The URL can be used to link to this page

Project 168 - Insurance - Vadnais - 2007-07-24 OP ID RT DATE(MM/DDIVYYY)VADNAI1 07/24/07 PROD CORD CERTIFICATE OF;,, a=' „ r SU CERTIFICATE RANCEISSUED AS A MATTER OF INFORMATION The wooditch Company Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Services, Inc JUL 2 7 2i07HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1 Park Plaza, Suite 400 p ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Irvine CA 92614 TE SANITARY LL,,�� IA W1 N nn ��pp10�c�i Phone 999-553-9800 Fax 949-553-06Y0' J14}1®114tERS AFFORDING COVERAGE NAIC# INSURED INSURER A old Republic Constrnotlnn GLp ,124139 At IX INSURER B National Union Fire Ins. Co 119445 A+XV Vadnais Corporation INSURERC I --2130 La Mirada Dr INSURER — ---- Vista CA 92081 INSURERS 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. NUMBER MSR'ADDT' - �17CQEFFECTWE-POLICY EXPIRATION LIMITS LTR INSRD TYPE OF INSURANCE POLICY DATEIMMIDDIYY) DATE(MIDD MIYY) I GENERAL LIABILITY EACH OCCURRENCE 41,000,000_ UAMNbt IUNGN I g 100,000 A X X COMMERCIAL GENERAL LIABILRY A1CG36530700 02/01/07 02/01/08 PREMISES(Ea crolrence) _ . MED EXP(A,yo person) f 5,000 1—�I )CLAIMS MADE X I OCCUR X (BLANKET CONTR. PERSONAL 8 ADV INJURY 81 000 000 GENERA ACCRECATE s 2,000 000 J GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG 52,000,000 I POLICY ]( I J20T LOG I AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ 1 000 000 A accident)'X ANY AUTO A1CA36530700 02/01/07 02/01/08 (Ea I ALL OWNED AUTOS BODILY INJURY S I (Pe person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Pe accident) _ (JON-OWNED AUTOS PROPERTY DAMAGE —_ --- (Pe nettle t) . I ' 'GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTC OTHER THAN EA ACC f AUTO ONLY AGG $ 'EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 4,000,000 — B i X OCCUR I J CLAIMS MADE 13E7227597 02/01/07 02/01/08 AGGREGATE f 4 000 000 f $ iDEDUCTIBLE jX RETENTION 510,000 .. •- • $ I WORKERS COMPENSATION AND X TORY LIMITS ER A EMPLOYERS'LIABILITY A1CW36530700 02/01/07 02/01/08 EL EACH ACCIDENT 11,000,000 ANY PROPRIETOR/PARTNERIEXECUTIVE E L DISEASE EA EMPLOYE- $ 1,000,000 yes,de/MEMBER EXCLUDED O -- II yes,de cnbe under E L DISEASE POLICY LIME 11,000,000 I SPECIAL PROVISIONS below I OTHER 1 DESCRIPTION OF OPERATIONS/LOCATIONS(VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *Except 10 days notice of cancellation for non-Payment of premium * Costa Mesa Sanitary District its employees and agents are included as Additional Insureds as respects General and Auto Liability per attached endorsements RE Vadnais Job 4741 Costa Mesa Sanitary District Job #168 Irvine Pumping Station Relocation **SEE NOTES** glaip/auai/wcwv/x CERTIFICATE HOLDER CANCELLATION COSTASX SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING INSURER WILL ERCLRAIFlT!MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,...... ...,.., .•.,....L Costa Mesa Sanitary District 62$ W 19th Street Mes Costa Mesa CA 92627 AUTH PRES 1 ACORO 25(2001/08) ®ACORD CORPORATION 198E 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. AGORD 25(2001/08) I� PAG 3 NOTEPA - _l y i �WaS E3Ipsi=iustda-tu6C ritait.t it i -ikut aum , lIATE`97/24/D7 This insurance shall apply as Primary and Non-Contributory per attached endorsement Waiver of Subrogation for Workers Compensation See Attached Endorsement **THIS VOIDS AND SUPERSEDES PREVIOUS CERTIFICATE DATED 06/26/07** I COMMERCIAL GENERAL LIABILITY POLICY NUMBER. A1CG36530700 INSURED: Vadnais Corporation THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS (FORM B) The endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization Costa Mesa Sanitary District, its employees and agents Re. Vadnais Job#741 Costa Mesa Sanitary District Job #168; Irvine Pumping Station Relocation. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations 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 as respect to liability arising out of your work' for that insured by or for you. CG 2010 11 85 Copyright, Insurance Services Office, Inc. 1984 OLD REPUBLIC GENERAL INSURANCE CORPORATION CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY THIS ENDORSEMENT MODIFIES INSURANCE PRO VIDEO UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(s) Or Organlzatlon(s): Costa Mesa Sanitary District, its employees and agents Location(s) of Covered Operations: Vadnais Job#741 Costa Mesa Sanitary District Job#168; Irvine Pumping Station Relocation. As required by written contract: Information required to complete this Schedule, it not shown above, will be shown in the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other insurance of a like kind available to the person or organization shown in the schedule above unless the other insurance is provided by a contractor other than the person or organization shown in the schedule above for the same operation and job location. It so, we will share with that other insurance by the method described in paragraph 4.c of Section IV— Commercial General Liability Conditions. All other terms and conditions remain unchanged. 'Named Insured Vadnais Corporation Policy Number A1CG36530700 Endorsement No. Policy Period: 02/01/07-02/01/08 Endorsement Effective Date: Producer's Name: Producer Number 7/24/2007 AUTHORIZED REPRESENTATIVE DATE CG EN GN 0029 09 06 POLICY NUMBER: Al CA36530700 COMMERCIAL AUTO CA2001 1001 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY LESSOR - ADDITIONAL INSURED AND LOSS PAYEE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below Endorsement Effective: 02/01/07 Countersigned By Named Insured: Vadnais Corporation (Authorized Representative) SCHEDULE Insurance Company Old Republic Construction Group Policy Number A1CA36530700 Effective Date: 02/01/07 Expiration Date: 02/01/08 Named Insured Address: 2130 La Mirada Dr, Vista, CA 92081 Additional Insured (Lessor)WHERE REQUIRED BY WRITTEN CONTRACT Designation or Description of"Leased Autos° ON FILE WITH COMPANY Coverages Limit of Insurance Liability $1,000,000 Each "Accident" Personal Injury Protection (or equivalent no-fault coverage) $ Comprehensive ACTUAL CASH VALUE OR COST OF REPAIR WHICHEVER IS LESS; MINUS: For Each Covered "Leased Auto" Collision ACTUAL CASH VALUE OR COST OF REPAIR WHICHEVER IS LESS; MINUS: For Each Covered "Leased Auto° Specified Causes of Loss ACTUAL CASH VALUE OR COST OF REPAIR WHICHEVER IS LESS; MINUS: For Each Covered °Leased Auto" (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) CA 20 0110 01 ©ISO Properties, Inc. 2000 OLD REPUBLIC GENERAL INSURANCE CORPORATION WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: WORKERS'COMPENSATION AND EMPLOYERS! LIABILITY INSURANCE We have the right to recover our payments from anyone liable for an injury covered by this policy We will not enforce our right against the person or organization named in the Schedule.This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WHEN REQUIRED BY WRITTEN CONTRACT fThe premium charge for this endorsement is $0.00 Named Insured Vadnais Corporation Policy Number A1CW36530700 Endorsement No Policy Period 02/01/07-02/01/08 Endorsement Effective Date' Producer's Name: Producer Number 7/24/2007 AUTHORIZED REPRESENTATIVE DATE A. Coverage C. Cancellation 1 Any 'leased auto' designated or 1 If we cancel the policy we will mail described in the Schedule will be notice to the lessor in accordance with considered a covered 'auto' you own the Cancellation Common Policy and not a covered 'auto' you hire or Condition. borrow For a covered 'auto' that is a 'leased auto' Who Is An Insured is 2. If you cancel the policy we will mail changed to include as an 'insured' notice to the lessor the lessor named in the Schedule. 3. Cancellation ends this agreement. 2. The coverages provided under this endorsement apply to any 'leased auto' described in the Schedule until D. The lessor is not liable for payment of the expiration date shown in the your premiums. Schedule, or when the lessor or his or her agent takes possession of the E. Additional Definition 'leased auto' whichever occurs first. As used in this endorsement: B. Loss Payable Clause 'Leased auto' means an 'auto' leased or 1 We will pay as interest may appear rented to you, including any substitute, you and the lessor named in this replacement or extra "auto' needed to endorsement for 'loss' to a 'leased meet seasonal or other needs, under a auto' leasing or rental agreement that requires you to provide direct primary insurance for 2. The insurance covers the interest of the lessor the lessor unless the 'loss' results from fraudulent acts or omissions on your part. 3. If we make any payment to the lessor we will obtain his or her rights against any other party Page 2 of 2 ©ISO Properties, Inc. 2000