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Insurance - Willdan Engineering - 2012 • • • ACORD T. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YY) 2/19/2013 PRODUCER THIS CERTIFICATE IS'ISSUED AS A MATTER OF INFORMATION Dealey, Renton & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P. O. Box 10550 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Santa Ana CA 92711-0550 • ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE • INSURED INSURER A:Travelers Property Casualty Co of Ameri Willdan Engineering INSURERB: Catlin Insurance Company, Inc. 2401 E. Katella Avenue, Ste. 300 INSURERC:American Automobile Ins. Co. Anaheim CA 92806 INSURER D: • INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE IMM/DDM I DATE IMM/DD/YYI A GENERALLIABILITY 6301158P020 11/9/2012 11/9/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $1,000,000 CLAIMS MADE X OCCUR MED EXP(Any one person) $10, 000 X Contractual PERSONAL&ADVINJURY $1,000,000 X BFPD, XCU GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X 'r LOC • A AUTOMOBILELIABILITY 8101158P020 11/9/2012 11/9/2013 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS • (Per person) • X HIRED AUTOS BODILY INJURY • X NON-OWNED AUTOS • (Per accident) • • PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $• EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE ;AGGREGATE $ $ DEDUCTIBLE j $ RETENTION $ $ WC STATU- H- C WORKERS COMPENSATION AND WZP81007462 11/9/2012 11/9/2013 X TOY LIMITS ER EMPLOYERS'LIABWTY E.L.EACH ACCIDENT $1,000,000 • E.L.DISEASE-EA EMPLOYEE $1,000,000 E.L.DISEASE-POLICY LIMIT $1,000,000 B OTHER AED977441113 11/9/2012 11/9/2013 Per Claim $1,000,000 Professional Liability Annual Aggregate $1,000,000 Claims Made DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS General Liability policy excludes•claims arising out of the performance of professional services. Independent Contractors are included as respects to General Liability. Re: Permit technician counter services • Costa Mesa Sanitary District, its directors, officials, officers, employees, agents, and volunteers are additional insured as respects to General Liability as required by written contract. Primary and Non-Contributing coverage applies to GL as required by written contract. Waiver of Subrogation or Rights applies to Workers' Compensation See Attached... • CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: _ CANCELLATION10 Day notice for Non-Paymnt of Prem SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER Costa Mesa Sanitary District WILL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE Attn: District Clerk /)A HOLDER NAMED TO THE LEFT. 628 West 19th Street • Costa Mesa CA 92627 1 • • AUTHORIZED REPRESENTATI n •ACORD 25-S(7/97) O ACORD CORPORATION 1988 J DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS / SPECIAL PROVISIONS policy only as required by a written signed contract prior to any loss occurring. (ANAHEIM) Workers' Compensation and Employers' Liability Insurance Policy Waiver of Our Right to Recover From Others Endorsement - California WC 04 03 06 If the following information is not complete, refer to the appropriate Schedule attached to the policy. Insured:Willdan Engineering Policy Number WZP81007462 Producer: Dealey, Renton&Associates Effective Date 2/19/2 013 Schedule Person or Organization Job Description Costa Mesa Sanitary District For which the insured has agreed by Attn: District Clerk written contract executed prior to loss 628 West 19th Street to furnish this waiver. The premium Costa Mesa CA 92627 charge is 2% of policy standard premium at final audit. Additional Premium % We have the right to recover our payments from any- You must maintain payroll records accurately segre- one liable for an injury- covered by this policy. We gating the remuneration of your employees while en- will not enforce our right against the person or gaged in the work described in the Schedule. organization named in the Schedule. (This agreement applies only to the extent that you perform work The additional premium for this endorsement shall be under a written contract that requires you to obtain the percentage, as shown in the Schedule applicable this agreement from us.) to this endorsement, of the California workers' compensation premium otherwise due on such remuneration. • 61101P Authorized Representative WC040306 COMMERCIAL GENERAL LIABILITY 6301158P020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - WRITTEN CONTRACTS (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II —WHO IS plies only to such "bodily injury" or "property AN INSURED: damage" that occurs before the end of the pe- Any person or organization that you agree in a rind of time for which the "written contract re °written contract requiring insurance" to include as quiring insurance" requires you to provide an additional insured on this Coverage Part, but: such coverage or the end of the policy period, whichever is earlier. a. Only with respect to liability for"bodily injury", "property damage"or"personal injury"; and 2. The following is added to Paragraph 4.a. of SEC- TION IV— COMMERCIAL GENERAL LIABILITY b. If, and only to the extent that, the injury or CONDITIONS: damage is caused by acts or omissions of The insurance provided to the additional insured you or your subcontractor in the performance is excess over any valid and collectible "other in- requiring insurance" applies. The person or surance", whether primary, excess, contingent or organization does not qualify as an additional on any other basis, that is available to the addi- insured with respect to the independent acts tional insured for a loss we cover. However, if you or omissions of such person or organization. specifically agree in the "written contract requiring insurance" that this insurance provided to the ad- The insurance provided to such additional insured ditional insured under this Coverage Part must is limited as follows: apply on a primary basis or a primary and non- c. In the event that the Limits of Insurance of contributory basis. this insurance is primary to this Coverage Part shown in the Declarations "other insurance" available to the additional in- exceed the limits of liability required by the sured which covers that person or organization as "written contract requiring insurance", the in- a named insured for such loss, and we will not surance provided to the additional insured share with that "other insurance`. But this insur- shall be limited to the limits of liability required ance provided to the additional insured still is ex- by that "written contract requiring insurance". cess over any valid and collectible "other insur- This endorsement shall not increase the limits ance", whether primary, excess, contingent or on of insurance described in Section III — Limits any other basis, that is available to the additional Of Insurance. insured when that person or organization is an d. This insurance does not apply to the render- ing of or failure to render any "professional 3. The following is added to SECTION IV — COM- services" or construction management errors MERCIAL GENERAL LIABILITY CONDITIONS: or omissions. Duties Of An Additional Insured e. This insurance does not apply to "bodily in- As a condition of coverage provided to the addi- jury" or "property damage" caused by "your tional insured: work" and included in the "products- completed operations hazard" unless the a. The additional insured must give us written "written contract requiring insurance" specifi- notice as soon as practicable of an "occur- cally requires you to provide such coverage rence" or an offense which may result in a for that additional insured, and then the insur- claim. To the extent possible, such notice ance provided to the additional insured ap should include: CG D4 14 04 08 ©2008 The Travelers Compares, .nc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY I. How, when and where the "occurrence" any provider of other insurance which would or offense took place; cover the additional insured for a loss we II. The names and addresses of any injured cover. However, this condition does not affect persons and witnesses; and whether this insurance provided to the addi- ili. The nature and location of any injury or tional insured is primary to that other insur- damage arising out of the "occurrence" or once available to the additional insured which offense. covers that person or organization as a named insured. b. If a claim is made or "suit" is brought against the additional insured, the additional insured 4. The following is added to the DEFINITIONS Sec must: tion: I. Immediately record the specifics of the "Written contract requiring insurance" means that claim or"suit"and the date received; and part of any written contract or agreement under which you are required to include a person or or- Ii. Notify us as soon as practicable. ganization as an additional insured on this Ccver- The additional insured must see to it that we age Part, provided that the "bodily injury" and receive written notice of the claim or "suit" as "property damage" occurs and the "personal in- soon as practicable, jury" is caused by an offense committed: c. The additional insured must immediately send a. After the signing and execution of the contract us copies of all legal papers received in con- or agreement by you; nection with the claim or"suit", cooperate with b. While that part of the contract or agreement is us in the investigation or settlement of the in effect; and claim or defense against the "suit", and oth- erwise comply with all policy conditions. c. Before the end of the policy period. d. The additional insured must tender the de- fense and indemnity of any claim or "suit" to • Page 2 of 2 0 2008 The Travelers Companies, Inc. CG D4 14 04 08