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Insurance - Nikola - 2007-03-30 l l• ACORD CERTIFICATE OF LIABILITY INSURANCE OPID CA DATE(MMIDD/YYY fl NICHO-1 03/30/07 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. COSTA MESA CA 92626 Phone 719-949-2679 Fax 714-444R17C u I V F ® INSURERS AFFORDING COVERAGE NAIC#/e f33 INSURED INSURERA Gemini Insurance Company /9 ,' X &/ Nikola Construction APR 2007 INSURERS t Pe atio Fund _ iQia, Corporation INSURER C QBE Specialty i�G AJet4 DBA: Nikola Corporatio SANITARY I 18012 Cowan, Suite 290L'OSTA MESA SANITARY DISTRICT INSURER D ,Led el 4 F 4P / mss e 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 TLTR NSRC POLICY NUMBER DATE(MM/DD/YYE POLICY TE(MMDD/YYIN LIMITS ISR TWEL TYPE OF INSURANCE ) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 —DANIA t W Xt r- A X X COMMERCIAL GENERAL LIABILITY vCGP013092 08/15/06 08/15/07 PREMISES(Eaoccurence) $ 50,000 CLAIMS MADE X OCCUR MED EXP(Any o pc n) $ 5,000 X Blanket Addl Insd PERSONAL&ADV INJURY $ 1,000,000 X Waiver of Subro GENERAL AGGREGATE $ 2,000,000 GENII AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG $ 2,000,000 - PRCT n POLICY O- n LOC F JE AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea cadent) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Pe Pe n) HIRED AUTOS BODILY INJURY $ NON OWNED AUTOS (Pa cideni) PROPERTY DAMAGE $ (PP accident) GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN EAACO $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 C X OCCUR CLAIMSMADE FCX0004549 03/15/07 06/01/07 AGGREGATE $ 5,000,000 $ DEDUCTIBLE $ X I RETENTION $10,000 H $WCSIAIJ WORKERS COMPENSATION AND X TORY LIMITS IOER EMPLOYERS'LIABILITY B 046-12549-2005 12/24/06 12/24/07 ELEACHACCIDENT ( $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E L DISEASE EA EMPLOYEE $ 1,000,000 It yes,de cnbe under SPECIAL PROVISIONS below EL DISEASE POLICY LIMIT $ 1,000,000 OTHER C Leased Borrowed 2598480 07/10/06 07/10/07 Contrs EQ $100 000 Rented Equipment 2% ded $5,000 max DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holders & its officers agents and employees are named as additional insured per the Blanket Additional Insured Endorsement CG2010 11/85 as respect to Costa Mesa Sanitary District Project #181-Newport Blvd Sewer at 19th St & Placentia Ave Sewer at 18th Street Waiver of Subro- gation Endorsement applies *except 10 days for nonpay REPLACES PRIOR CERT CERTIFICATE HOLDER CANCELLATION COSTAME SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Costa Mesa Sanitary District DATE THEREOF THE ISSUING INSURER WILLENDEAYBRSP MAIL 30* DAYS WRITTEN Joan Revak, Board Secretary NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,,ULEAILU: IRDO SO SHALL FAX 949-650-2253 • . _ 628 W 19th Street Costa Mesa CA 92627 A ED REPR lap ACORD 25(2001/08) �G/r—� ©ACORD CORPORATION 1988 POLICY #• VCGP013092 COMMERCIAL GENERAL LIABILITY INSURED. NIKOLA CONSTRUCTION CORPORATION THE 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 Its Officers, Agents and Employees 628 W 19th Street Costa Mesa, CA 92627 Re. Project#181-Newport Blvd. Sewer at 19th Street & Placentia Avenue, Sewer at 18th Street. (If no entry appears above, information required to complete this endorsement would be shown in the Declarations as applicable to this endorsement.) WHO IS 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 CG 20 10 11 85 Policy Number VCGP013092 CC 24 04 10 93 Insured Name:NIKOLA CONSTRUCTION CORP DBA.NIKOLA CORPORATION Number. 33 Effective Date:08/15/2006 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: 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.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition(Section IV—COMMERCIAL GENERAL LIABILITY CONDITIONS)is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or"your work' done under a contract with that person or organization and included in the 'products-completed operations hazard" This waiver applies only to the person or organization shown in the Schedule above. CC 24 04 10 93 Copyright,Insurance Services Office,Inc. 1992 Page 1 of 1 ❑