Insurance - Atlas Underground - 1998-10-21 RD CERTIFICATE OF LIABILITY INSURANCE 12/02/98
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
CALBOND SURETY INSURANCE AGENCY ALTER THE COVERAGE AFFORDED BY THE PO{L,ICIES BELOW.
400 S. RAMONA, STE 205 COMPANIES AFFORDING COVERAGE CORONA, CA 91719 COMPANY • • s'•
(909) 371-8147 FAX (909) 371-2027 A SCOTTSDALE INSURANCE COMPANY- ,It+- ` '
INSUREp COMPANY PPnn�� Pi 1`" 43
ATLAS UNDERGROUND CO. B GENERAL SECURITY INSURAL E' °.66: \t 1U
P 0 BOX 951 COMPANY C.KCeIF�f
CHINO, CA 91708-0951 C RLI INSURANCE COMPANY 14. 5 (-qp
(909) 465-5710 FAX(909) 465-5730 COMPANY 1
D
COVERAGES, ..
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.
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LSAITS
LTR DATE(MINDDIYY) GATE(MMA)DIYV)
GENERAL LIABILITY GENERAL AGGREGATE 52, 000, 000
X COMMERCIAL GENERAL LIABILITY
PRODUCTS-COMP/OP AGG 52, 000, 000 I
_. CLAIMS MADE X OCCUR PERSONALBADV INJURY 51, 000, 000
A X OWNER'SBCONTRACTOR'SPROT CLS 277837 11/29/98 11/29/99 EACH(YrURRENCE $1, 000, 000
FIRE DAMAGE(Any one ere) $ 50, 000
MEDEXP(Anyoneperson) $ 1, 000
AUTOMOBILE LIABILITY
X ANY AUTO COMBINEDSINGLELIMIT $1, 000, 000
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS (Per person)
B X HIRED AUTOS CA4010153 02/24/98 02/24/99 BODILYINJURY
X NON-OWNED AUTOS (Per eceMer $
t)
PROPERTY DAMAGE 5
GARAGE LIABILIT' AUTO ONLY EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY ...L.........-._i
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $4, 000, 000
C X UMBREL AFORM OUL 0029530 11/29/98 11/29/99 AGGREGATE $4, 000, 00 0
OTHER THAN UMBRELLA FORM $ 1
WORKERS COMPENSATION AND (TORY LIMIT$ IDR
EMPLOYERS'LIABILITY
EL EACH ACCIDENT $
—
THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT S
PARTNERS/EXECUTIVE —
OFFICERS ARE EACL EL DISEASE EA EMPLOYEE $
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES!SPECIAL ITEMS
CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED PER THE ATTACHED FORM.
CERTIFICATE MOLDER , ,; < .._. .. , . CANGELLATIQN"r . .,j
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF COSTA MESA EXP RATION DATE THEREOF, THE ISSUING COMPANY WLL ENBEAVOfl TO Malt
SANITARY DISTRICT O'E DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
77 FAIR DRIVE
COSTA MESA, CA 92628 OF ANY KIND UPON THE I`r1MOAUV LT$ A • "'� '" - EE
AUTHORIZED REPRESENTATIVE
ACORD254(1195}_.. _ — �/ + • ORPORATiON!1988
s 10 DAY..'NOTICE FO I t• PAYMEN1,.
(11-85)
POLICY NUMBER: CLS 277837 - - - -
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. - -- - -- - -
CG 20 10 11 85
- ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following: --
SCHEDULE - _ -
Name of Person or Organization: CITY OF COSTA MESA
- SANITARY DISTRICT
- 77 FAIR DRIVE -
- - COSTA MESA, CA 92628 - -
ADDITIONAL INSURED. -
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations-as
- - applicable to this endorsement.) - -
WHO IS AN INSURED (Section II)-is amended to include as an insured the person or organization shown in the
Schedule, but only with respect to liability arising out of "your work" for that insured by or for you.
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y7.^r':!7. 'EMPLOYER,:S`:L`IABILIT Y`LIMIT INCLUDING DEFENSE •COSTS: $1 ,000,000'.00 PER,OCCURRENCE `: i::3u 1.
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,`s6¢ nCtr tut. I ON9.SINDI VI DUAL. EMP,LOYERS- AND Hy S B AM7;?AND..WIPEE`EMPLOYERS'ARE%NOT}ELIGIBLE,,}.•,'.`-;.:� •
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' 'THIS.DOCUMENT_HAS.A.BLUE.PATTERNED.BACKGROUND SCIF 10265.(REV..z 95)