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HomeMy WebLinkAboutH2020-0577 - MiscN ?-02-0- WHITMEC-01 SKUMAR7 ACORO' CERTIFICATE OF LIABILITY INSURANCE `—/ OATS 12120/YVYY) 102/2020 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SURROr;ATION IS WAIVED. suhinct to the terms and conditions of the nolirv. certain nnlir.ies mail reauire an endorsement. A statomenf on this certificate does not confer rights to the certificate holder in lieu of such endersement(s). PRODUCER License # 0757776 NpMPOT Lilit Hasasyan PHONE E#: (818) 257-7471 ,No16030 a: HUB International Insurance Services Inc. Ventura Blvd. Suite500 Encino, CA 91436 E-oAlLss:Illit.hasasyan hubinternational.com INSURE S AFFORDING COVERAGE NAIC_# INSURERA:West American Insurance Co 44393 INSURED INSURER B:The Travelers Indemnity Company of Connecticut ,25682 INSURER C: Travelers Property Casualty Company of America 25674 White Mechanical, Inc. INSURER D: INSURER E 27221 Burbank Foothill Ranch, CA 92610 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR INSO WIND POUCYNUMBER POUCYEFF IMMIDDIYYNYI POLICY UP (MMIN)ONYTY1 LIMITS A 7MZRCIAL GENERAL LIABILITY CGIMS-MADE � OCCUR X X BK02056583996 10/1/2020 10/112021 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500,000 GEN'L MED EXP An one arson $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY ] jEaT � LOG OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 $ a _AUTOAlowJ LIABILITY X ANYAUTO OMEU SCHEDULED AUTOS ON'Y. AUTOS X HIRFO X NON-0WNED I I ALI OS ONLY AUTOS ONLY 810-3R577426-20-26-G 101112020 10/112021 COM�BI cctlEeD SINGLE LIMIT $ 1,000,000 BODILY INJURY Per rsolf $ BODILY INJURY Per accitlenl $ ROPE DAMAGE PseacciI;t - $ C X UMBRFIFI EAB EXCESS LU18 X OCCUR CLAIMS -MADE '" ;,�f-5A f1�,O'.'01!rb� Ei °$ 10/1/2020 101112021 EACH OCCURRENCE $ 8,000,000 AGGREGATE $ 6'000'000 DED I X I RETENTION$ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN AApFFICERMIEMBORfERTNER/ ECUTIVE❑NIA (Mantlatory In NH) If yes, tlescnbe under DESCRIPTION OF OPERATIONS below UB-3R581218.20.26-G 10/1/2020 10/112021 X PER OTH- E.L. EACH ACCIDENT 1,000,000 $ EL. DISEASEEAEMPLOYE $ 11000,000 I E.L. DISEASE- POLICY LIMIT 1,000,000 I $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD fell Additional Remarks Schedule, may beattached if more space is re umad) 1045 Katella, LLC, DSB Orange, LLC & PR Properties, Inc. are included as Additional Insured for General Liability, including Primary & Non -Contributory Wording and Waiver of Subrogation, as required by written contract or agreement per policy form #CG 8810 0413 & CG 85 83 0413. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1045 Katella, LLC, DSB Orange, LLC & PR Properties, Inc. 9 P THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1241 N. Lakeview Avenue, Suite F Anaheim, CA 92807 AUTHORIZEDDD REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PROJECT SUMMARY Project Name: Address: City, State, Zip: Building Department: Permit Number: Building Energy Code: 89 Hillsdale 89 Hillsdale Dr Newport Beach, CA 92660 Newport Beach, City of H2O20-OS77 2019 Standards Scan to Validate HERS VERIFIABLE MEASURES COMPLETE ENERGY CODE COMPLETE COMPLIANCE CERTIFICATE OF COMPLIANCE (CF1R) DATE DOCUMENT TITLE REGISTRATION NUMBER STATUS 10/J9/2020 CF1R-ALT-02-E Residential HVAC Alterations 420-AO20130011A-000-000-0000000-0000 D10 changed from "14" to "16" CERTIFICATE OF INSTALLATION (CF2R) DATE DOCUMENT TITLE REGISTRATION NUMBER STATUS 10/09/2020 CF2R-MCH-01b-E HVAC, Ducts and Fans 420-AO20130011A-000-001-M01001A-0000 Location 1 10/09/2020 CF2R-MCH-20d-H Duct Leakage 420-AO20130011A-000-001-M20002A-0000 CERTIFICATE OF VERIFICATION (CF3R) DATE DOCUMENT TITLE REGISTRATION NUMBER Location 1 10/09/2020 CF3R-MCH-20d-H Duct Leakage 420-AO20130011A-000-001-M20002A- M20A NOTICE: This compliance summary report has been generated by a registration platform provided by CHEERS using 11 Q information that has been uploaded to that registration platform by third parties that are not affiliated or related to CHEERJ CHEERS. Therefore, CHEERS is not responsible for, and cannot guarantee, the accuracy or completeness of the information contained in this certificate. STATUS Page 1 of 1 CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 www.newportbeachca.gov 1 (949) 644-3200 SMOKE DETECTOR AND CARBON MONOXIDE SELF -CERTIFICATION (this certification is to be filled out by the permittee or homeowner) Project Address: Permit Number: Property Owner: I)RO1'S f C IGA0QP_ U,Si-I0 Licensed Contractor: Lic #: h , CR (?,66a The State of California now requires that smoke and carbon monoxide detectors must be installed in all residential buildings California Residential Code (CRC) Section R314.1, CRC R315.2 states in part that existing dwellings be "retrofitted with smoke detectors and carbon monoxide detectors. CRC Section R314.3, CRC R315.3 defines required locations. Both boxes below must be checked: p Carbon Monoxide Alarm: On the ceiling or wall outside of each separate sleeping area in the immediate vicinity of bedrooms or in each hallway outside of the rooms, and each level of the dwelling. Detectors are also required in bedrooms with gas fired appliances 011 OT-Smoke Alarms: Installed in each room used for sleeping purposes, outside each sleeping area, and on each level of the dwelling unit. Retrofitted detectors may be battery operated for buildings where no alterations are performed on the interior. Multiple -purpose alarms (carbon monoxide and smoke alarms) shall comply with all applicable standards and must be approved by the State Fire Marshall. The devices must be installed per manufacturer's specifications. I, the undersigned, hereby certify that I am the permittee or homeowner of the project. I further certify that smoke alarms and carbon monoxide alarms are present and tested to bitfuncOiGnat =[theollowing locations: Signature: Date: NOTE: This self -certification is only used for projects to t e exterior of the structure where access to the interior of the dwelling by the City of Newport Beach Building Inspector is not achieved during the course of construction. FoonslSmokeDetectomndCarbonMonoXldeSelfCert 08/12/16