The URL can be used to link to this page

Project 161 - Insurance - Atlas-Allied - 2002-11-01 Client#: 32903 ATLAALL ACORDT CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDITY) 11/01/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arrnstrong/Robitaille Bus&InsSv ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 680 Langsdorf Drive, Suite 100 RECEIVED HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 34009 Fullerton, CA 92834-9409 f;�O V — 4 20 '2 INSURERS AFFORDING COVERAGE INSURED Y tl I INSURER A Royal Surplus Lines Ins Co 4 ( vs,N i, ATLAS-ALLIED, INC. 61r1$;A ,ME ',I `IIAIIy over I INSURER B. American Casualty Ins Co 1210 N. Las Brisas INSURERC State Compensation Insurance Fund � --�-�-� Anaheim, CA 92806 I INSURER D Royal Insurance Co of America � p I tit---J�—I L k INSURER E. p 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 TYPE OF INSURANCE POLICY NUMBER PDATE(MF DTYYE P DAITE(MM/IDD/VYY) LIMITS• A I GENERAL LIABILITY 1K2HA121622 11/01/02 11/01/03 I EACH OCCURRENCE Is1,000,000 hI COMM ERCIAL GENERAL LIABILITY 1 I FIRE DAMAGE(Any one lire) IS50,000 I I CLAIMS MADE I X I OCCUR. MED EXP(Any o person) I sExcluded X IBI/PD Ded:5,000 PERSONAL 8 ADV INJURY I Si,000,000 II I GENERAL AGGREGATE i S2,000,000 I GEN'L AGGREGATE LIMRAPPLIES PER. I PRODUCTS -COMP/OP AGG I Si,000,000 I! POLICY I X I JEC I I LOC I B AUTOMOBILE LIABILITY jBUA1010931884 11/01/02 11/01/03 X ANY AUTO (Ea COMBINED et)INGLE LIMB 51,000,000 ALL OWNED AUTOS I BODILY INJURY 5 SCHEDULED AUTOS (Per person) X HIRED AUTOS I BODILY INJURY I X I NON-OWNED AUTOS I(Pe me I) S PROPERTY DAMAGE I (Pe ndem) S I GARAGE LIABILITY I AUTO ONLY EA ACCIDENT I S I I ANY AUTO li OTHER THAN EA ACC I S ni AUTO ONLY: AGG IS D I EXCESS LIABILITY :P2HA207710 11/01/02 II11/O1/O3 (EACH OCCURRENCE I54,000,QQQ I X I OCCUR I I CLAIMS MADE I I AGGREGATE 1 54,000,000 I IS I 1 DEDUCTIBLE • I s 1I RETENTION S10000 I I I I S C I WORKERS COMPENSATION AND 3197202 11/01/02 '11/01/03 I X ITORV U TI ID R 1 EMPLOYERS'LIABILITY I E.L.EACH ACCIDENT I Si,000,000 !E.L DISEASE-EA EMPLOYEE.51,000,000 ' I I E L DISEASE POLICY LIMIT I Si,000,000 B I OTHER Equipment ITCP1010931870 11/01/02 111/01/03 $2,500 deductible Rented/Leased $257,000 Max Limit (Scheduled I $293,316 Limit DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 30 Days Notice of Cancellation Except 10 Days for Non Payment of Premium. (See Attached Descriptions) CERTIFICATE HOLDER 1 I ADDmONALINSURED;INSURER LETTER: ___ CANCELLATION Ten Day Notice for Non-Payment of Premium SHOULD ANYOFTH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Costa Mesa Sanitary DATE THEREOF THE ISSUING INSURER WILL tMRISA MxfS MAIL 3O—DAYS WRITTEN District/Clerk of the District NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT,BR151111 RIX7nlgRZRRRl4X.XX PO Box 1200 W EY215 UDD1QWUpRnpt-0[JBWUWpxRXRR7t0IXC1RR?1RRXXIK 0114 R51.70)5(U6XXIXARX Costa Mesa, CA 92660-1200 Xei RBOSE1011,04M1 x AUTHORIZED REPRESENTATIVE I / * ~ ACORD 25-S(7/97)1 of 3 #M185932 SLS © ACORD CORPORATION 1988 • DESCRIPTIONS (Continued from Page 1) *Re: project#1112100-161 Water Services for Sewer Pump Station."Costa Mesa Sanitary District and its employees are added as additional insured for the above project. This insurance is primary and noncontributory as required by written contract. Waiver of subrogation for General Liability applies.Waiver of subrogation applies as respects Workers Compensation Policy Admitted carrier/cut-thru endorsement to be issued by carrier AMS 25.3(07/97) 3 of 3 #M185932 POLICY NUMBER: K2HA121622 COMMERCIAL GENERAL LIABILITY THIS 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/Clerk of the District PO Box 1200 Costa Mesa CA 92660-1200 (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 with respect to liability arising out of 'your work' for that insured by or for you. **Re project# 1112100-161 Water Services for Sewer Pump Station ** Costa Mesa Sanitary District and its employees are added as additional insured for the above project PRIMARY INSURANCE IT IS UNDERSTOOD AND AGREED THAT THIS INSURANCE IS PRIMARY AND ANY OTHER INSURANCE MAINTAINED BY THE ADDITIONAL INSURED SHALL BE EXCESS ONLY AND NOT CONTRIBUTING WITH THIS INSURANCE CG 20 10 11 85 ROYAL SURPLUS LINES INSURANCE COMPANY Named Insured. ATLAS-ALLIED INC. Endorsement No: Policy KZB518549 Effective Date: 11-1-01 COMMERCIAL GENERAL LIABILITY 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 OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: ANY PERSON OR ORGANIZATION AS REQUIRED BY WRITTEN CONTRACT The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHER TO US Condition S. (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 payment we make for injury or damage arising out of your ongoing operations or 'your work done under a written contract with that person or organization. This waiver applies only to the person or organization shown in the Schedule above. RSA1001 (11/99) ✓ RECEIVED STATE DEC 0 4 2002 COMPENSATION INSURANCE COSTA MESA SANITARY DISTRICT FUND IN REPLY REFER TO NOVEMBER 25 2002 COSTA MESA SANITARY DISTRICT CLERK OF THE DISTRICT PO BOX 1200 COSTA MESA CA 92660-1200 CERTIFICATE OF WORKERS COMPENSATION INSURANCE CANCELLATION/CONVERSION NOTICE RE CERTIFICATE DATED JUNE 5 2002 THE WORKERS COMPENSATION COVERAGE PROVIDED UNDER THE POLICY LISTED BELOW IS BEING CONVERTED TO A NEW POLICY EFFECTIVE NOVEMBER 1 2002 THE NEW POLICY WILL PROVIDE UNINTERRUPTED COVERAGE YOU WILL RECEIVE A NEW CERTIFICATE OF INSURANCE UNDER THE NEW POLICY NUMBER 046- 12470-02 IF YOU HAVE ANY QUESTIONS PLEASE CONTACT THE CUSTOMER SERVICES UNIT AT THE NUMBER LISTED BELOW EMPLOYER ATLAS- ALLIED INC 1210 N LAS BRISAS ANAHEIM CALIF 92806 319-01 UNIT 0000072 POLICYHOLDER SERVICES SANTA ANA DISTRICT OFFICE ( 714) 565-5995 1275 Market Street San Francisco, CA 94103-1410 Mailing Address: P.O. Box 420807 San Francisco. CA 94142-0807 SCIF 19102