Loading...
PROOF OF INSURANCE (2015) CLOSEDa I DATE (MM /DD/YYYY) �M CERTIFICATE OF LIABILITY INSURANCE 6/19/2014 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 - ORESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. )RTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to 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 Ed Partners Insurance Center (EPIC) NAME 19000 MacArthur Blvd. PH Floor PHONE 949 263 -os FAX (AIGa N�qa Fxtt ....., ,,,, �, ) _ 06 �- (NP , ),. (949) 263 0906 Irvine, CA 92612 E-MAIL www.edgewoodins.com INSURED Ortco, Inc. 2163 N. Glassell Avenue Orange CA 92186 Ilnsurance INSURER B: INSURER G Cypress Insurance INSURER D: RSUI IndemnitvCc rnv=onr-GC rFRTIFIrATF MI IMR1 =R• ")AA70101 REVISIC)N NLIMRER: NAIC # 21415 22314 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. INSR ............... 'ADOL StGt1A . � ...... ......... _. POUtlCY EFF POLICY EXP LIMITS '...... LTR TYPE OF INSURANCE POLICY NUMBER WDD/YYYY MMIDD/YYYY. A ✓ COMMERCIAL GENERAL LIABILITY CA000005173 -11 6/21/2014 6/21/2015 CCU E CE $ 1,000,000 DAMAGE R 50,000 CLAIMS -MADE OCCUR PREMISES Ea ocLL ( currence) $ 5,000 Dedmper P999rrence MED EXP (Any one „person) $ Excluded ... PERSONAL & ADV INJURY ... $ 1,000,000 ._ . GEN'L _ AGGREGATE LIMIT APPLIES PER: E GENERAL AGGREGATE $ 2,000,000 POLICY ✓ PRO JECT LOC CTS COMP /OP AGG PRODU w $ 2,000 000'' OTHER $ JTOMOBILE LIABILITY 5x14528 6/21/2014 6/21/2015 SINGLE LIMIT � acc4,ctotud $ 1,.000,00' ✓ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY LY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED I'iOREIIYDAMFLtE $ ✓ HIRED AUTOS r/ AUTOS „(Prraeide t) ------ 1000 ded COMP& Coll $ D UMBRELLA LIAB OCCUR NHA235771 6/21/2014 6/21/2015 EACH OCCURRENCE $ 1 000,000 ..... -.- ............. ........ .... ........,E EXCESS LIAR - CLAIMS-MADE AGGREGATE $ 1,000,000 0 DED RETENTION $0 $ C WORKERS COMPENSATION 3300008099 -131 10/1/2013 10/1/2014 E ✓ SATUTE �H AND EMPLOYERS' LIABILITY Y / N 1 000,000' ;ANY PROPRIETORIPARTNER /EXF_CUTIVE E L EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? (Mandatory in NH) NIA E L DISEASE - EMPLOYE $ 1,000 000 If yes, describe under DESCRIPTION OF OPERATIONS below E POLICY LIMIT $ 1,000,000 L DISEASE - DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Certificate Holder is additional insured as respects General Liability performs CG20100413 and CG20370413 and Auto Liability per form CA7270 0307, but only if required by signed written contract with Narned Insured prior to an occurrence. Blanket Primary Wording form AD06571203, and Blanket Waiver of Subrogation form CG24040509 apply to General Liability. Workers Compensation Blanket Waiver of Subrogation per Form WC990410A (Ed 07 -07), Subject to all policy terms and conditions, tv of EI Segundo 'reatlon & Parks Department Main Street Segundo CA 90245 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE c Kent Briggs ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 20579192 Tina Coleman 6/19/2014 3:44:17 PM (PDT) Page 1 of 9 Ortco, Inc. POLICY NUMBER:CA000005173 -11 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • to RJ6"JOKKO-1 • "" • This endorsement modifies insurance provided under the followings. 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 Com leted Operations Blanket where required by written contract signed COMMERCIAL WORK ONLY by both parties and the Insured contract is executed prior to any loss. 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. Chi a[;] 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 required by a contract or will pay on behalf of the amount of insurance: the additional insured is agreement, the most we additional insured is the 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. O - - • - CERT NO.: 20579192 Tina Coleman 6/19/2014 3:44:17 PM (PDT) Page 2 of 9 Page 1 of 1 POLICY NUMBER: CA000005173 -11 Ortco, Inc. 6/19/2014 COMMERCIAL GENERAL LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, S, 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) Locations Of Covered Operations When required by written contract. 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 B 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. 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 CERT NO.: 20579192 Tina Coleman 6/19/2014 3:44:17 PM (PDT) Page 3 of 9 Page 1 of 2 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 Page 2 of 2 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 CE 'Tr r NO.: 205791.92 Tina Coleman 6/19/201.4 3:44:17 PM (PD'1) Page 4 of 9 CG 20 10 04 13 ox 14OZO vi i yicu i Ortco, Inc. COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTO AMENDMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The BUSINESS AUTO COVERAGE FORM is amended to include the following clarifications and extensions of coverage. With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. BLANKET ADDITIONAL INSURED SECTION II — LIABILITY COVERAGE, A.1. Who Is An Insured is amended by adding the following: d. Any person or organization who is a party to a written agreement or contract with you in which you agree to provide the type of insurance afforded under this Business Auto Coverage Form. This provision applies to claims for "bodily injury' or "property damage" which occur after the execution of any written agreement or contract. B. NEWLY FORMED OR ACQUIRED ORGANIZATIONS SECTION II — LIABILITY COVERAGE, A.I. Who Is An Insured is amended by adding the following: e. Any organization which you acquire or form after the effective date of this policy in which you maintain ownership or majority interest.. However: (1) Coverage under this provision is afforded only up to 180 days after you acquire or form the organization, or to the end of the policy period, whichever is earlier. (2) Any organization you acquire or form will not be considered an "insured" if: A. The organization is a partnership or a joint venture; or B. That organization is covered under other similar insurance. (3) Coverage under this provision does not apply to any claim for "bodily injury" or "property damage" resulting from an "accident" that occurred before you formed or acquired the organization. C. SUBSIDIARIES AS INSUREDS SECTION II — LIABILITY COVERAGE, A.1. Who Is An Insured is amended by adding the following: f. Any legally incorporated subsidiary in which you own more than 50% of the voting stock on the effective date of this policy. However, "insured" does not include any subsidiary that is an "insured" under any other automobile liability policy or was an "insured" under such a policy but for termination of that policy or the exhaustion of the policy's limits of liability. D. COVERAGE EXTENSIONS — SUPPLEMENTARY PAYMENTS SECTION II — LIABILITY COVERAGE, A.2.a. Coverage Extensions, Supplementary Payments (2) and (4) are replaced by the following: (2) Up to $3,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $350 a day because of time off from work. E. PHYSICAL DAMAGE — TOWING SECTION III — PHYSICAL DAMAGE COVERAGE, A.2. "Towing is replaced with the following: We will pay for towing and labor costs incurred, subject to the following: a. Up to $100 each time a covered "auto" of the private passenger type is disabled; or b. Up to $500 each time a covered "auto" other than the private passenger type is disabled. However, the labor must be performed at the place of disablement. F. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES SECTION III — PHYSICAL DAMAGE COVERAGE, A.4. Coverage Extensions subparagraph a. Transportation Expenses is replaced by the following: (1) We will pay up to $75 per day to a maximum of $1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Cause of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expirations, when the covered "auto" is returned to use or we pay for its "loss." CA7270(3 -07) Includes copyrighted material of ISO Properties, Inc. with its permission. Pagel 02 CERT NO.: 20579192 Tina Coleman 6/19/2014 3:44:17 PM (PDT) Page 5 of 9 (2) If the temporary transportation expenses you incur arise from your rental of an "auto" of the private passenger type, the most we will pay is the amount it costs to rent an "auto" of the private passenger type which is of the same like kind and quality as the stolen covered "auto." G. HIRED AUTO PHYSICAL DAMAGE SECTION III — PHYSICAL DAMAGE COVERAGE, A.4. Coverage Extensions is amended by adding the following: c. If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss, or Collision coverage is provided for any "auto" you own, then the Physical Damage coverages provided are extended to "autos" you hire, subject to the following limit and deductible: (1) The most we will pay for loss to any hired "auto" is the lesser of $50,000 or Actual Cash Value or Cost of Repair, minus the deductible. (2) The deductible will be equal to the largest deductible applicable to any owned "auto " for that coverage. No deductible applies to "loss" caused by fire or lightning. (3) Subject to the above limit, deductible and excess provisions, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. The insurance provided under this provision is excess over any other collectible insurance. H. PERSONAL PROPERTY OF OTHERS SECTION III — PHYSICAL DAMAGE COVERAGE, A.4. Coverage Extensions is amended by adding the following: d. We will pay up to $500 for loss to personal property of others in or on your covered "auto." This coverage applies only in the event of "loss" to your covered "auto" caused by fire" lightning, explosion, theft, mischief or vandalism, the covered "auto's "' collision with another object, or the covered "auto's" overturn. No deductibles apply to this coverage. I. AIRBAG COVERAGE SECTION III — PHYSICAL DAMAGE COVERAGE, B.3.a. Exclusions is amended by adding the following: If you have purchased Comprehensive or Collision Coverage under this policy„ the exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag. 1. LOSS TO TWO OR MORE COVERED AUTOS FROM ONE ACCIDENT SECTION 111 — PHYSICAL DAMAGE COVERAGE, D. Deductible is amended by adding the following: If a Comprehensive, Specified Causes of Loss or Collision Coverage "loss" from one "accident" involves two or more covered "autos ", only the highest deductible applicable to those coverages will be applied to the "accident ". This provision only applies if you carry Comprehensive, Collision or Specified Causes of Loss Coverage for those vehicles, and does not extend coverage to any covered "autos" for which you do not carry such coverage. K. WAIVER OF DEDUCTIBLE — GLASS REPAIR OR REPLACEMENT SECTION III — PHYSICAL DAMAGE COVERAGE, D. Deductible is amended by adding the following: If a Comprehensive Coverage deductible is shown in the Declarations it does not apply to the cost of repairing or replacing damaged glass. L. DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS SECTION IV — BUSINESS AUTO CONDITIONS, A.2. Duties in the Event of Accident, Claim, Suit or Loss is amended by adding the following: d. Your obligation to notify us promptly of an "accident," claim, "suit" or "loss" is satisfied if you send us the required notice as soon as practicable after your Insurance Administrator or anyone else designated by you to be responsible for insurance matters is notified, or in any manner made aware, of an "accident," claim, "suit" or "loss." M. UNINTENTIONAL FAILURE TO DISCLOSE EXPOSURES SECTION IV — BUSINESS AUTO CONDITIONS, B.2. Concealment, Misrepresentation, or Fraud is amended by adding the following: If you unintentionally fail to disclose any exposures existing at the inception date of this policy, we will not deny coverage under this Coverage Part solely because of such failure to disclose. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non - renewal. N. MENTAL ANGUISH SECTION V — DEFINITIONS, C. is replaced by the following: "Bod'i'ly injury" means bodily injury, sickness or disease sustained by a person, including mental anguish or death resulting from bodily injury, sickness or disease. O. LIBERALIZATION If we revise this endorsement to provide greater coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. 0 CA727Q -07) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 2 of 2 CERT NO.: 2057 192 Tina Coleman 6/19/2014 3:4 :17 PM (PDT) Page 6 of 9 6/19/2014 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 10A (Ed 07.07) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA BLANKET BASIS We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, (This agreement applies only to the extent that you perform work under a wrtllen contract that requires you to obtain this agreement from us.) The additional premium for this endorsement shall be _2,00m re% of the total policy premium otherwise due on such remuneration. The minimum premium for this endorsement is $ 350 nn Schedule Person or Organization Job Description ALL ORGANIZATIONS FOR WHOM THE WAIVER OF SUBROGATION IS ALL CALIFORNIA OPERATIONS ISSUED This endorsement changes the policy to which it is attached and Is effective on the date issued unissa otherwise stated, (The Information below la required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10/1/2013 Policy No, 3300008099 -131 Endorsement No. 1 Insured ORTCO, INC. Premium $ Insurance Company Counlersigned by Cypress Insurance Company WC 99 04 10A (Ed 07 -07) CERT NO.: 20579192 'Pima Coleman 6/19/201.4 3A4:1.7 PM (PDT) Pages 7 of 9 Ortco, Inc. Policy Number: CA000005173 -11 6/19/2014 AD 06 57 12 03 Effective Date: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY/NON-CONTRIBUTING INSURANCE EN DORSEMENT This endorsement modes insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE ANY PERSON OR ORGANIZATION QUALIFYING AS AN INSURED UNDER THE ADDI- TIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS ENDORSEMENT FORM AT- TACHED TO THIS POLICY. It is agreed that Commercial General Liability Coverage Form CG 00 01 Section IV paragraphs 4.b. and 4.c. do not apply with respect to other valid and collectible Commercial General Liabil- ity insurance, whether primary or excess, avail- able to the person or organization shown in the Schedule and: 1) Who is an insured under an Additional Insured - Owners, Lessees or Contractors endorsement at- tached to this policy; and AD 06 5712 03 CERT NO.: 20579192 Tina Coleman 6/7.9/2014 3:44:17 PM (PDT) Page 8 of 9 2) Who requires by specific written contract that this insurance is to be primary and/or non - contributory to other valid and col- lectible insurance available to that person or organization. This endorsement does not change the scope of coverage provided to the person or organization by any Additional Insured endorsement. All other terms and conditions remain un- changed. Page 1 of 1 Ortco, Inc. POLICY NUMBER: CA000005173-11 6/19/2014 •' AP M VA illllli��ll� Name Of Person Or OrgaiMution., Any rperson or organization w7hen. you and such plerson or organization hwre agreed in a contract: or agreement thaf,: such. pexson or organization be, added with waiver of transfer of rigbts on yrju.r ]r,>oLicy to performanc,e of the agreement. TIVEMMMMM wdl bestumn in CERT NO.: 20579192 Tina Coleman 6/19/2014 3:44:17 PM (PDT) Page 9 of 9