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Insurance - National Plant Services - 2002-10-30 ACORD CERTIFICATE OF LIABILITY INSURANCE, 0 PID4 KR DATE(MM/DD/YY) TI-14 10/30/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION E' ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Associated Agencies Inc R E C E I N HOLDER.TH S CERTIFICATE DOES OT AMEND,EXTEND OR 1701 Golf Rd, Tower 3, 7th Flr I1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Rolling Meadows IL 60008-4267 %eV - 4 Inn INSURERS AFFORDING COVERAGE Phone 847-427-8400 ❑C4r`' T INSURED CpS1pMESASpti11pk9 U+°'IN �URERA Employers Insurance of Wausau INSURER B Gulf Underwriters Ins Co National Plant Services Inc INSURER C 1461 Harbor Avenue INSURER D Long Beach CA 90813-2741 I INSURER E 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 POLICYEFPECTIVE POLICY EXPIRATION1 LIMITS LTR DATE(MM/DD/YY) DATE(MMIODNV) GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY TZCZ91544946082 10/31/02 10/31/03 FIRE DAMAGE(Any o efire) $ 100000 CLAIMS MADE X OCCUR MEDEXP(Anyo person) $ 50000 X XCU Included PERSONALSADV INJURY $ 1000000 X Blkt Contractual GENERAL AGGREGATE $ 3000000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 3000000 7 POLICY I A I PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANY AUTO ASCZ91544946012 10/31/02 10/31/03 (Ea cadent) $ 1000000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Pe person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Pe accident) PROPERTY DAMAGE $ (Pe accident) GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY' AGG $ EXCESS LIABILITY EACH OCCURRENCE I $5000000 B X OCCUR CLAIMSMADE GU2858587 10/31/02 10/31/03 AGGREGATE $5000000 $ DEDUCTIBLE $ X RETENTION $ 10000 $ WORKERS COMPENSATION AND X I WC S' U- I 0TH- TORV LIMITS ER EMPLOYERS'LIABILITY A WACZ9D544946092 10/31/02 10/31/03 E L.EACH ACCIDENT $ 1000000 EL DISEASE EA EMPLOYEE $ 1000000 E L DISEASE POLICY LIMIT I $ 1000000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Costa Mesa Sanitary District and its employees & agents are added as Additional Insureds w/respect to the general liability coverage per CG2010 11-85 equivalent and a waiver of subrogation is included in their favor with respect to the workers comp cov for operations performed by the Insured CERTIFICATE HOLDER I N I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION COSTA-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING INSURER WILL•INBERYOR•TOMAIL 30 DAYS WRITTEN Costa Mesa Sanitary District NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn Joan Revak P 0 Box 1200 I - - - - - - - - - Costa Mesa CA 92628-1200 = ___ I-__ A O IZ_ED REPRE�SEENTTATIVE`/` 0,, ,, I O A� it t iAn JgrAi a-) At/ ACORD 25-S(7/97) 111 ©ACORD CORPORATION 1988 Policy number TZCZ91544946082 This endorsem nt is effective 10-31-02 and will terminate with the policy It is i-suea by the company des,gnated in the Declarations All other provisions of the policy remain unchanged. THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY Additional Insured Endorsement Owners, Lessees or Contractors Scheduled Person.or Organization This endorsement modifies insurance provided under the following: CO&D/11ERCIAL GENERAL LIABILITY COVERAGE PART WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the ScheduL but only with respect to liability arising out of"your work' for that insured by or for you. The coverage afforded by this endorsement does not apply to"bodily injury' or "property damage included in the products/completed operations hazard' unless such coverage is required by an 'insured contract' between you and the additional insured shown in the Schedule. Schedule Name of Person or Organization. AS REQUIRED BY WRITTEN CONTRACT &AL ..Ci't✓rhe✓ CL? r_ 03-'7