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Project 132 - Insurance - Grbavac - 1994-01-18 CERTIFICATE OF INSURANCE ISSUE DATE (MM/GD/YY) 1/19/94 ,PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE P•LI IE BELOW The Rule Company Inc COMPANIES AFFORDING COVERAGE P.O Box 7072 COMPANY Pasadena CA 91109 LETTER A CNA/TRANSCONTINENTAL COMPANY LD CNA/TRANSPORTATION LETTER o INSURED COMPANY Grgo & Gordon Grbava,. LETTER C CHUBB GROUP OF INS CO Construction Co Inc COMPANY D 401 W Longden Ave LETTER Arcadia Ca 91007 COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. II TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS_ DATE (MM/DD/YY)DATE (MM/DD/YY) I GENERAL LIABILITY 120926559 10/16/93 10/16/94 " c.�i n , '�.J2000�ri ©GQMM. GENERAL LIABILITY PROD•COMP/OP AGG. 1000000 .-CLAIMS MADE , OCC. PERS & ADV INJURY 1000000 ©OWNER'S& CONTRACT'S PRO EACH OCCURRENCE 1000000 . FIRE DAMAGE(One Fire) 50000 MED. EXP. One Per 5000 AUTOMOBILE LIABILITY 120926562 10/16/93 10/16/94 COMBINED SINGLE 1000000 ©ANY AUTO LIMIT .ALL OWNED AUTOS BODILY INJURY _ .SCHEDULED AUTOS (Pe Pe ) ®f11RED AUTOS BODILY INJURY — ©NON-OWNED AUTOS (Pe ardent) .GARAGE LIABILITY - PROPERTY DAMAGE I EXCESS LIABILITY ©UMBRELLA FORM 79690146 12/01/93 10/16/94 EACH OCCURRENCE `3000000-' AGGREGATE MOTHER THAN UMBRELLA FOR in STATUTORY LIMITS I WORKER'S COMPENSATION EACH ACCIDENT AND APP OVED AS TO FORM DISEASE-POLICY LIMIT I{ —, EMPLOYERS' LIABILITY STATUTORY OTHER . `� • • • c I DISTRICT" DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS ENDORSEMENT G17957A ATTACHED COSTA MESA SANITARY DISTRICT ITS ELECTIVE BOARD, OFFICERS AGENTS EMPLOYEES ARE ADDITIONAL INSUREDS COVERAGE IS PRIMARY & NON CONTRIBUTING CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING COMPANY WILILOIODPRV9lW MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT COSTA MESA SANITARY DISTRICT .++F. P 0 BOX 1200 COSTA MESA, CA. 92628-1200 – AUTIIOIy�ED)RES diT IVE -ACORD 25-S 7/90 11/rc\/ // tWA •t.AU or Cam datum=v..Make THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART WHO IS AN INSURED (Section 11) is amended to include as an insured any person or organization (called additional insured) whom you are required to add as an additional insured on this policy under a written contract or agreement currently in effect or becoming effective during the tern of this policy provided that a xrtificate of insurance showing that person or organization as an additional insured has been issued. The insurance provided to the additional insured is limited as follows: That person or organization is only an additional insured with respect to liability arising out of a. Premises you own, rent, lease, or occupy or b. Your work- for that additional insured by or for you. 1 The limits of insurance applicable to the additional insured are those specified in the written contract or agreement or in the Declarations for this policy whichever are less. These limits of insurance are inclusive cf and not in addition to he limits of insurance shown in the Declarations. The insurance provided to 'he accitional insured does not apply to -bodily injury property damage persona it ury or advertising in•ury arising cut of an architect s engineer's, or surveyors rendering of or failure render any professional services including' The preparing, approving or failing to prepare or approve maps, drawings. opinions• reports, surveys cnange orders, designs or specifications: and 1 Supervisory inspection, or engineering services. COSTA MESA SANITARY DISTRICT COSTA MESA SANITARY DISTRICT ITS ELECTIVE P 0 BOX 1200 BOARD OFFICERS AGENTS & EMPLOYEES ARE COSTA MESA, CA. 92628-1200 ADDITIONAL INSUREDS COVERAGE IS PRIMARY & NON CONTRIBUTING S Ti:S ENDORSEMENT IS A PART OF YOUR POLICY AND TAKES EFFECT ON THE EFFECTIVE DATE OF YOUF- POLICY UNLESS ANOTHER EFFECTIVE DATE IS SHOWN BELOW POLICY CHANGE NO EFFECTIVE DATE OF THIS POLICY CHANGE 1/18/94 CDUNTEERSIGNED DATE AUT, it -D RSVr. ESENTATIVE 1/18/94 //`/ APP;•VED AS TO FORM! a • A 0 NEY T DISTRICT C-17957-A lED 02/92)