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Insurance - GCI Construction - 2008-07-14 I I I I , ACORD CERTIFICATE OF LIABILITY INSURANCE OPID AA DATE(MMIODMryY) I GCICO-1 07/14/08 PRODUCER 1 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Seltzer •Insurance Services HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 140 Centennial Way ,ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Tustin CA 92867 I I I Phone' 714-665-9800 Fax 714-665-9801 INSURERS AFFORDING COVERAGE NAIC# INSURED I I INSURER A; 'Lexington Ins. Co. (AIG Group) 19437 GCI Construction, Inc INSURER e. ,Granite State (AIG Group) 23809 CME, Inc. INSURER C. ' ' Pacific Equipment LLC I Nat. Un. F,re Ins Co (AID Gr.) I 19445 245 Fischer Ave. , Ste B3 INSURERD Redwood Fire & Casualty 1 11673 Costa Mesa CA 92626 I I INSURER E Finnan.Fad/Aas. Co. of.Amor. 21873 COVERAGES II ( I 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. I Th15R�Qy OLICCTIVEI POUCY EXPIRATION LTR NSROD'. ■ TYPE OF INSURANCE POLICY NUMBER DATE(M1BMIDDIYY) I DATE(NM/DD/YY) I LIMITS I,GENERAL LIABILITY I f , I EACHOCCURRENCE 51000000 I uRMAOe IU Hen,eU A X X COMMERCIAL GENERAL LIABILITY 1260420 04/01/08 04/01/09 PREMISES(Ea=Lance) $50000 I CLAIMS MADE IX I OCCUR I MED EXP(Airy one person) S X Owner s/Cont. Pro I PERSONAL SAD,/INJURY $1000000 X iCCU/Deductible $10 000 I I GENERAL AGGREGATE s2000000 GEM AGGREGATE LIMIT APPUES PER PRODUCTS-COMP/OP AGG 52000000 -I aouCY Fl Tai LOC Emp, !Ben. 1000000 AUTOMOBILE LIABIUTY ' I I COMBINED SINGLE LIMIT $1 000 000 B X X ANY AUTO 02-CA 009349089 0 04/01/08 04/01/09 (Ea.-to I I ALL OWNED AUTO BODILY INJURY $ SCHEDULED AUTOS I(Per pane,,) X HIRED AUTOS I BODILY INJURY S I X VON-OWNED AUTOS (Pe acddent) IX Comp/Coll Ded $1000 PROPERTY OHMAGE $ •. IX No Liab. Ded/SIR (Paracddent) GARAGE UABIUTY IAUTO ONLY EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S I I AUTO ONLY AGG S EXCESSAJMBRELLAUABIUTY I EACH OCCURRENCE 54000000 C X OCCUR I I CLAIMS MADE )3E9219788 04/01/08 04/01/09 AGGREGATE $4000000 I 5 DEDUCTIBLE S IRETENTION $ i Is IAH. WORKERS COMPENSATION AND TORVJLY S LIMITS IU- 0T X ER D EMPLOYERS' ETOR AY 4403006113-081 03/17/08 03/17/09 E.L.EACH ACCIDENT $1000000 RIETORIPA ANY PROPRTNER/EXECLMVE OFFICER/MEMBER EXCLUDED? EL DISEASE-EAEMPLOYEE $1000000 II y S.deso,be VYIe SPEC/AL PROVISIONS be cw EL DISEASE POLICY LIMIT $ 1000000 I OTHER I I i 8 IM-Bqp /Lesd-Hrd R MXI98401780 04/01/08 04/01/09 Sch Limit 1 8M/838k/5 ICOCI - 'Zurich BR67721425 06/12/08 06/12/09 Limit 172095 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holder along with the City of Costa Mesa are additional insured with regards to operations of named insured for project Victoria St & 1 HarboriBlvd, SW Main Replacement City of Costa Mesa as per contract as per attached blanket endorsements *10-day notice of cancellation for non-payment of premium CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE I$$UING INSURER WILL EXXINXiiiMMIL 30 DAYS WRITTEN I NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,RUT F Costa Mesa Sanitary District, I its agents and employees ,.:•:. ., _...._'..,.:_. _.,.._ :-.. . .stone* 628 W 19th Street Preilltenallocuursa Casts Mesa CA 92627 2716 I AUTHORIZCD REP nESeHTAT,Ve I ✓,�W. I . ACORD 25(001/OS) , V ©A R ORPORATION 1 GCI Construction Inc POLICY NUMBER ENDORSEMENT COMMERCIAL GENERAL LIABILITY 1260420 CG 20 37 10 01 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OARS, LESSEES OR cONWORS - OONPLETFD OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization. Blanket As Required By Written Contract This endorsement applies to work performed on Commercial Projects only and excludes any and all Residential Structures work as defined by LX 9911 (02/06) on the pol icy Location And Description of Completed Operations: Additional Premium: Ilf no entry appears above, information required to complete this endorsement will be shown in the Declara- tions as applicable to this endorsement.) Section II Who Is An Insured 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 at the location designated and described in the schedule of this endorsement performed for that insured and included in the products-completed operations hazard' CG 20 37 10 01 C ISO Properties, Inc. 2000 Page 1 of 1 0 LX9604 ENDORSEMENT This endorsement, effective 12:01 AM 04/01 /2008 Forms a part of policy no. 1260420 Issued to GCI CONSTRUCTION INC By. LEXINGTON INSURANCE COMPANY WAIVER OF SUBROGATION (BLANKET) It is agreed that we, in the event of a payment under this policy, waive our right of subrogation against any person or organization where the insured has waived liability of such person or organization as part of a written contractual agreement between the insured and such person or organization entered into prior to the occurrence or offense. All other terms and conditions remain unchanged. ra Au orized Representative OR Countersignature (In states where applicable) LEXOCC234 111/031 LX048S ENDORSEMENT This endorsement, effective 12:01 AM 04/01/2008 Forms a part of policy no. 1260420 Issued to: GCI CONSTRUCTION INC B y• LEXINGTON INSURANCE COMPANY PRIMARY/NON CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided by the policy Notwithstanding any other provision of the policy to the contrary the insurance afforded by this policy for the benefit of the Additional Insured shall be primary insurance, but only with respect to any claim, loss or liability arising out of the Named Insured's operations; and any insurance maintained by the Additional Insured shall be non-contributing. All other terms and conditions of the policy remain the same. a7 thorized Representative OR Countersignature (In states where applicable) 0X9939(09)05) a WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY FORM NUMBER INSURER REDWOOD FIRE & CASUALTY INSURANCE COMPANY WC-99-03-06 CALIFORNIA WAIVER OF SUBROGATION We agree that in consideration of the additional premium charged, the Right of Subrogation Clause contained in this policy is hereby waived as respects the following persons or entities: Any person or organization to whom you are obligated by valid written contract wherein you have agreed to furnish this waiver. This endorsement applies only to those persons or entities listed in the foregoing paragraph. The insured agrees to maintain contract records in order to determine for which jobs this waiver will apply.That information will be verified by the insurer at final audit. A surcharge of 1% shall be applied to the risk's Standard Premium, subject to a minimum charge of$500, and will be collected upon completion of the final audit. This endorsement changes the policy to which It Is attached and Is effective on the date Issued unless otherwise stated. (The Information below is required only when this endorsement Is issued subsequent to preparation of the policy.) Endorsement Effective: 03/17/2008 Policy No. 4403006113-081 Endorsement No. 1 Insured: GCI CONSTRUCTION, INC.(A CORP) � , Insurance Company Countersigned by: Redwood Fire And Casualty Insurance Company