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HomeMy WebLinkAboutCOI_ United Pumping Service Inc _ 12.30.24SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 12/30/2024 IMA, Inc. 3475 E. Foothill Blvd., Suite 100 Pasadena, CA 91107 (626) 799-7000 (626) 583-2117 www.boltonco.com 0H64724 Cassandra Rosales United Pumping Service, Inc. 14000 East Valley Blvd. City of Industry CA 91746 83359549 3 3 33 3 GL Primary &Non-ContributoryWording applies per XIL4240605 attached. Auto Additional Insured and Primary Wording applies per XIC4141013 of Cancellation apply per IL00171198, IL00171198 & WC040601B attached. RE: Operations of the Named Insured County of San Bernardino/County Flood Control District and its officers, employees, agents and volunteers Attn: Administrative Services 825 East Third Street, Room 207 San Bernardino, CA 92415-0835 GL Additional Insured applies per CG20101219 & CG20371219, only if required by written contract/agreement. attached. GL, Auto & WC Waivers of Subrogation apply per CG24041219, CA04441013 and WC040306 attached.GL, Auto and WC Notice Additional Insured(s): County of San Bernardino/County Flood Control District and its officers, employees,agents and volunteers. 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 1,000,000 10,000,000 10,000,000 1,000,000 1,000,000 1,000,000 A GEC3001691 12/31/2024 12/31/20253 3 3 B AEC0062630 12/31/2024 12/31/2025 3 AEC0062631C 3 3 C UEC0062632 12/31/2024 12/31/20253 3 3 10,000 D WEC3001692 12/31/2024 12/31/2025 3 N C Pollution Liability - Per Occurrence PEC0062633 12/31/2024 12/31/2025 $15,000,000 Each Claim/Agg / $25,000 Ded. C Professional Liab - Claims Made PEC0062633 12/31/2024 12/31/2025 $15,000,000 Each Claim/Agg / $25,000 Ded. E Excess Liability ELZ677135 12/31/2024 12/31/2025 $5Mil xs of $10Mil Ea Occ/Aggregate Greenwich Insurance Company 22322 XL Insurance America, Inc.24554 Indian Harbor Insurance Company 36940 XL Specialty Insurance Company 37885 AXIS Surplus Insurance Company 26620 83359549 | UNITPUM-01 | 24-25 All Lines | Jazmin Hernandez | 12/30/2024 1:55:25 PM (PST) | Page 1 of 12 AEC0062630 AEC0062631 83359549 | UNITPUM-01 | 24-25 All Lines | Jazmin Hernandez | 12/30/2024 1:55:25 PM (PST) | Page 2 of 12 Named Insured: Endorsement Effective Date: POLICY NUMBER: COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM W ith respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. SCHEDULE The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED IN A W RITTEN CONTRACT OR W RITTEN AGREEMENT TO W AIVE ANY RIGHT OF RECOVERY W E MAY HAVE AGAINST THE PERSON OR ORGANIZATION, PROVIDED THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS SUBSEQUENT TO THE EXECUTION OF THE W RITTEN CONTRACT OR W RITTEN AGREEMENT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. AEC0062631 United Pumping Service, Inc. AEC0062630 12/31/2024 83359549 | UNITPUM-01 | 24-25 All Lines | Jazmin Hernandez | 12/30/2024 1:55:25 PM (PST) | Page 3 of 12 IL 00 17 11 98 IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1  COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation 1.The first Named Insured shown in the Declara- tions may cancel this policy by mailing or de- livering to us advance written notice of cancel- lation. 2.We may cancel this policy by mailing or deliv- ering to the first Named Insured written notice of cancellation at least: a.10 days before the effective date of cancel- lation if we cancel for nonpayment of pre- mium; or b.30 days before the effective date of cancel- lation if we cancel for any other reason. 3.We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4.Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5.If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be ef- fective even if we have not made or offered a refund. 6.If notice is mailed, proof of mailing will be suf- ficient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declara- tions is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C. Examination Of Your Books And Records We may examine and audit your books and rec- ords as they relate to this policy at any time during the policy period and up to three years afterward. D. Inspections And Surveys 1.We have the right to: a.Make inspections and surveys at any time; b.Give you reports on the conditions we find; and c.Recommend changes. 2.We are not obligated to make any inspections, surveys, reports or recommendations and any such actions we do undertake relate only to in- surability and the premiums to be charged. We do not make safety inspections. We do not un- dertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a.Are safe or healthful; or b.Comply with laws, regulations, codes or standards. 3.Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations. 4.Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recom- mendations we may make relative to certifica- tion, under state or municipal statutes, ordi- nances or regulations, of boilers, pressure ves- sels or elevators. E. Premiums The first Named Insured shown in the Declara- tions: 1.Is responsible for the payment of all premiums; and 2.Will be the payee for any return premiums we pay. F. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named in- sured. If you die, your rights and duties will be trans- ferred to your legal representative but only while acting within the scope of duties as your legal rep- resentative. Until your legal representative is ap- pointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. AEC0062630 83359549 | UNITPUM-01 | 24-25 All Lines | Jazmin Hernandez | 12/30/2024 1:55:25 PM (PST) | Page 4 of 12 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES ORCONTRACTORS – SCHEDULED PERSON ORORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A. Section II – Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" ordamage" or "personal and advertising injury""property damage" occurring after:caused, in whole or in part, by:1. All work, including materials, parts or1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf;maintenance or repairs) to be performed by or on behalf of the additional insured(s) at thein the performance of your ongoing operations for location of the covered operations has beenthe additional insured(s) at the location(s)completed; ordesignated above. 2. That portion of "your work" out of which theHowever:injury or damage arises has been put to its1. The insurance afforded to such additional intended use by any person or organizationinsured only applies to the extent permitted by other than another contractor or subcontractorlaw; and engaged in performing operations for a principal as a part of the same project.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. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 Name Of Additional Insured Person(s) Or Organization(s)Location(s) Of Covered Operations Any person or organization where required by written contract provided that such contract was executed prior to the date of loss All Locations as required per written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. GEC3001691 83359549 | UNITPUM-01 | 24-25 All Lines | Jazmin Hernandez | 12/30/2024 1:55:25 PM (PST) | Page 5 of 12 C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III – Limits Of Insurance:whichever is less. If coverage provided to the additional insured is This endorsement shall not increase therequired by a contract or agreement, the most we applicable limits of insurance.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 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 83359549 | UNITPUM-01 | 24-25 All Lines | Jazmin Hernandez | 12/30/2024 1:55:25 PM (PST) | Page 6 of 12 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES ORCONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE A. Section II – Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III – Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is"property damage" caused, in whole or in part, by required by a contract or agreement, the most we"your work" at the location designated and will pay on behalf of the additional insured is thedescribed in the Schedule of this endorsement amount of insurance:performed for that additional insured and included 1. Required by the contract or agreement; orin the "products-completed operations hazard". 2. Available under the applicable limits ofHowever:insurance;1. The insurance afforded to such additional whichever is less.insured only applies to the extent permitted by law; and This endorsement shall not increase the applicable limits of insurance.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. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Name Of Additional Insured Person(s) Or Organization(s)Location And Description Of Completed Operations Any person or organization where required by written contract provided that such contract was executed prior to the date of loss All Locations as required per written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. GEC3001691 83359549 | UNITPUM-01 | 24-25 All Lines | Jazmin Hernandez | 12/30/2024 1:55:25 PM (PST) | Page 7 of 12 ENDORSEMENT # This endorsement, effective 12:01 a.m., , forms a part of Policy No. issued to United Pumping Service, Inc. by Greenwich Insurance Company. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS COVERAGE PART It is agreed that to the extent that insurance is afforded to any Additional Insured under this policy, this insurance shall apply as primary and not contributing with any insurance carried by such Additional Insured, as required by written contract. All other terms and conditions of this policy remain unchanged. XIL 424 0605 ©, 2005, XL America, Inc. GEC3001691 12/31/2024 83359549 | UNITPUM-01 | 24-25 All Lines | Jazmin Hernandez | 12/30/2024 1:55:25 PM (PST) | Page 8 of 12 Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations. GEC3001691 83359549 | UNITPUM-01 | 24-25 All Lines | Jazmin Hernandez | 12/30/2024 1:55:25 PM (PST) | Page 9 of 12 IL 00 17 11 98 IL 00 17 11 98 Page 1 of 1 COMMON POLICY CONDITIONS A. Cancellation 1. 2. a. b. 3. 4. 5. 6. B. Changes C. Examination Of Your Books And Records D. Inspections And Surveys 1. a. b. c. 2. a. b. 3.1.2. 4.2. E. Premiums 1. 2. F. Transfer Of Your Rights And Duties Under This Policy GEC3001691 83359549 | UNITPUM-01 | 24-25 All Lines | Jazmin Hernandez | 12/30/2024 1:55:25 PM (PST) | Page 10 of 12 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT —CALIFORNIA 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 written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 %of the California workers'compensation premium otherwise due onsuchremuneration. Schedule Person or Organization Job Description Where required by written agreement signed prior to loss All California Operations. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement No. Countersigned By Page 1 of 1WC040306 (Ed.04-84)Copyright 1984 Workers'Compensation insurance Rating Bureau of California.All Rights Reserved. Policy No. Insurance Company Endorsement Effective Insured WEC300169212/31/2024 United Pumping Service, Inc. XL Specialty Insurance Company 83359549 | UNITPUM-01 | 24-25 All Lines | Jazmin Hernandez | 12/30/2024 1:55:25 PM (PST) | Page 11 of 12 WEC3001692 83359549 | UNITPUM-01 | 24-25 All Lines | Jazmin Hernandez | 12/30/2024 1:55:25 PM (PST) | Page 12 of 12