Insurance - GCI Construction - 2006-06-20 ii ----1 (CERTIFICATE OF LIABILITY INSURANCE 1Da I 'dd'y"
Pro - 06/20/06
(714) 6 6 5-9 8 0 0 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Seltzer Insurance Service ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
140 Centennial THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
Tustin Ca 92780 COVERAGE AFFORDED BY THE POLICIES BELOW
COMPANIES AFFORDING COVERAGE
pony Scottsdale Insurance Company
A NATIONWTDE GROUP
c'- '""v Lincoln General Insurance Company
Insured CIC082-JBS B
GCI Construction Inc n,pany
CME Inc AIG
Pacific Equipment L L C C
245 Fischer Ave Suite B-3 'Pa"y D = Redwood Fire & Casualty Co
Costa Mesa CA 92 . 6 D E = F ' renan s Fund Insu a re Co
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRATT OR OTHER DOCUMENT WITH RESPECT TO WHICH
THIS CERTIFI_ATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED B', THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED Br PAID CLAIMS
POLICY POLICY
CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS
LTR DATE DATE
GENERAL LIABILITY General Aggregate $ 2 , 000 , 000
A Co alGe al Liability BCS0012603 04/01/06 04/01/07 Pmtlus-completed Ors Agg $ 2 , 000 . 000
CIa Made
Own &Co Pr�OC Personal&Advertising Injury $ 1 . 000 . 000
Each Occurrence $ J_,QO 0 , 0 0 0
Fire Damage tally inrer $ 100. 000
Tnd.Co rar Or Medical Expense Ian/cne person) $
AUTOMOBILE LIABILITY
B An Au 6310002686 04/01/06 04/01/07 com tlsingleL' s 1. 000 . 000
All 0r ed Au Bodily InµN
Scheduled Au Ipe Pe rd S
Hi d Au Bodily In
No ed Ipe ide tl 5
Comp/Coll Ded $ 1 000
Prope ty Damage
GARAGE LIABILITY Auto Only Eacg Accident $
An Au Other Than Auto Only
—
Each Accident S
Aggregate S
EXCESS LIABILITY Each Occurrence $ 4 . 0 0 0 , 0 0 0
C UmbellaForm BE7412375 04/01/06 04/01/07 Aggregate $ 4 . 000 . 000_
if
Other Than umbrella ram RETENTTON$10. 000 $
WORKERS' COMPENSATION 8 _]Statutory Lund Omer
D EMPLOYERS' LIABILITY W633-6113 03/17/06 03/17/07 EL EachACCrtlem $ 1. 000 . 000
Inc) EL Disease-Polk Limit S
The are / v :.0.0000 . 000 Offers are Excl EL Disease-Ea Employee 5 0 0 0 OTHER E M / Equipment MXI98401780 04/01/06 04/01/075ch Limit $550
eased/Hired/Ren Limit $150 000/$5 000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
Certificate Holder its employees and agents are named as Additional Insureds
per attached endorsement as reqquired by contract with respect to operations
Df named insured Waiver of Subrogation to be included
CERTIFICATE HOLDER CANCELLATION
184
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL EIZZOIMINI MAIL
30- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT B
Costa Mesa Sanitary District
628 W 19th Street
Costa Mesa CA 92627 Authorize epresentative
.l'Alit(-4/dek
ACORD 25-S 101/951 SyrIn ran Vi In OACORD CORPORATION 1988
GCI'CONSTRUCTION, INC. SCOTTSDALE INSURANCE COMPANY
POLICY NUMBER: BCS0012603 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY
ADDITIONAL INSURED - OWNERS, LESEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERICAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
Costa Mesa Sanitary District
Its Employees and Agents
628 W 19th Street
Costa Mesa, CA 92627
Location and Description of Completed Operations: Agreement For Emergency Services
Additional Premium: INCLUDED
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement).
SECTION II—WHO IS AN INSURED is amended to included as an insured the person or organization shown in the
Schedule, but only with respect to liability arising out of"your work"at the location designated and described in the
schedule of this endorsement performed for that insured and included in the"products—completed operations hazard"
IT IS AGREED that this policy is primary as respect any insurance maintained by the additional insured(s)and that such
insurance maintained by the additional insured(s)is excess and non-contributory with this policy as respects to work
performed by the named insured.
IT IS FURTHER AGREED that we waive any right of recovery we may have against the person or organization shown in
the schedule above because of payments we make for injury or damage arising out of your ongoing operations or 'your
work' done under a contract with that person or organization and included in the"products-completed operations hazard"
This waiver applies only to the person or organization shown in the schedule above.
L /1Yi/ i,11 J
Auth razed representative ( fY
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