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HomeMy WebLinkAboutA7286 - WATERLINE TECHNOLOGIES AMENDMENT #1AC & OATS IMM100—YI %.�CERTIFICATE OF LIABILITY INSURANCE 0723/2024 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 POHLAies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, sutiI to the terra and conditions of the policy, certain policies may rapdre an endorsement A staternMdt On this certificate does nut confer rights to the,certificate holder in lieu Of such endors.Mn lsJ PROWLER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 OWATONNA, MN 55060 RECEIVEDxEwRERSgfFORDNOCOVERAGE RA,D. usuRER A:FEDERATED MUTUAL INSURANCE COMPANY 13MS INSURED 308-577-6 WATERLINE TECHNOLOGIES INC JUL .11 2014 620 N SANTIAGO ST SANTA ANA, CA 92701-3942 OFFICE OF THE CITY C uwRER a: uwREN c: IdwNER o: MwNEN E: uwRER r: ef"I mnrece. n COVERAGES CERTIFICATE NUMBER' MI 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 POUCHES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IHSR TYPE OFIHEURPHCE ADDL SUBN pUCy NUMBER jamyEfF Ytl{P OMITS X COMMEACNLLOENEftM.Uummure I EKN OCCURRENCE $1,000,000 AMAOE TORENTED"EWES $100,000 �CWxsMAOEX OCCUR MEDEXP(AMd pamm) EXCLUDED PERSONn a Anv INJURY 1000,000 A Y Y D623485 08/152024 08/15/2025 GENT AGGREGATE UNIT JUNIUMS PER' MUCX � FLOC GENERAL QQQ 0 PRODUCTS b COMPNIP AGO S2,000,000 OTHER OTHER', AU rOMOBIIE IIABIUTY X µYAUTO EOMa=ED,SI UE UNT f10DQ000 BODILY INJURY IP ftmIM A OY,NEO AUTOS ONLY SCCT�ULED � Y Y 0623485 08/152024 Da"5/2025 eODLr INJURY IPW Aw4ME 1IR.=D AUTOS ONLY NON-OWNEO AUTOS ONLY PROPE0.TV DAMPOf X �UA163E_A LMB XEICWR fAL`N OCCURRENCE $10,000,OD0 A :.. EXt4Sb LMB l!AI M1IADE N N 0623486 08/152024 08/152025 ,00w"m 510,1XIODOD OED I IRETIENTION WORKERS COMPENSATION NANO EMPLOTERSLIANILITY PER bTATUTE THE. ANY PROPR'ETOS(PMTNERI ERECUTNi OF ERIMEMBER EXCLUOEOi IM-..' In NNI I Yo.:.s Iiw M N/q ILL EKH KCNMryT EL OMI EA EMPLOYEE I.A. OISEAEE PO.ICT UNIT 9ESCRIPTION CP OPERATIONS NI .111MON OF OPERATIONS I LOCATIONS I VEHICLES IACORD MI. AYEMul RmIMtr SOI ma, b MWNe It men pace Is M m4l SEE ATTACHED PAGE 3DO-577$ - - --- 220 0 CITY OF PALM SPRINGS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 3200 E TAHQUITZ CANYON WAY BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PALM SPRINGS, CA 922624959 ACCORDANCE WITH THE POLICY PROVISIONS. wTHORIZEOREPREsion.vF =3 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2015=) The ACORD name J id logo .hie registered marks of ACORD ACq AGENCY CUSTOMER ID: 308577-6 LOC M ADDITIONAL REMARKS SCHEDULE Page 1 of 1 ADENCY FEDERATED MUTUAL INSURANCE COMPANY NAMEDINSURED WATERLINE TECHNOLOGIES INC 620 N SANTIAGO ST SANTA ANA, CA 92701-8542 POucY NUMBER SEE CERTIFICATE p220.0 CARRIER nae coDE Er =IW DAZE SEE CERTIFICATE }] 220.0 SEE CERTIFICATE N 220.0 1DDITIONAL REMARKS THIS ADDITIONAL: REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE: _CERTIFICATE OF UABWTY INSURANCE THE CITY OF PALM SPRINGS, ITS OFFICIALS,. EMPLOYEES AND AGENTS ARE NAMED AS AN ADDITIONAL INSURED. THIS INSURANCE IS. PRIMARY AND P NON-CONTRIBUTORY OVER ANY INSURANCE OR SELF-INSURANCE THE CITY MAY HAVE. GENERAL LIABILITY CONTAINS A WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC ENDORSEMENT - BUSINESS AUTO LIABILITY CONTAINS A WAIVER OF SUBROGATION'IN FAVOR OF THE CERTIFICATE HOLDER SUBJECT TO THE CONDITIONS OF THE BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY ENDORSEMENT. FOR REASONS -OTHER THAN NON-PAYMENT OF PREMIUM, 30 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. FOR NON-PAYMENT OF PREMIUM, 10 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. ACORD 101 (2008101) O 2008 ACORD CORPORATION. All rlgMs reserved. The ACORD name and 1090 a registered markS 0f ACORD COMMERCIAL GENERAL LIABILITY CG 20 33 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured 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. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. © Insurance Services Office, Inc., 2018 Page 1 of 2 CG 20 33 12 19 Policy Number: 0623485 Transaction Effective Date: 08/15/2024 2. "Bodily injury" or "property damage" occurring after. a. All work, including materials, parts or equipment furnished lin connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on be alf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of 'your work" out of which the injury or damage rises 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. f i C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 Insurance Services Office, Inc., 2018 CG 20 33 12 19 Pol cy Number: 0623485 Transaction Effective Date: 08/15/2024 COMMERCIAL GENERAL LIABILITY CG 24 53 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE'LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery against any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 24 53 12 19 Policy Number: 0623485 Transaction Effective Date: 08/15/2024 308-577-6 220 #BWNDHBS BO l01-0015 #XWXWO021 xxxxxxxs# CITY OF PALM SPRINGS 3200 E Tahquitz Canyon Way Palm Springs, CA 92262-6959 RECEIVED JUL 31 2024 OFFICE OF THE CITY CLERK COMMERCIAL AUTO CA 04 49 11 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. The following is added to the Other Insurance B. Condition in the Business Auto Coverage Form and the Other Insurance - Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". The following is added to the Other Insurance Condition in the Auto Dealers Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage and General Liability Coverages are primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed -in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". © Insurance Services Office, Inc., 2016 Page 1 of 1 CA 04 49 11 16 Policy Number: 0623485 Transaction Effective Date: 08/15/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. WHO IS AN INSURED for "bodily injury" and "property damage" liability is amended to include: Any person or organization other than a joint venture, for which you have agreed by written contract to procure bodily injury or property damage "auto-' liability insurance arising out of operation of a covered "auto' with your permission. However, this additional insurance does not apply to: (1) The owner or anyone else from whom you hire or borrow a covered "auto". This exception does not apply if the covered "auto' is a "trailer" connected to a covered "auto" you own. (2) Your "employee" if the covered "auto' is owned by that "employee" or a member of his or her household. (3) Someone using a covered "auto' while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours. (4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from a covered "auto". (5) A partner (if you are a partnership), or a member (if you are a limited liability company) for a covered "auto' owned by him or her or a member of his or her household. B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any insured, or to procure insurance. C. The limits of insurance applicable to such insurance shall be the lesser of the limits required by the agreement between the parties, or the limits provided by this policy. D. Additional exclusions. The insurance afforded to any person or organization as an insured under this endorsement does not apply: 1. To "loss" which occurs prior to the date of your contract with such person or organization; 2. To "loss" arising out of the sole negligence of any person or organization that would not be an insured except for this endorsement. 3. To "loss" for any leased or rented "auto' when the lessor or his or her agent takes possession of the leased or rented "auto" or the policy period ends, whichever occurs first. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA-F-127 (03-03) Policy Number: 0623485 Transaction Effective Date: 08/15/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. In the event of any payment for a loss under this Business Auto Coverage Part arising out of your ongoing operations, we agree to waive our rights under the TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US condition against any person or organization, its subsidiaries, directors, agents or employees, for which you have agreed by written contract, prior to the occurrence of any loss, to waive such rights, except when the payment results from the sole negligence of that person or organization, its subsidiaries, directors, agents or employees. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA-F-128 (03-03) Policy Number:0623485 Transaction Effective Date: 08115/2024 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR 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 primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Policy Number: 0623485 Page 1 of 1 Transaction Effective Date: 08/15/2024