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Insurance - Mike Kilbride, Ltd. - 2022-10-25CERTIFICATE OF LIABILITY INSURANCE fDATEMM/DDtYYYY) [:l0 22 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 GMGS Risk Management & Insurance Services NAME: cT Charise Ferguson 6201 Oak Canyon, Suite 100 PHONE �— - ----- - Irvine, CA 9261$ _ _ (949)559-3367 i (G,(' H.,1. rraurctKI51 AFFORDING COVERAGE I www.gmgs.com OB84519 NAIC INSURER A: Crum & SURER Forster SpeClaity Insurance Co '� 44520 - Mike Kilbride, LTD INSURER B.- State Compensation Insurance Fund _ 22314 Coast Water and Power INSURER C: PO Bax 3341 WSURER O : ` Newport Beach CA 92659 INSURER E: COVERAGES CERTIFICATE NUMBER: 70946606 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. TR TYPE OF INSURANCE ADDL}SUBR, -� POLICY EFF POLICY EXP WVn I POLICY NUMBER LIMITS A COMMERCIAL GENERAL LIABILITY j GLO-091961 10/30/2022 10/30/2023 EACH OCCURRENCE$1,000 000 �— -- CLAIMS -MADE OCCUR i D ENTER-- DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: All operations of the named insured subject to the terms and conditions of the policies. As respects General Liability coverage, Costa Mesa Sanitary District, its elected and appointed officials, agents, officers and employees added as Additional Insured per CG20101219, and this insurance is primary per CFSIC GL 1002 09/20 attached. As respects Workers' Compensation coverage, a Waiver of Subrogation is hereby included, per 2572 attached. CERTIFICATE HOLDER CANCELLATION All Operations Costa Mesa Sanitary District SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 290 Paularino Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa CA 92626 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE -*' (j ' Calvin Sistrunk---'�-._ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 70946506 1 22-23 G/XS/W I Charise Ferguson ; 10/25/2022 11:00:21 AM (PDT) 1 Page 1 of 4 — �GEN'L AGGREGATE LIMIT APPLIES PER: [[[ - POLICY U PRO- L LOC OTHER: j III PREMISES (Ea occurrence i501000 MED EXPA { ny one person} $ 5,000 PERSONAL & ADV INJURY $1000,000 GENERAL AGGREGATE _ $ 2,000,000 PRODUCTS - COMP/OP AGG --- - — _ j $ 2 000 000 - COMBINED SINGLE LIMIT Ea accident $ $ AUTOMOBILE r� r LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY _ AUTOS HIRED NON -OWNED AUTOS ONLY _; AUTOS ONLY + j BODILY INJURY {Per person} $ BODILY INJURY (Per accident) $ PR PROPERTYDA Per accidentl _ ;$ $ " A ✓ _ UMBRELLAUAB OCCUR EXCESS LIAB `CLAIMS -MADE DED _.I RETENTIONS SEO-120999 10/30/2022 _ � 10/30/2023 EACH OCCURRENCE --- __ $ 5,000 OOO AGGREGATE B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ 1N/A' (Mandatory in NH) if yes, describe underE DESCRIPTION OF OPERATIONS below I 19087110-2022 10/1/2022 ' $ 10/1/2023 i ,�_ STATUTE + EORH- - — - E.L. EACH ACCIDENT _____._._.__� L DISEASE - EA EMPLOYEE' $1 000000 $ E L. DISEASE POLICY LIMIT $1,000.000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: All operations of the named insured subject to the terms and conditions of the policies. As respects General Liability coverage, Costa Mesa Sanitary District, its elected and appointed officials, agents, officers and employees added as Additional Insured per CG20101219, and this insurance is primary per CFSIC GL 1002 09/20 attached. As respects Workers' Compensation coverage, a Waiver of Subrogation is hereby included, per 2572 attached. CERTIFICATE HOLDER CANCELLATION All Operations Costa Mesa Sanitary District SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 290 Paularino Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa CA 92626 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE -*' (j ' Calvin Sistrunk---'�-._ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 70946506 1 22-23 G/XS/W I Charise Ferguson ; 10/25/2022 11:00:21 AM (PDT) 1 Page 1 of 4 Mike Kilbride, LTD POLICY NUMBER: GLO-091961 COMMERCIAL GENERAL LIABILITY CG 20 1012 19 I 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 have agreed in a written Locations and operations covered under this policy -contract to add as an additional insured on your policy when required by written contract signed prior to the provided the. written contract Is signed prior to the "bodily injury", "property damage" or "personal and "bodily injury", "property damage' or "personal .and advertising injury" advertising injury" 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: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in theperformance of your ongoing -operations for the additional insured(sl at the locatlion(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 20101219 B. VMth 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 prihcipal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is addedto Section III — Limits Of Insurance: If coverage provided to the additional insured it required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance; 0 Insurance Services Office, Inc., 2018 70946506 1 22-23 G/XS/W 1 Charise Ferguson 110/25/2022 11:00:21 P.M (PDT) I Page 2 of 9 Page I of 2 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 20 10 12 19 Q Insurance Services Office, Inc., 2018 Page 2 of 2 70946506 1 22-23 G'1XS/W j Charise Ferguson ( 10/25/2022 11:00:21 AM (PDT) I Page 3 of 4 GLo-0y/as/ Mike Kilbride, LTD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ [rCAREFULLY. PRIMARY AND NONCONTRIBUTORYOTHER INSURANCE CONDITION 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 primaryto and will not seek ounu1uuuon from any other insurance available to an auumuna| insured under this policy provided that: (1) The additional insured |oanamed insured under such other insurance; and (a) You have agreed in writing in e contract or agreement prior to the injury or damage that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured where the additional insured iaanamed insured. Howevar, the insurance provided under this endorsement will not apply beyond the extent nyqu|mu by such contract or agreement. ALL OTHER TERMS AND CONDITIONS OFTHIS POLICY REMAIN UNCHANGED. Cr8o'gL-1002(0e/2020) 7094e0v 1 o-so,XS/lq ' nha,iserernus" 1:/25/222 zz.no.o ^m (PDT) ' Page of 4 Page 1or1