Insurance - National Plant Services - 2011-10-22 A ROC RC °® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYVY)
6/20/20„
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
MARSH USA INC. NAME:
500 WEST MONROE STREET PHONE FAX
_
CHICAGO,IL 60661 E-MCAANo.Ext.). (ac,No):
Am ContracLReviewCSS @marsh.com Phone 1-512-342-4400 ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC a
227309-UMB-UMB-11-12 INSURER A.Zurich American Insurance Company 16535
INSURED INSURER B. Lexington Insurance Company 19437
NATIONAL PLANT SERVICES,INC.
1461 HARBOR AVENUE INSURER C.
LONG BEACH,CA 90813-2741 INSURER D.
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: CHI-003957944-14 REVISION NUMBER:4
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.
INSB ADDL SUER
LTR TYPE OF INSURANCE N R WVD POLICY NUMBER POLICY EFF POLICY EXP
(MM/DD/YYVV1 IMM/DD/YYVV, LIMITS
A GENERAL LIABILITY GLO9377201-08 10/31/2011 10/31/2012 EACH OCCURRENCE $ 1,000,000
DAMAGE TO X I COMMERCIAL GENERAL LIABILITY
PREMISES(En occurrence) $ 1.000000
_CLAIMS-MADE X OCCUR MED EXP()My one person) $ 10,000
X XCU INCLUDED PERSONAL 8 ACV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG $ 2,000,000
nPOLICY I ( I PEei: n LOC $
A AUTOMOBILE LIABILITY BAP 9377199-08 10/31/2011 10/31/2012 COMBINED SINGLE LIMIT
__(Ea accident R 2,000.000
A ANY AUTO BODILY INJURY(Per per n) $
ALL OWNED SCHEDULED
AUTOS _ AUTOS BODILY INJURY(Pe ode U $
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS
AUTOS (Per accident) $
$
B X UMBRELLA LIAB X OCCUR 015438245 10/31/2011 10/31/2012
EACH OCCURRENCE $ 1,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1.000,000
DED X RETENTION$10.00) $
A WORKERS COMPENSATION WC 9377202-08 10/31/2011 10/31/2012 X WC STATU- OTH.
AND EMPLOYERS'LIABILITY Y/N TORY LIMITS FR
ANY PROPRIETOftPARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? N N/A
(Mandatory' NH) E L DISEASE EA EMPLOYEE $ 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E L.DISEASE POLICY LIMIT $ 1.000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule if mo spa requ red)
RE.PROJECT NO.175 OCSD COOPERATIVE PROJECTS GRANT PROGRAM TELEVISING CMSD SEWER LINES THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED UNDER THE GENERAL
LIABILITY BUT ONLY TO THE EXTENT REQUIRED BY THEIR WRITTEN CONTRACT WITH THE NAMED INSURED FOR OPERATIONS PERFORMED BY THE NAMED INSURED A WAIVER OF
SUBROGATION APPLIES UNDER THE WORKERS COMPENSATION POLICY FOR OPERATIONS PERFORMED BY THE NAMED INSURED
CERTIFICATE HOLDER CANCELLATION
COSTA MESA SANITARY DISTRICT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
234 E.17TH ST. SUITE 205 THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN
COSTA MESA,CA 92627 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Ma sh USA In
Manashi Mukherlee �lytylDekA. .0
I ®1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD