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Insurance - Nikola - 2012-12-21
M CERTIFICATE OF LIABILITY INSURANCE I DAM(MMIDDIYVY)'I I 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 1ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED tEPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must 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 endorsementtsl. PRODUCER Patriot Risk & Insurance 8105 Irvine Center Drive DEC 262012 INSURED Nikola Construction Corporation DBA: Nikola Corporation 2950 Airway Avenue, Suite A -4 Costa Mesa CA 92626 COVERAGES CERTIFICATE NUMBER: 15070733 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 IS 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 ADD NWR SUBR POLICY NUMBER POLICY EFF MM/DD/YY Y POLICY EXP MM/DD/'YYYY LIMITS A GENERAL LIABILITY GL953601 8115/2012 8115/2013 EACH OCCURRENCE $ 1,000,000 ,/ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE IV] OCCUR DAMAGE TO RENTED PREMISES (Ea occunence) $ 50.000 MED EXP (Any one person) $ 10,000 PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS- COMPiOP AGO $ 2.000,000 POLICY F, / PRO- LOC JECT 1:1 $ AUTOMOBILE LIABILITY (CE018 d DSINGLE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY"JURY(Per accident ) $ NON -OWNED HIREDAUTOS AUTOS PROPERTY DAMAGE Peracddent $ S B UMBRELLALIAB OCCUR BE059322905 8/15/2012 8/15/2013 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 EXCESS LIAB CLAIMS -MADE DED Ll RETENTION$ $ $ G WORKERS COMPENSATION ANDEMPLOYERS'LIABILIW YIN WC13979165 12/2412012 12124/2013 WCSTATU- OTyy- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETORIPARTNER /EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ 1000000 (Mandator, in NH) it yes, descnbe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below ON OF OCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, amore space Is required) Qu li Z esa Sanitary District, its directors, officers, engineers, employees, and authorized agents are named as Additional Insured includes Primary & Non - Contributory as respects to General Liability per endorsement attached where required by written contract. Per Project Aggregate applies per endorsement attached. 30 days notice of cancellation, 10 days for non - payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 628 W. 19th Street ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa CA 92627 AUTHORIZED REPRESENTATIVE / Leonard E. Ziminsk © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AT NO.: 1507pJ33 Lisa And de 12/ 1 2012 2:4h '38 1 f 4 1e Cert lL lcata cance E; and2 �upersees �},� revlously issued certificates. GL953601 Nikola Construction Corporation DBA: Nikola Corporation THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - COMPLETED OPERATIONS & ONGOING OPERATIONS AS SCHEDULED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Operations WHERE REQUIRED BY WRITTEN CONTRACT WHERE REQUIRED BY WRITTEN CONTRACT A. Section it —Who Is An Insured is amended to include the person(s) or organization(s) shown in the Schedule (called additional insured), but only with respect to: (1) Liability for "bodily injury" or "property damage" caused, in whole or in part, resulting from "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" when you and such person(s) or organization(s) have agreed in writing in a con- tract or agreement that such person(s) or organization(s) be named as an additional in- sured on your policy. (2) Liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by resulting from: (a) Your acts or omissions; or (b) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the loca- tions) designated above. B. Section IV — Commercial General Liability Conditions, 4. Other Insurance is amended and the following added: If you are required by written contract to provide primary insurance, the insurance afforded by this Coverage Part for the additional insured shown in the Schedule is primary insurance and we will not seek contribution from any other insurance available to that additional insured. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, U462 -0310 Includes copyrighted material of ISO Properties, Inc., 2004 Page 1 of 1 with its permission. T91No.; li f 733 Lisa A-dr . 12/21/2012 2:4138 %LV ¢ 2 f 4 1s cer leate cancels an aperseo'es ALL �revlously issued certificates. GL953601 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT - RESTRICTED FORM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: WHERE REQUIRED BY WRITTEN CONTRACT (If no entry appears above, information required to complete this endorsement will be shown in the Decl lions as applicable to this endorsement.) A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, and for all medical expenses caused by accidents under SECTION I — COVERAGE C MEDICAL PAYMENTS, which can be attributed only to ongoing operations at a single designated con - struction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under SECTION 1 — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, except damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard ", and. for medical expenses under SECTION I - COVERAGE C MEDICAL PAYMENTS regardless of the number of: a. Insureds: b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits ". 3. Any payments made under SECTION 7 — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY for damages or under SECTION 1 - COVERAGE C MEDICAL EXPENSES shall reduce the Designated Construction Project General Aggregate Limit for that des- ignated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown In the Declarations for Each Occurrence; Damages to Premises Rented to You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. S. The most we will pay for the sum of all Designated Construction Project General Aggregate Limits combined and to which this insurance applies is $ UCG2503 -0310 Contains material Copyright, insurance Services Office, Inc., 1996 Page 1 of 2 with its permission. '1'YIRi sNOCErC i'iic3te Lisa An an6? uperse'd'e's 5"i.f,8�ir'eviouSly issued certificates. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences' under SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, and caused by accidents under SECTION I - COVERAGE C MEDICAL PAYMENTS, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY for damages or under SECTION I - COVERAGE C MEDICAL PAYMENTS shall reduce the amount available under the General Aggregate Limit or the Products - Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. C. When coverage for liability resulting from the "products- completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard" will reduce the Products - Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit, D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables', the project will still be deemed to be the same construction project. E. The provisions of SECTION III - LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Page 2 of 2 Contains material Copyright, Insurance Services Office, Inc., 1996 UCG2503 -0310 with its permission. RT NO.: 1 07 )33 Lisa And de 12/ 3 2012 2:4 .]0 4 ( 4 rt'h>s cerE�]ircate cance'las and2 �uperse�d'es it'l.V reviously issued certificates. " CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDfYYYY) 2012 `� 12/19/2012 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 ^PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. aORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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). PRODUCER CONTAC T CT � . Elke Riddles NAME: Commercial Associates PHONE -4No 949 FA( ( ) 524 FAX No(. (]14) 524 -4940 4226 E. La Palma Avenue R ;;M;1«R C RECEIVE Anaheim CA 92807 DEC 1 1 LU1Z INSURERA:Golden Eagle Insurance Co INSURED INSURER B Nikola Construction Corporatic,401A 1ALSA SANITARY DISTRIC. INSURER C: 2950 Airway Ave INSURER D: Ste A -4 INSURER E Costa Mesa CA 92626 INSURER F: rnVFRAr:FC PPRTICIPATF 1,11 IRAMC10•1 9 /7q GT. 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. INTR TYPE OF INSURANCE IN BR POLICY NUMBER MM/DDY EFY I tMM/DDfYYYY1 LIMITS GENERAL LIABILITY EACH O CCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMA ET TED PREMISES Ea occurrence $ MED EXP (Any one person) $ CLAIMS -MADE F—I OCCUR PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS- COMP /OP AGG $ POLICY PRO- IFCT LOC $ AUTOMOBILE LIABILITY OMBI t ED SINGLE LIMIT 1,000,000 X. ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS 8882682 2/19/201212/19/2013 BODILY INJURY Per accident ( ) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ Uninsured motorist Blsplit limit $ 100,0001 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEO I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? N/A WC STATU- OTH- E. L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatary in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 1111, AddiVonal Remarks Schedule, R more space is required) Re: Operations usual to named insured. City of Costa Mesa and Costa Mesa Sanitary District are added as additional insured where required by written contract as respects the auto liability policy per attached endorsement GECA 701 (01/07). City of Costa Mesa Costa Mesa Sanitary District 628 W. 19th Street Costa Mesa, CA 92627 -2716 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 �RE1I11PR� \ESEENTA� \I\IXEE ©1988 -2010 ACORD CORPORATION. All rights reserved. IINJUL9 (201005)� 01 The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO GOLD ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SECTION II — LIABILITY COVERAGE A. COVERAGE 1. WHO IS AN INSURED The following is added: d. Any organization, other than a partnership or joint venture, over which you maintain ownership or a majority interest on the effective date of this Coverage Form, if there is no similar insurance available to that organization. e. Any organization you newly acquire or form other than a partnership or joint venture, and over which you maintain ownership of a majority interest. However, coverage under this provision does not apply: (1) If there is similar insurance or a self- insured retention plan available to that organization; or (2) To "bodily injury' or "property damage" that occurred before you acquired or formed the organization. f. Any volunteer or employee of yours while using a covered "auto" you do not own, hire or borrow in your business or your personal affairs. Insurance provided by this endorsement is excess over any other insurance available to any volunteer or employee. g. Any person, organization, trustee, estate or governmental entity with respect to the operation, maintenance or use of a covered "auto" by an insured, if: (1) You are obligated to add that person, organization, trustee, estate or governmental entity as an additional insured to this policy by: (a) an expressed provision of an "insured contract", or written agreement; or (b) an expressed condition of a written permit issued to you by a governmental or public authority. (2) The "bodily injury" or "property damage" is caused by an "accident" which takes place after: (a) You executed the "insured contract" or written agreement; or (b) the permit has been issued to you. 2. COVERAGE EXTENSIONS a. Supplementary Payments. Subparagraphs (2) and (4) are amended as follows: (2) Up to $2500 for 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 earning up to $500 a day because of time off from work. GECA 701 (01107) Includes copyrighted material of Insurance services Offices, Inc. with its permission Page 1 of 3 INSURED COPY o�..e SECTION III — PHYSICAL DAMAGE COVERAGE A. COVERAGE The following is added: 5. Hired Auto Physical Damage a. Any "auto" you lease, hire, rent or borrow from someone other than your employees or partners or members of their household is a covered "auto" for each of your physical damage coverages. b. The most we will pay for "loss" in any one "accident" is the smallest of: (1) $50,000 (2) The actual cash value of the damaged or stolen property as of the time of the "loss "; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. If you are liable for the "accident ", we will also pay up to $500 per "accident" for the actual loss of use to the owner of the covered "auto ". c. Our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by an amount that is equal to the amount of the largest deductible shown for any owned "auto" for that coverage. However, any Comprehensive Coverage deductible shown in the Declarations does not apply to "loss" caused by fire or lightning. d. For this coverage, the insurance provided is primary for any covered "auto" you hire without a driver and excess over any other collectible insurance for any covered "auto" that you hire with a driver. 6. Rental Reimbursement Coverage We will pay up to $75 per day for up to 30 days, for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto ". Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for a period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your materials and equipment from the covered "auto ". If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under paragraph 4. Coverage Extension. 7. Lease Gap Coverage If a long -term leased "auto" is a covered "auto" and the lessor is named as an Additional Insured — Lessor, In the event of a total loss, we will pay your additional legal obligation to the lessor for any difference between the actual cash value of the "auto" at the time of the loss and the "outstanding balance" of the lease. "Outstanding balance" means the amount you owe on the lease at the time of loss less any amounts representing taxes; overdue payments; penalties, interest or charges resulting from overdue payments; additional mileage charges; excess wear and tear charges; and lease termination fees. B. EXCLUSIONS The following is added to Paragraph 3 The exclusion for "loss" caused by or resulting from mechanical or electrical breakdown does not apply to the accidental discharge of an airbag. Includes copyrighted material of Insurance services Offices, Inc. with its permission GECA 701 (01/07) Page 2 of 3 INSURED COPY Paragraph 4 is replaced with the following: 4. We will not pay for "loss" to any of the following: a. Tapes, records, disks or other similar audio, visual or data electronic devices designed for use with audio, visual or data electronic equipment. b. Equipment designed or used for the detection or location of radar. c. Any electronic equipment that receives or transmits audio, visual or data signals. Exclusion 4.c does not apply to: (1) Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed solely for the reproduction of sound, if the equipment is permanently installed in the covered "auto' at the time of the "loss" and such equipment is designed to be solely operated by use of the power from the "auto's" electrical system, in or upon the covered "auto'; or (2) Any other electronic equipment that is: (a) Necessary for the normal operation of the covered "auto" or the monitoring of the covered "auto's "operating system; or (b) An integral part of the same unit housing any sound reproducing equipment described in (1) above and permanently installed in the opening of the dash or console of the covered "auto" normally used by the manufacturer for installation of a radio. D. DEDUCTIBLE The following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. SECTION IV. BUSINESS AUTO CONDITIONS A. LOSS CONDITIONS Item 2.a. and b. are replaced with: 2. Duties In The Event of Accident, Claim, Suit, or Loss a. You must promptly notify us. Your duty to promptly notify us is effective when any of your executive officers, partners, members, or legal representatives is aware of the accident, claim, "suit", or loss. Knowledge of an accident, claim, "suit ", or loss, by other employee(s) does not imply you also have such knowledge. b. To the extent possible, notice to us should include: (1) How, when and where the accident or loss took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the accident or loss. The following is added to 5. We waive any right of recovery we may have against any additional insured under Coverage A. 1. Who Is An Insured g., but only as respects loss arising out of the operation, maintenance or use of a covered "auto" pursuant to the provisions of the "insured contract ", written agreement, or permit. B. GENERAL CONDITIONS 9. is added 9. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Your unintentional failure to disclose any hazards existing at the effective date of your policy will not prejudice the coverage afforded. However, we have the right to collect additional premium for any such hazard. COMMON POLICY CONDITIONS 21. is replaced by the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. GECA 701 (01/07) Includes copyrighted material of Insurance services Offices, Inc, with its permission Page 3 of 3 INSURED COPY o�,.e