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Project 183- 2 - Insurance - Nikola Corp. - 2010-10-04 1 AC©RD CERTIFICATE OF LIABILITY INSURANCE OP ID M DATE(M OD YYYY) NICHO-1 10/04/10 ,_ PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CLARKE MARINE INSURANCE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 245 FISCHER AVENUE, SUITE D-8 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. - "OSTA MESA CA 92626 \--�hone 714-444-2679 Fax 714-444-0176 INSURERSAFFORDINGCOVERAGE NAIC# INSURED INSURERA QBE Specialty Insurance Co Nikola Construction INwRER • Evanston Insurance Co - Corporation INSURER C: state uw.n,nc,en Ineuance DEA: Nikola Corporation ..— 18012 uite 290 INSURER D. century Su ety insurance co Irvine CA Cowan,92614 -- INSURER E: ,_ COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR�-•• POLICY NUMBER DATE MMIDDIYY) DATE(MM/DD N LIMITS LTR NSRD TYPE OF INSURANCE ( GENERAL L IABILITY EACH OCCURRENCE $ 1,000,000 _- . �AAHG I'H[Nleu $50,000 A X X COMMERCIAL GENERAL LIABILITY GXG00722 08/15/10 08/15/11 1-1) 5ES Ea nav,ence) CLAIMS MADE X OCCUR MEDEXP(Any one person) $5,000 X Blanket Addl Insd PERSONAL S ADV INJURY $1;000,000 X Waiver of Subro GENERAL AGGREGATE $2,000,000 - GENLAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OP AGO $2:000,000 —I POLICY il JP( fl LOC ._ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) S ANY AUTO _ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) —HIRED AUTOS BODILY INJURY $ NON—OWNED AUTOS (Per accident) PROPERTY DAMAGE g (Per accident) GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ 1 v ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $2;000,000 B X OCCUR LI CLAIMS MADE XOWE228010 08/15/10 08/15/11 AGGREGATE $2,000,000 $ X 1 DEDUCTIBLE •$ ._• RETENTION $10000 S WORKERS COMPENSATION AND XITORYLJMITS I IOER 1 C EMPLOYERS'LIABILITY 1886603-2009 12/24/09 12/24/10 E.LEACHACCIDENT $1,000,000 • OFFICER/MEMBER EXCLUDED' EL DISEASE EA EMPLOYEE $ 1;000,000 U yyees.tlL PRO larder E.L DISEASE POLICY LIMIT $1,000,000 SPECV0.PROWSIONS below OTHER D Excess Liability TO FOLLOW 10/04/10 08/15/11 Per Occur $2 000 000 $10,000 SIR Genl Aggr 62,000,00C DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Certificate holders are named as an additional insured with respect to Contract #183-2 Bristol Street Sewer n/o Randolph Ave and per Blanket Additional Insured Endorsement no CG 2010 07/04 Coverage is primary & non contributory to any other insurance *except 10 day notice of cancellation for non payment CERTIFICATE HOLDER CANCELLATION .- COSTAME SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAT )N Costa Mesa Sanitary District & DATE THEREOF THE ISSUING INSURER WILLACM MAIL 30* DAYS WRJREI• it s employees & agents NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn Robin Hamers D.E _ . .• 628 W 19th Street Costa Mesa CA 92627-2716 fenaeewRSasee. - A ED REPR ACORD 25(2001/08) ©ACORD CORPORATION 1988 POLICY NUMBER: GXG00722 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s)Of Covered Operations Costa Mesa Sanitary District & it's Contract#183-2 Bristol Street Sewer employees & agents n/o Randolph Avenue Attn: Robin Hamers, D.E. 628 W 19th Street Costa Mesa, CA 92627-2716 Information required to complete this Schedule,if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury" 'property This insurance does not apply to 'bodily injury" or damage' or personal and advertising injury' "property damage' occurring after' caused,in whole or in part, by: 1 All work, including materials, parts or equip- 1 Your acts or omissions; or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project(other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed; or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 ©ISO Properties, Inc. 2004 Page 1 of 1 ❑