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Project 181 - Insurance - Nikola - 2007-04-06 I, ACORD CERTIFICATE OF LIABILITY INSURANCE 04/06/00) PRODUCER (714)524-4949 FAX (714)524-4940 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION "Commercial Associates Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4226 E. La Palma Avenue HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Anaheim, CA 92807 ,E C F{v r D INSURERS AFFORDING COVERAGE NAIC# INSURED Ni kola Construction Corporat INSURERA Netherlands Insurance Company 18012 Cowan #290 INSURER B. Irvine CA 92614 APR - 9 2007 INSURERC INSURER D COSTA MESA SANMMAR).UISIRICT 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 INSR UDC TYPE OF INSURANCE POLICY NUMBER POLICY I EM MINI POUCY IMM/D�1N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PRFM RFC(Fa ewer.. I CLAIMS MADE n OCCUR MED EXP(Anyone person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OPAGG $ POLICY n PRO n LOC JECT AUTOMOBILELIABILITY BA8096362 12/19/2006 12/19/2007 COMBINED SINGLE LIMIT $ ANY AUTO (Eeamdent) 1,000,000 ALL OWNED AUTOS BODILY INJURY $ A X SCHEDULED AUTOS THIS CERTIFICATE SUPERSEDES Q Fermi) Fen) X HIRED AUTOS ALL PREVIOJS CERTIFICATEfi BODILY INJURY $ X NON.OWNED AUTOS (Pe amdent) PROPERTY DAMAGE $ (Per emdent) GARAGE LABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO THAN EA ACC $ AUTO ONLY_ AGG $ EXCESS/UMBRELLA LABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE E RETENTION $ $ WORKERS COMPENSATION AND I Ttc,SLAMRS I I°a - EMPLOYERS'LABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E L DISEASE EA EMPLOYEE $ N yes,desaibe under SPECIAL PROVISIONS beim E.L.DISEASE POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS Re Operations usual to the named insured *10 days notice may be given in the event of non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING INSURER WILL KIXXXIXXXIX MAIL Costa Mesa Sanitary District 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Joan Revak, Board Secretary/Program Manager/ Clerk of the District •'=T" " ' •"'' ` '^ • =Mean 628 W 19th Street r. ,• . : XXXXXXX Costa Mesa CA 92627 AUTHORIZE9 if E / elp,ACORD 25(2001/08) / ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED the policy(ies)must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer and the certificate holder nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 26(2001/08)