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Insurance - Manhole - 2005-12-08 r IIPuIsuw I I CERTIFICATE OF LIABILITY INSURANCE DATE(/2o 5"" PRODUCEFI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Ann Fisk Services,Inc.of Southern California CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 707 WVSSe BML.Suite 6000 DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Um Angeles,CA 90017 POLICIES BELOW. Plpne (213)630-3200 INSURERS AFFORDING COVERAGE NAIC# INSURED R E C""I INSURER A. National Union Fire Ins Co of Pittsburgh 19445 Manhole Adj stng Contractors Inc. INSURER B 9500 Beverly Rd. DEC 1 9 2005 INSURER C Pico FSvaa,CA 90660 INSURER D. COSTA MESA SANITARY D' INSURER E. i.3,-sb s7; iYlfl`'w ,*rt_ia L,'t.4,*,"`A- �` ' ih -44.0' c ' Cr:r s vs .r "71 y,,,. ',citi r g �7;'s ;,x. t. tR•t `-I '-sv f M £.F,?+` ✓ .x:.?4 ..--ai +I`t,tn.- A.7,°I -b?'.. S, - 7?fern--Ci- ,.r `7.�a,'S ws, ^' :'ta.. THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWTTMSTANDNG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WM-I 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. A6B AWL POLICY TYPE OF NSURANCE POLICY NUMBER POLICY EFFECTIVE EXPIRATION UM 'S LTA NSW DATE(MWM' DY) DATE(MWDWYY A ❑ GENERALLNBILITY GL 706-58-37 4/30/2005 4/30/2006 EACH OCCURRENCE $ 1,000,000 V CUCQ(CIAL GENERAL UASRnY DAMAGE TO RENTED IA CLANS HIDE ® OCCURRENCE PREMISES(Ea eccurence) $ 300,000 ❑ MED O P(Arty o a person) $ 5,000 ❑ PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GBNAGGREGATE L MIT APFUES PER PRODUCTS-COMP/OP AGG $ 2,000,000 El potty V PROJECT ❑LOC A ❑ AUVOYOBILE LIABILITY CA 826-20-46 4/30/2005 4/30/2006 COMBINED SINGLE LIMIT $ 1000000 e ANY AUTO (Ea accident) ❑ AU-OWED AUTOS BODILY INJURY &2tX EDA TOS (Per pe50n) $ El ❑ HIRED AUTOS BODILY INJURY V NIL pMED A TOS (Pe cadent) $ ❑ PROPERTY DAMAGE $ 111 (Pe accident) ❑ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ❑ Awl AUTO OTHER THAN ACC $ ❑ AUTO ONLY: AGG $ ❑ EXCESS/UMBRELLA LIABILITY ) EACH OCCURRENCE $ ❑ oOOW ❑ GLOMS MADE AGGREGATE $ ❑ Dams rot..E $ ❑ REreAION $ $ A waneensCOSIFEISSAllON AND WC 118-02-09 4/30/2005 4/30/2006 0 =urns ❑O11ei ' _ . i'.`'.' .4..<I*. E.L EACH ACCIDENT $ 1,000,000 NWPAOPrEI /PARTNER/IXECUTIVE $ 1,000,000 Of1�NC EXCLUDED? E.L DISEASE-EA EMPLOYEE Yes aaae um SPECIAL PROVISIONS below EL DISEASE-POLICY UMIT $ 1,0■0,000 OMER DESCRIPTOR OFOPERADONS/LOCATWNSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Manhole 05-0604105(3)77453 i RE Jobe:MPO6-23540,Costa Mesa Sanitary District,State,American,Woodland,&Lehigh St.Improvements. Costa Mesa Sanitary District is included as Additional Insured as respects to General Liability arising out of operations(work)performed by or on behalf of the Named Insured. Ixxto-ICATEHOLDER' -"� ` '"" - `"`"`CANCELL'ATION` 1Odaysnot efo - 'pavmentdpremmm - ` '.' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE Costa Mesa Sanitary District THEREOF,THE ISSUING COMPANY WILL 680X AXlN o MAIL 30 DAYS WRITTEN NOTICE TO THE 628 W.19th Street 94491XXIXX1)t)!")P1( XIXIXX4Yk704:tK/(RXX1561000 XT(0.4CXXVX)T(SM cIX)CR9F)C.ATtoN Costa Mesa,CA 92627 NAX RXXDOODCXXXPAXXXIX1 CY)CXXXXIEX206)X90EXO9bX9l4PRIXFC' AUTHORIZED REPRESENTATIVE •I / ACORD 25(2001108) ©ACORD CORPORATION 1988 Poly Number GL 706-58-37 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 77453 Name Of Additional Insured Person(s) Location(s)Of Covered Operations Or Organization(s : Costa Mesa Sanitary District RE: Job it:MPOG-2-3540,Costa Mesa Sanitary District,State, American,Woodland,&Lehigh St.Improvements. Information required to complete this Schedule,if not shown above,will be shown in the Declarations. A. Section II—Who Is An Insured is amended to include B. With respect to the insurance afforded to these addi- as an additional insured the person(s)or organization(s) bona] insureds, the following additional exclusions ap- shown in the Schedule,but only with respect to liability ply for"bodily injury' 'property damage' or 'personal and This insurance does not apply to 'bodily injury' or advertising injury caused,in whole or in part,by 'property damage' occurring after: L Your acts or omissions;or 1. All work, including materials, parts or equipment 2. The acts or omissions of those acting on your be furnished in connection with such work, on the pro- half; ject (other than service, maintenance or repairs) to in the performance of your ongoing operations for the be performed by or on behalf of the additional in- additional insured(s) at the location(s) designated sured(s) at the location of the covered operations above has been completed;or 2. That portion of 'your work' out of which the injury or damage arises has been put to its intended use by any person or organization other than another con- tractor or subcontractor engaged in performing op- erations for a principal as a part of the same project. CG 20 10 07 04 ISO Properties.Inc. 2004 Page I of I POLICY NUMBER: GL 706-58-37 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 77453 Name Of Additional Insured Person(s) Location And Description Of Completed Operations Or Organization(s): Costa Mesa Sanitary District RE. Job# MP06-2-3540, Costa Mesa Sanitary District, State, American,Woodland, & Lehigh St. Improvements. Information required to complete this Schedule,if not shown above,will be shown in the Declarations. Section II—Who Is An Insured is amended to include as an additional insured the person(s)or organization(s) shown in the Schedule,but only with respect to liability for 'bodily injury' or"property damage' caused,in whole or in part,by 'your work at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the 'products-completed operations hazard' CG 20 37 07 04 ISO Properties,Inc 2004