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EKI Certificate of Insurance - 22 Jan 19SHOULD 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 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. $ $ $ $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 belowIf 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 HIREDAUTOS ONLY 1/22/2019 Dealey,Renton &AssociatesP.O.Box 12675Attn:David C.EckmanOaklandCA94604-2675 Doris A Chambers 510-465-3090 510-452-2193 dchambers@dealeyrenton.com Greenwich Insurance Company 22322 EKIENVIRO1 Sentinel Insurance Co.LTD 11000EKIEnvironment&Water,Inc.577 Airport Boulevard,Suite 500BurlingameCA94010-2023 American Automobile Ins.Co.21849 XL Specialty Ins.Co. 1812522187 A X 1,000,000 X 1,000,000 5,000 1,000,000 2,000,000 X Y Y GEC000341518 6/16/2018 6/16/2019 2,000,000 B 1,000,000 X X X Y Y 57UEGAM9746 6/16/2018 6/16/2019 D X 4,000,000 X Y UEC000341718 6/16/2018Y 6/16/2019 4,000,000 C X N Y SCW0030171801 7/1/2018 7/1/2019 1,000,000 1,000,000 1,000,000 A Professional&Contractor'sPollutionLiab. PEC000341617 6/16/2018 6/16/2019 $2,000,000per Claim$2,000,000Annl Aggr REF:Sample wells on South Tahoe Public Utility District (STPUD)property.GENERAL LIABILITY/AUTOMOBILE LIABILITY ADDITIONAL INSURED:SouthTahoePublicUtilityDistrict(STPUD)are named as Additional Insured as respects General Liability and Auto Liability as required per written contract oragreement.The Excess-Umbrella Liability is Following Form to the General Liability,Automobile Liability and Employers'Liability policies.General Liability isPrimary/Non-Contributory per policy form wording.Waiver of Subrogation applies to Commercial General Liability,Automobile Liability and WorkersCompensation.30 Day Notice of Cancellation. 30 Day NOC/10 Day for NonPay of Prem South Tahoe Public Utility District (STPUD)1275 Meadow Crest DriveSouthLakeTahoeCA96150 POLICY NUMBER:COMMERCIAL AUTOCA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE 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 this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverageunder the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverageprovided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicatedbelow. Named Insured: Endorsement Effective Date: SCHEDULE Name Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifiesas an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II – Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I – Covered Autos Coverages of the Auto Dealers Coverage Form. 57UEGAM9746 EKI Environment &Water,Inc. 6/16/2018 NAME OF PERSON OR ORGANIZATION CONTINUATION:South Tahoe Public Utility District (STPUD) POLICY NUMBER:COMMERCIAL GENERAL LIABILITYCG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 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 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 yourbehalf; 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 additionalinsured only applies to the extent permitted bylaw; and 2. If coverage provided to the additional insured isrequired by a contract or agreement, theinsurance afforded to such additional insuredwill not be broader than that which you arerequired by the contract or agreement toprovide 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 orequipment furnished in connection with suchwork, on the project (other than service,maintenance or repairs) to be performed by oron behalf of the additional insured(s) at thelocation of the covered operations has beencompleted; or 2. That portion of "your work" out of which theinjury or damage arises has been put to itsintended use by any person or organizationother than another contractor or subcontractorengaged in performing operations for aprincipal as a part of the same project. GEC000341518 South Tahoe Public Utility District (STPUD) 1275 Meadow Crest Drive South Lake Tahoe CA 96150 NAME OF PERSON OR ORGANIZATION CONTINUATION:South Tahoe Public Utility District (STPUD) Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 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 ofInsurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. POLICY NUMBER:COMMERCIAL GENERAL LIABILITYCG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 ADDITIONAL INSURED – OWNERS, LESSEES ORCONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PARTPRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Or Organization(s)Location And Description Of Completed Operations 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 toinclude as an additional insured the person(s) ororganization(s) shown in the Schedule, but onlywith respect to liability for "bodily injury" or"property damage" caused, in whole or in part, by"your work" at the location designated anddescribed in the Schedule of this endorsementperformed for that additional insured andincluded in the "products-completed operationshazard". However: 1.The insurance afforded to such additionalinsured only applies to the extent permittedby law; and 2.If coverage provided to the additional insuredis required by a contract or agreement, theinsurance afforded to such additional insuredwill not be broader than that which you arerequired by the contract or agreement toprovide for such additional insured. B. With respect to the insurance afforded to theseadditional insureds, the following is added toSection III – Limits Of Insurance: If coverage provided to the additional insured isrequired by a contract or agreement, the most wewill pay on behalf of the additional insured is theamount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits ofInsurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicableLimits of Insurance shown in the Declarations. GEC000341518 South Tahoe Public Utility District (STPUD)1275 Meadow Crest DriveSouthLakeTahoeCA96150 NAME OF PERSON OR ORGANIZATIONCONTINUATION:South Tahoe Public Utility District(STPUD) WC040306 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. Policy NumberInsured: Producer: Dealey, Renton & Associates Effective Date Schedule Person or Organization Job Description Additional Premium % We have the right to recover our payments from any- one 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 segre- gating the remuneration of your employees while en- gaged in the work described in the Schedule. The additional premium for this endorsement shall be the percentage, as shown in the Schedule applicable to this endorsement, of the California workers' compensation premium otherwise due on such remuneration. __________________________________________________________ Authorized Representative EKI Environment &Water,Inc.SCW0030171801 7/1/2018 South Tahoe Public Utility District (STPUD) 1275 Meadow Crest Drive South Lake Tahoe CA 96150 NAME OF PERSON OR ORGANIZATION CONTINUATION:South Tahoe Public Utility District (STPUD)