Loading...
HomeMy WebLinkAboutSeaside Heating and Air Conditioning Inc; 2021-12-15; PWM22-1734FACDocuSign Envelope ID: F3C14745-B475-4692-9E85-4F214A7789A0 December15th DocuSign Envelope ID: F3C14745-B475-4692-9E85-4F214A7789A0 DocuSign Envelope ID: F3C14745-B475-4692-9E85-4F214A7789A0 DocuSign Envelope ID: F3C14745-B475-4692-9E85-4F214A7789A0 DocuSign Envelope ID: F3C14745-B475-4692-9E85-4F214A7789A0 DocuSign Envelope ID: F3C14745-B475-4692-9E85-4F214A7789A0 DocuSign Envelope ID: F3C14745-B475-4692-9E85-4F214A7789A0 DocuSign Envelope ID: F3C14745-B475-4692-9E85-4F214A7789A0 DocuSign Envelope ID: F3C14745-B475-4692-9E85-4F214A7789A0 DocuSign Envelope ID: F3C14745-B475-4692-9E85-4F214A7789A0 DocuSign Envelope ID: F3C14745-B475-4692-9E85-4F214A7789A0 DocuSign Envelope ID: F3C14745-B475-4692-9E85-4F214A7789A0 DocuSign Envelope ID: F3C14745-B475-4692-9E85-4F214A7789A0 DocuSign Envelope ID: F3C14745-B475-4692-9E85-4F214A7789A0 CERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS WC STATU-TORY LIMITS OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe underDESCRIPTION OF OPERATIONS below (Mandatory in NH)OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNEDAUTOSAUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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 THISCERTIFICATE 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 ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) 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). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Wood Gutmann & Bogart Insurance BrokersLicense #067926315901 Red Hill Ave., Suite 100Tustin CA 92780 Bobbie Mace 714-824-8373 714-573-1770 BMace@wgbib.com Middlesex Insurance Company 23434 SEASI-1 Insurance Company of the West 27847Seaside Heating & Air Conditioning, Inc.1359 Rocky Point Dr.Oceanside CA 92056-5864 1070374944 A X 1,000,000 100,000 X 1,000,000 3,000,000 2,000,000 AO112596004 9/18/2021 9/18/2022YY 5,000 A 1,000,000 X X X X Comp $500Ded X Coll $500Ded A0112596001 9/18/2021YY 9/18/2022 A X X 3,000,000 X NIL AO112596005 9/18/2021 9/18/2022YY B Y Y WSD502592007 3/1/2021 3/1/2022 1,000,000 1,000,000 1,000,000 9/15/2021 X City of Carlsbad/CMWD, its officers, officials, employees, agents and volunteers are named as additional insured on the General Liability per attached CG 2010 04 13 and CG 20 37 04 13 as required by written contract subject to the terms and conditions of the policy. Waiver of Subrogation applies to the Workers'Compensation per attached WC 99 06 34. City of Carlsbad/CMWDAttn: Contract Administration1635 Faraday AvenueCarlsbad CA 92008 © Insurance Services Office, Inc., 2012 POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS 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 an additional insured under a written contract or agreement in effect prior to any accident, injury, loss or damage All locations and jobs performed that have a written contract, agreement or permit 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" 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. 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. A0112596004 Page 1 of 1CG 20 37 04 13 08/27/2021A0112596 Middlesex 00001 0000000000 21239 0 N1 516336ea-c79d-45f3-a59f-97b4065b9ef0516336ea-c79d-45f3-a59f-97b4065b9ef0 Page 1 of 2CG 20 10 04 13 08/27/2021A0112596 Middlesex POLICY NUMBER: © Insurance Services Office, Inc., 2012 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 an additional insured under a written contract or agreement in effect prior to any accident, injury, loss or damage All locations per written contract, agreement or permit Description: All jobs performed that have a written contract, agreement or permit 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. 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. A0112596004 00001 0000000000 21239 0 N1 164f821b-f71f-4cd7-8d0d-f4092c341581164f821b-f71f-4cd7-8d0d-f4092c341581 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 shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 CG 20 10 04 13Page 2 of 2 08/27/2021A0112596 Middlesex