Insurance - Kennedy - 1998-10-27 ` CERTIFICATE OF INSURANCE ' DATE(PAISUDDnn)/
. . -10/26/98
PRODUCER 909-273-7555 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND RECEIVED
CONFERS NO RIGHT'S UPON TIIE CERTIFICATE HOLDER.THIS CERTIFICATE
Golden Pacific Insurance DOES NOT AMEND,EXTEND OR ALTER TIIE COVERAGE AFFORDED BY TIIE
Services, Inc. POLICIES BELO\v. 90
7 2 19
110 N. Lincoln Ave. #200 COMPANIES AFFORDING COVERAGE OCT I 2 7 JJU
Corona, CA 92720
COMPANY COSTA COSTA MESA SANITARY DISTRICT
A Newmarket Underwriters Ins Co a.)r
INSURED COMPANY 1 1
B Fi eman Fund
Kennedy Pipeline Company
COMPANY n
Post Office Box 3460 C Gulf Insurance Company Ti_
Laguna Hills CA 92653 tf
COMPANY
D Transcontinental Insurance Co 1�/1 c
yon- AGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TIIE POLICY PERIOD
INDICATED,NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTIIER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,TIIE INSURANCE AFFORDED BY TIIE POLICIES DESCRIBED HEREIN IS SUBJECT'1'O 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 ElY. POLICY EXP. LIMITS
LTR DATE(MM/DD/YY) DATE(MM/DDM')
:ENERAL LIAR!ATY GENERAL AGGREGATE 2000000
A X COMM.GENERAL LIABILITY NMG001O25 6/30/98 9/30/99 J PROD-COMP/OPAGG 1000000
CLAIMS MADE X OCCUR PERS.&ADV.INJURY 1000000
OWNER'S&CONTRACT'S PROT EACH OCCURRENCE 1000000
FIRE DAMAGE(One Fire) 50000
MED EXP(Any one person)
AUTOMOBILE LIABILITY COMBINED SINGLE.
B X ANY AUTO DZA80181156 6/30/98 6/30/99 LIMIT 1000000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Pr Perron)
X AIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Pr accident)
— PROPERTY DAMAGE
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT
ANY AUTO OTHER TITAN ALTO ONLY:
EACH ACCIDENT
AGGREGATE
—EXCESS LIABILITY EACH OCCURRENCE 4000000
C x IUMHRET.I.n FORM CU6087241 6/30/98 9/30/99 AGGREGATE 4000000
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND / I STATUTORY LIMITS
EMPLOYERS'LIABILITY J
D WC1081661448 6/30/98 6/30/99 EACH ACCIDENT 1000000
THE PROPRIETOR/ INCA
PARTNERS/EXECUTIVE DISEASE-POLICY LIMIT 1000000
OFFICERS ARE- EXCL DISEASE-EACH EMPL 1000000
OTHER
DE-SCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
J Re: Emergency Servi es. Certholder named add'I sd pe attached G.L.
Blanket Add'I Insd Endorsement. !neuron Primary& Non-Contribt
tory per attached. 10 days NOC for non-pay/non report payroll
, �� Y��cmu»nBi`.--_10 ` i, X18
-CERTIE3 ' TE HOLDER . - _ CANCELLATION ..
SIIOUI,D ANY OF TIIE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL
J Costa Mesa Sanitary District /'
V MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Attn: Joan Revak LEF9', ,. .•," ' "-•_........... ......._..._._.........._...__..._...._.__ _.. ..
P O. Box 1200
AUTIIORIZED REPRESENTATIVE
Costa Mesa, CA 92628-1200
ACORD X,9-S(3/93) ' . 2-87: : : .
•
POLICY NUMBER NMG001025 COMMERCIAL GENERAL LIABILITY
INSURED Kennedy Pipeline Company
INSURANCE COMPANY Newmarket Underwriters Insurance Co
THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY
ADDITIONAL INSURED--OWNERS, LESSEES ✓
OR CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART INCL. AUTOMOBILE
SCHEDULE
Name of Person or Organization:
Blanket, As Required by Written Contract
(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
'The coverage afforded by Contractor is primary and any other
insurance maintained by the additional insured shall be excess only
and not contribute with this insurance
CG 20 10 11 85 Copyright, Insurance Services Office, Inc. 1984
,
GOLDIN PU ( IfI (
RE Newmarket Underwriters Insurance Co
Insured Kennedy Pipeline Company
Pol No NMG001025
Term 6/30/98 to 9/30/99
Certholder,
It is agreed and understood that in the event of cancellation
or non-renewal Golden Pacific Insurance Services Inc will
advise the certholder of said change and will not be the
responsibility of Newmarket Underwriters Insurance Co
A
M-ry Bi .fore
GOLDIN PA ( I -FI ( ' NSUMN ( I WAvvu IN (
3280 E. Foothill Boulevard,Suite 100, Pasadena, California 91107-3103 626 583 1900 FAX 626 583 8535
110 N. Lincoln Avenue,Suite 200,Corona, California 91720-2516 909 273 7555 FAX 909 279 5615
License No.0773850