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Insurance - National Plant Services - 1999-01-26 DATE(M ACORD CERTIFICATE OF LIABILITY INSURANCEPID ER M DD Y NATI-14 01/26/99 PRODUCER RECEIVE I ONLY AND CONFERS NO RIGHTS UPON THE OCERTIFICATE ION Associated Agencies Inc HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 1701 Golf Rd Tower 3, 7th Flr JAN 2 8 1999 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Rolling Meadows IL 60008-4267 COMPANIES AFFORDING COVERAGE Robert Franz COSTA MESA SANITARY DIST IIDI MA PANY Reliance Insurance Company : • 11 INSURED No 847-427-8400 Fax No INSURED COMPANY B V" COMPANY National Plant Services Inc C 1461 Harbor Avenue COMP Y Long Beach CA 90813-2741 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. • • POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS PATE EFFECTIVE DATE(EXPIR T') IGENERAL LIABILITY GENERAL AGGREGATE $ 3000000 © COMMERCIAL GENERAL LIABILITY VQ2846756 10/31/98 10/31/99 PRODUCTS-COMP/OPAGG $ 3000000 in CLAIMS MADE X OCCUR PERSONALBADVINJURY $ 1000000 ■ OWNER'SB CONTRACTOR'S PROT EACH OCCURRENCE $ 1000000 © XCU Included FIREDAMAGE(Any efire) $ 100000 ■ MED EXP(Any pe n) $ 50000 AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ 1000000 © ANY AUTO VQ2846757 10/31/98 10/31/99 III ALL OWNED AUTOS BODILY INJURY ■ SCHEDULED AUTOS © HIRED AUTOS (Pe person) $ BODILY INJURY $ © NON-OWNED AUTOS (Pe aoadent) PROPERTY DAMAGE $ IGARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ■ ANY AUTO OTHER THAN AUTO ONLY ■ EACH ACCIDENT $ ■ AGGREGATE $ EXCESS LIABILITY EXC EACH OCCURRENCE $ 5000000 © UMBRELLA FORM WU2846758 10/31/98 10/31/99 AGGREGATE $ 5000000 OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND X WC STATU- OTH- TORV LIMITS ■ ER EMPLOYERS LIABILITY EL EACH ACCIDENT $ 500000 A THE PROPRIETOR/ © INCL WD2846755 10/31/98 10/31/99 EL DISEASE POLICY LIMIT $ 500000 PARTNERS/E(ECUITVE OFFICERS ARE ■ EXCL EL DISEASE EA EMPLOYEE $ 500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Costa Mesa Sanitary District and its employees. & agents are added as Additional Insureds w/respect to the general liability coverage per form CG2010 11-85 and a waiver of subrogation is included in their favor with respect to the workers' comp cov for operations performed by the Insured. CERTIFICATE HOLDER CANCELLATION COSTA-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL Er DC WVOR TO MAIL Costa Mesa Sanitary District 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn Joan Revak __ a. ___ _ a _ __ a __ _ a LIADILRY P 0 Box 1200 Costa Mesa CA 92628-1200 'terux&e a'"'°'`-' aisel- - - - -- - - • - O'IZ D RE i REE#�FE pITATIVE �,QM,, ACORD 25-S(1/95) ACORD CORPORATION 1988 POLICY NUMBER x92846756 COMMERCIAL GENERAL LIABILITY 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 SCHEDULE Name of Person or Organization: Costa Mesa Sanitary District P 0 Box 1200 Costa Mesa CA 92628-1200 Of no entry appears above, information required to complete this endorsement will be shown in the Dec- larations 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 Id- SLetrov CG 20 10 11 85 C /right, Insurance Services Office, Inc 984