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Insurance - Kilbride - 1999-05-26 . RE-- \S ACORD CERTIFICATE OF LIABILITY INSURANCEcSR DM DATE(MM/DDNY) -MIKEK 1 _ 05/26/99 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATER OF INFORMATION Wood-Gutmann Insurance Brokers ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE License #0679263 HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 14192 Franklin Ave Suite 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tustin CA 92780 7044 COMPANIES AFFORDING COVERAGE Diane Fortner COMPANY IY — PhoneNo 714 505 7000 FaxNo 714 573 1770 A Odyssey Re London LTD ILA` INSURED COMPAN � n RECEIVED B vxn�.6lMnn� u-� 9y COMPANY Mike Kilbride MAY 2 8 1999 C P 0 Box 3341 Newport Beach CA 92659 v �,,,C COMPANY COVERAGES tDSit ",),,!._t". '" " I JI IMP 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 CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DDIYV) DATE(MM/DD/YY) GENERAL LIABILITY I GENERAL AGGREGATE I $ 1000000 A X COMMERCIAL GENERAL LIABILITY SD22426 00 10/30/98 10/30/99 PRODUCTS COMP/OPAGG I$ 1000000 I CLAIMS MADE X OCCUR PERSONAL 8ADV INJURY I$ 1000000 OWNER'S B CONTRACTOR'S PROT EACH OCCURRENCE 151000000 Blanket Al Endt FIRE DAMAGE(Any a lire) I$ 50000 I MEDEXP(Any person) 15500° I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS IPerpe n) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Pe °dent) $ • PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM 1 WORKERS COMPENSATION AND WC STATU- 0TH- I TORY LIMITS rat EMPLO YERS'LIABILITY EL EACH ACCIDENT I$ THE PROPRIETOR/ INCL EL DISEASE POLICY LIMIT I$ PARTNERS/EXECUTIVE OFFICERS ARE EXCL EL DISEASE EA EMPLOYEE I $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS 10 day notice of cancellation for non payment of premium. Costa Mesa Sanitary District its employees & agents are listed as additional insured per the attached AAI 3/97 additional insured endorsement CERTIFICATE HOLDER CANCELLATION COSTAO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL ESE iI`yEI MAIL Costa Mesa Sanitary District 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn Joan Revak % XIO XXXXIX40KIXQ [IX N Xi X XXYANCatal ita P O Box 1200 Costa Mesa CA 92628 1200 X4FXM> IkXIKc gFX¢¢ylgAXXXX XI X AUTHORIZED REPRESENTATIVE , Q— Diane Fortner Ji ' ,`.^ "\-9--..N ACORD 25-5(V95) ACORD CORPORATION-1988 AUTOMATIC ADDITIONAL INSUREDS CONSTRUCTION CONTRACTS THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY This Endorsement modifies insurance provided under the following_ COMMERCIAL GENERAL LIABILITY COVERAGE FORM Policy No. SDI 2426 Endorsement Effcetive: 10/30/98 (At 12.0t A.M.Standard T■x) Named Insured: MIKE KILBRIDE LTD This endorsement changes the policy effective on the inception date of the policy unless another date is indicated above. Please read it carefully The following provision is added to Section II(WHO IS AN INSURED). 5 Any person(s) or organization(s) (hereinafter called Additiontd Insured") with whom you agree in a written contract to name as an Insured is an Insured with respect to liability arising out of 'Your Work' for the Additional Insured on the project specified in the contract, including acts or omissions of the Additional Insured in conne,:tion with the general supervision of"Your Work_ However, the insurance provided to the Additional Insured does not al ply to: a. Property damage' to: 1) Property owned, used or occupied by or rented to the Additional Insured; 2) Property in the care, custody or control of the Additional Insured or over which the Additional Insured is for any purpose exercising physical control; or b. 'Bodily injury 'property damage, or 'personal injury' arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional services for you, for the Additional Insured, or for others, including I) The preparing, approving, or failing to approve maps, dr.twings, opinions, reports, surveys, change orders, designs or specifications, and 2) Supervisory inspection, or engineering services. c. `Bodily injury' or 'property damages' arising out of any act or omission of the ADDITIONAL INSURED(S) or any of their "employees' other than the general supervision by the additional insured(s)of your ongoing operation performed for the ADDITIONAL INSURED(S) These exclusions apply in addition to those contained in the Commercial General Liability Coverage part. Costa Mesa Sanitary District AAI 3/97 P 0 Box 1200 Costa Mesa Ca 92628-1200 FROM KELLI 9REIHHHRN STATE FRREII INS FR' Nr_l. 949 7-'0 2084 Apr EE 19PP 1 3AM PL CERTIFICATE OF INSURANCE This ceruf:es that ❑ STATE FARM FIRE AND CASUALTY COMPANY Bloomington, Illinois ❑ STATE FARM GENERAL INSURANCE COMPANY Bloomington, Illino,s insures the following policyholder for the coverages indicated below Name of policyholder MIKE KILBR IDE Address of policyholcer P 0 BOX 3341 NEWPORT BEACH, CA 92659 Location of operations Description of operations The policies listed below have been issued to the policyholder for the policy periods shown. The Insurance descriosd in these policies is subject to at the terms exclusions, and conditions of those policies.The limits of liability shown may have been reduced by any paid c:aims. POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY Effective Doke Expiration Date (at beginning of policyperiod) Comprehensive BODILY INJURY AND 1 Business Liability PROPERTY DAMAGE l This insurance,ncludes: ❑ Products Completed Operations I ❑ Contractual Liabi,fty ❑ Underground Hazard Coverage Each Occurrence $ ❑ Personal Injury i ❑ Advertising Injury General Aggregate $ ❑ Explosion Hazard Coverage Products Completed ❑ Collapse Hazard Coverage Operations Aggregate $ ❑ General Aggregate Limit applies to each project o EXCESS LIABILITY POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE Effective Date Expiration Date (Combined Single Lunt) ❑ Umbrella i Each Occurrence $ ❑Other Aggregate $ PartI STATUTORY Part 2 BODILY INJURY Workers'Compensation and Employers Debility Each Accident $ Disease Each Employee $ .. Disease Pokey Limit $ TY POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS Of LIAl yI Effective Date Expiration Date (at beginning of policy period)period) P45 6785 A01 AUTOMOBILE 1/1/99 7/1/99 1, 000, 000 I I if any of the described policies are canceled before Is expiration date, State Farm will try to mail a written notice to the certificate holder 30 days before cancellation. If, however,we fall to mail such notice, no obligation or liabilty will be imposed on State Farm or is agents representatives Name and Address of Certificate Hada ,_. / I/,C Sianatu /off Autho IzeLtl_St ` � STATE FARM Vt ��i T �j i INSURANCE COMPANIES Title ©© HOME OFFICES' BLOOMINGTON, ILLINOIS t- `;)51C267 Act-5c C`, 2 Kelly Curtis-Brennan, Agent Data f CC LIC NO 0676344 \/ 27676 Santa Margarita Parkway BUS (949)770-6100 Mission Viejo CA 92691 cir..- 4,-co.415_94-..1` , -" .,-,.i.- go ki: - ,m,- ..- b _ Q 4t;" cc" ii.:1'ilrih g. '4' ' T.-,22 ,, IC. ,2-,,,,?-firs-- "I, ,3F-1,3., r • .-St,.; "t" ,..., ,P7-1 1 i: -,,,@,1,2•4,37,EW la DC-T-1'11E Lit ti-‘4.,,:./1,-4-4-/ .Y. 4 .Y,c..$r. tik, ,, sr xii.. • ,-,,..s.r.- ;‘, -,,,L-- 1.,- iY17. 44,p ‘r•i .1( 4.° -; ;',.... ,i..... ., .t,.., a r, .;,-,•47/,,,./2 rt I -al;. '1'4,1:: /14 ." * 4 -t. :P't40.. I -I. 4. XI . ti . . ,/.. .., '.:6V- St, .:1S, 4. Z;f: ! F - dr `21N/7/"'" 2.22-.2t. ‘.7.....-;.. ,--0--s-- -..-r . . • ' ..... '•"-- Vt. . 4 .4.4.4.* . 4 Cr‘'`.0 ..." -AI ' P'Ez • ' "- - • ._.. . .1. m,.. .„4 ... ,, , 2321/pf c4. JO ■2.7. ,-..,.‘„STATE, - z..... -4.-,p O. BOX 42080T.SAN:VRA'NCISCOICA,94,142L08074..4y.'„Tre.44?':-/)?"7> -IC' frcoM PEA-saki-1014.71'f- ' --'4.4.4... t-- • t..'4-.!-- .1'*-/L^,-/. 4t/PI et.-aalc,84".•f.ki.- 'J."- '...". ri iscet.“,541.1( r/4 kl::i.:7543,-"4'•C' 'Tt.,‘Cl";"4r• COSTAT ' t ' •'-.I ;it k 4 tr! %cr.,S'U,Ft RON"C LE.1.-.P:f.' 7L: thjc,s ‘;.; -1-''1.21\14 C/,',./ ' CV;Li, YieS.*C` ' '0."lc'•'I' x-rsc. ethi.-,-*.i. ESA SANITARY OMIT •' ISI'Dr7 pi- r .,, • . ...-.-- -i-e-: 5;5' CE-TIFI-ATE4OF WORKERS'COMPENSATION'INSURANCE , ,fr-iii „- ft)..-kt' v?- .,.. „. _ , _ „ "ft".1 C -.1.,44.4...ty. .„., -te , ,t9;.....;„,s °-1-;tic,. ' " " - c- arcs, .i...,,-,,,..g. 20 :C.?.„teVVIRY,427.-; ,1999, F,', irA' 7 . r " POLICY,NIUMBER- 1%24.25 -,-0981 4' -5"1.te ,. . ...,,. , . '3.4 44" 7-4- pc,rss "d'-'' j tri.es - -4.:;:fp 1.4".-' <is c' y, yes •tat" CERTIFICATE EXRIREg. ,10-71-99 ;21-4' APS -2, - ---. ,1:1_,':-.4t-f,' -i:;1;;;;• -C;t4t. 4`.- -.4 TA:g ,„ --1- .c,... 1: rit- , •si-- - L'-'-'4' i4;_xi,„, ..., ....r • - ....V tit,'-4 •-k cer • 4.;" 7 t":.'x_.,-;-.: ...t-:,,, ..e t 1 2*-1.• "Z"•'' -COSTA--,friESII7SANITA RV:4D IStR I Ct -,LT: if A,- - -,.. ,„,. 4.--ect t"., A- P ,'t.,„i.,1-,-,;„, .,,..., t.-• . ,.. ' f. e.r,-AnITTN -DAWN-;Gb- hEISGE.R Cr , ''', '''' ,' ' 1 . cr:- - A 'Lb- vr.P••‘" - , 7.--•'4'.''.'-1' .",:if :3;•4. --2-. i. S ""t2, ?. •iif`d%-14.1;111.? <54 L-rsP -0.-4Bot 42603 .., .cs ' t _ r- zer.3. i.-"-t 111•1- i'-'41....”-22‘2,',;3-4131.3,23 -,-, , , 0 JOB g.. gl'aISSIR MESI1M•CPI 9262871200 kr -;-, .... .j O ',VARIOUS,LOCAT IONS '1 'kr' --- vki f-1-1 ;,k- '* --A, ,---„,.../.-4, ., z.,,s• $.€ ,-4°.;'‘ ',As- . Ats•-4- ,' -'4, f r---- ', 1?..k1- tr*d. ' tat "rr"1:te.ALIrPERAT IONY-;.t -44-- .AG.•,{;•-- ,--4-e-g.,--:4 ...,•c: ,121C.-0/. -2 ;I. A-'9A--,0 •>,r,- 44-4b,,g„.. ' ts'-i- .; " ,.....c.. . •- ■-.Ira- .'..%,C t•Oeitin.litT•,:ti lit''2..3,T3t.tft.,ct '.'-Ccikcgs= ' ',;•Cer .v.ka 4-- f..t...- '.):2? .1k,',,,,, _-• .1' „L-42^”IS 4:120„e' ,,:;'"12'*-*FIT2‘ciat_24-fr- 1, )027:,.. 5.,.st -.1. ty 1- ",..•1 .„......va. tt.4.;tc••••• -tt".9......4,At, 41: \ 1..- i'S7t: -4. 3. .1/4.---1.., _4, (k«:-.,.• .4... - •..Z$ - ,- .::,,,, :.`"..,;•• ,,.'4. 2Thisistobertifythat we have IssuedIa.valid WorkerSpimpansatiOninsUranceholicon a.formJappiOved b9 the California.; ,....,..-..4,:r . •i,„. 1-zi-:. !0.4ii-i?LirOriCeConimitstgioheYtofhgehliciloygrnaMVO tieloW7fOri the tObil6j,,*peribtel ihidica-tted?;4":-",.*:tra, . ,... . c - - -, p<- • ./.4.--: ”-- 7c -.." 30 fl 1- r ■cr Thigbalio9.is nbt'S-ubject to cancellation by thefund except upon hickdays..advance written notice to tifeemployei:. - • ei. inti,--0 '..01.. --tLV -1/..-ffT 43 49.,r, .,..,,,"4.'-rb.ii?, ,,:v ,-,1,-/-Niz --•-,,- gc-e.4-&-'30 „,, • ,,,Li..71, ..,..31,- -, '... -.con tc,cr c/Ibi.X. r- ...,:t' -, -,. --v - - NI" We will also give you Tkk.I'dayst advance notice should this policy be cancelled prior to its normal expiration.:(1- ;; .--.: i. - - ,--t. 'O. k 4 ',tee, 0.. x ,,i... \Stk.: ‘1, `4,:' „ .e,,, c . .. 21 ...• -2 ., ,•1',4-.. .„ ,,,: . -`r 3.. x;',... .... 1/4t1"-4:, 4.., ,....3rs te:,,,,s314... • - !r„T,hiS certificate ofiinsurance'ts nohanunsurance:policy.and.doeshOcanyeridJjextelioi-or alter,theipoyeragd.affordethbythe .:, -,..._a '" ISCiiibier-siisted:.filire;hNotvittistatidifig-,-,an9.Veguirefnent:yerni, or5bonditioft.oe-any contract Orr ofher. doeurnent yviyi_.24,. reiepect kJ-Which thisfcedificata..Of.insurance may be,issued Ortmaycpertain„the.iitsuiance",afforded„byitheepoliciesr.s .....-1--.; Jthcritied;herein'is subject to all the tengs,;exclusions and conditions of such policies. e",. -,;,-&--,- "440;..,.+. -..j,.:5 -Al . ll 14.: .: 654 : - rce u.'f ,, i ' N.-05 .3, . . i. ti."..i-ki: ' 1 .. . t4: $1.23:e i 4" sl r Ft' kej ."4'.- J1 :t .%\i' w 4.1t '4,. Ck, .....? ,2: ,i, *"..,. --., ,. ,4„, ....; .4, ''.,,,e,!-:?..", lc,. -;' - .23-'7. .%,'' .r .' 7/-c.:Cf,i; '''r •t, i!'. .... Az* nt, „67-e---A-lr:_l_Vaetri.-(1_42-e--- • - s':" ft 123, s, .. .., _ __. _• NTATIVE t, 2.3. , Vb• ., •;AUTHORIZED REPRESE , ••• •t•.- c *, ;4- , .,_PRESIDENT .1... j5- jx.= ta..A, ,7-- 1, -.--/-- '''' EhiPLOYERtt I AB I L.Ires-LI M I-T INCLUDING DEFENSE -COSTS S1 .000 000,PER OCCURRENCE: 'CI-, - -et, - Thr ,- __. • ' ``;-% ":1,:.- 1.--4-, ',14::Pffl• • „,* - ,,..* - re.:1C,,. 51' ..„-...-1;T; -,55_ , ,;.; -5" •:.--*t.'..,, -c-L p.,,,-IV: ,I , 5.5",. "r•rc..:13. cla••2511, ..;;c" ‘,., .4- . .‘.--,.. . v..,.•-•:LEND 0 RSEMENT42065PENT I-TEED CE RH F ICATEHOLDERS' -NOT ICE-;EFFECT,IV E-,, ...it, '‘,11.7Aa-li /4,4- - ,i:-., •1‘.7' -''''kif -" '" '"•'• r 0 ,:4-- - s. '--c---,. .' 't, ' ‘-' - .• P.' ' - .4 ' ''''''' - • t,,- '-' , --: 4“ ' ;9-- rc4 0.,` ' ,e10/011,99 IS4ATTACHED TO1IND FORMS-A., PART :0F...,:cTHISPOUICY4 tv --: • *--,;„, -74.. - fri.irrr - .;?- - --, ..1 7. ,t• ,-I 're. fa, ..."4". ,...•I-. .4, CC.. •Cl.ii". ...-et • ,..-4. ' ,3.. . ;.:.,.. 4--... 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',"e oi,".1-Zet ,4 460 c 4fic. •..1/27: 4 ...Jig: 3; r.,71:4:5V54. 4,,,'" ;CH', .01,..„., x;-.-54.s.S.,...-4k;,,e;frft.ke .ce..4.1"4-_-.A.,,,,„,.,_- -;;.•lit ,,..229• Tie.,, "ii,..!?;itz;ittei4, .;"ttio- "H. e,tml"` ,:-,1- 0,-°- , ' .- tc"-' , -t- - - N- , cr. N a.t't.. 0.t.tAt.:4 • '-nt. 4'.• ;b,".- ' % 4 ,..,;,... 1.Ye ,, tee., .4 1 a- •e r2-.' .fr ,,,,,IP ,...t., - •k.‘1/4 •.. , Se .0...-- ,:: N. k n. 4 •-••• "'4`" ' -• t.4 ar - tn. '",-4. """-' -4 ■L'... ,i• '.3-., .'St •i ''''' ,4,-„a2., .4,•,. ca• A ., ,.. et,1 ...... .." P.'''' ,,,, 7 -s-, VA," •?.. .,.. Itt., -I .,..,, ".." - ,L•EI■olPtOYER 41- - <C: •3:.e."1- ?"'' L'' 't ,. I.4 4...... 'fin- ,.4 .., i'l" • •;-; J r / 4 41. ' ef ,4 ''•"'CT'? a, „ '"C,Sft.. Lk ' . Vo, 2,,-;,.:ty,,it,„,71:/es ' ,,vc;• ' rt. .3 ;,,le '41- ...•:.,. ..i.,1:. 44, ... .,: ., z..t.,:nr'll ,a` ,,,,,:i s, It. .1.,.....''',,,:.:5;' ' :-.dt• `• +' 3E'"- i. 'Y'ir i'`..'kt. e t , ‘ ,..,,',"...1/4 ,..,,. i 1/4'' ‘2.44tt‘it •";'ri'•AcH-19.49:4.: 1. .44' ■ . '1,, •.. Ay:n.4 . -7., -' vrid,, I ---, ,>. %,"-'. ... r-,- 7.,', •.,•• -„ ,.-•r.- _ ''.....i■• e 21; '`,t 2-AL, -z---4----4(I tBR I DE' ,J,1 I CHREL„1..k--,r,,r - Y., ,,,,,z, -4:4. •-:,, 4,-!,-JC ”, • - --- ,-0, , 1..,,, , ...-.,.,-,, ,401--,--. • ' • , ' aBli. -1;11CHAEI! J K IEB Fi I bE- n - e.4 ''.1 'r. C„It' 1 t> .. *r .1V. ,c2•.! 1‘..-` 1:•r. 1.. -*--"ri • f -14. ... ,i, BOX 3341 .71- • t-t, c., 4 • tr,,....c.,,, ,. .,. ...., , ., ., -,n NEWPORT BEACH CW92659%-/ 3: ;1-1- ;; bfr t t 4 ' ,; i t 4- , ,,, ,,r,tr..st 0 ••; c a . . 4,- ,. ...,---. ....4.r,-"..1(-.1 -.7.? -.0. -_..„.- - ... THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SC IF 10262(REV.3-0)