have a written contract, agreement agreement or permit in effect prior to any accident, injury, loss or damage 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. CG 20 10 04 13 A0179402 Middlesex Insurance Company 1 00001 0000000000 21252 0 N B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. 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. © Insurance Services Office, Inc., 2012 048a3e96-a73f-4d8e-9506-64e32f208df3 Pagel of 2 09/09/2021 C. 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 applicable Limits of Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 A0179402 Middlesex Insurance Company shall not increase the Insurance shown in the CG 20 10 04 13 09/09/2021 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 0104 13 A0179402 Middlesex Insurance Company 1 00001 0000000000 21252 0 N (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. © Insurance Services Office, Inc., 2012 d147d55f-1610-4341-b869-4e847a71bb72 Page 1 of 1 09/09/2021