Insurance - Traffic -2010-05-05 EXHIBIT "R'
L-/AI nvl 1 LI
�Rb 0 DATE immros,YYYY)
rHODUCE0. CERTIFICATE OF LIABILITY INSURANCE TRAFF-1 05/05/10
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Unicko3 & Associates Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Unicke3 & Assoc Lic#0827703 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
P 0 Box 10727 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW —
San Bernardino CA 92423-0727 NAICM
Phone 909-890-9707 Fax 909-890-9237 INSURERS AFFORDING COVERAGE
INSURED NSURFr Tr "np et J.r,or 25674
INSURERS Aspen Specialty Insurance
Traffic Control
Engineering, inc. mswEN, r. 0.r. 25674
231 E Imperial Hwy #241 INSJtH.
Fullerton CA 92835 IHS,:REr,,.
COVERAGES
IF+PVI ICgs OF INSURANCE '6TEC EELIYN HAVE BEEN ISSUED 10.11P NSURED NAMED PROVE FOR It POJOY PERIOD INOrd1ED NO I'M I HSTANDING
Nn NtOCHEMEUT TERM On CONDO ON OP ANY IXW'TRACT OR DI HER DOCUMENT WIT I RESPECT 10 WHICH IHI LESTIFICATE MAY SE :SUED ON
MA PER<en,THE ASIIRANCE AFFORDED eY IHE 90 IFS DESCRIBED HERE'I SIJB.'FCT TOAL THE TERMS,EX LUSIUNS NO CONDO or CE SUL
111111X3 AGGREGATE LUSTS SHOWN MAY HAVE BEEN REDO CFO MY PAID CLA MS
1NSR I POLICY NUMBER tPOLICY M!OE EFFECTIVE IPOLICY N�DDIYYY YT') LIMITS
LTN INSRtl TYPE OF INSURANCE _—_
GENERAL LIABILITY 'EAIHI%:TJ IRRFNC 2 000 000
"DIMAGE7D HtNILD
A X It I cowancWLOENtRA_UAdl ITV 680-7507L122 10/08/09 10/08/10 i PRE�•HSEStta O) I 300 000_
cum*LINIE X OCCUR ' 1.1E 0 EXP tA Ty vo Pl,son l j 5 000
'bi.iboN AADY INJURY 152 000 000
1 GENERA AMORE-GATE 54 000,000
SENLN3UMt(iATE UM,T APPLIES PER I PRODUCTS COMPN)P AGG s4 000 000
X P0tCY in I LOC i - i
AUTOMOBILE LIABILITY i e0MBINEDSWGLE "IT I s 2 000 000
Mu u¢UI I)
ANY AUTO I
ALL()WNW AUTOS I 'BODILY UUURY S
1 (IP° ry>rw,)
I&MEWLED AUI05 I
A IX]HIRED AUIOS 680-75071.722 10/08/09 10/08/10 BODILY INJURY p
roe oJd,mt
'X I NON-CTNNE:D AUTOS
(Put ewde I)MAGE S
� I ---- AI/10 nN.'! CA ACCIDENT GARAGE LIABILITY
ANY AUTO OTHER•dAN A ACE -
AUTO ONLY' RL:G,S
1 EACH OCCURRENCE S
EXCESS f UMBRELLA LIABILITY I I AGGREGATE t
I I (OCCUR r0.AIMS MADE I
S
I
I I I3
I DEDUCTIBLE IS _. .
RETENTION S W.SIAI V' UIN
WORKERS COMPENSATION I X TORY SIAIU.. IR
AND EMPLOYERS'LIABILITY
C ANY MROPR'EIOREXOLUOaEXECUTIVEE 'IIUB6442Y19-4-10 04/14/10 04/14/11 ELEAG_1ACCDENT sl 000 000
IFE,LETLTAD.fNHI EXCYUOED> l EL DISEASE PA HAP/OYEE 1 000 000
IiNn, ryInNNl
ry,YEcLLWIEM VSIO E L DISEASE POLICY LIMO 3 1,000,000
I SPECIAL PROVISIONS Oahu
DINER
B I Professional Liab LBX306809 I 10/08/09 10/08/10 Occ/Agg $2 000 000
' bed $15,000
DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS
*Except 10 days notice of cancellation for non-payment of premium. Cert.
Holder is named additional insured regarding General Liability per attached
endorsement RE Sewer Line Improvement South Coast Drive 8 Harbor Blvd
Costa Mesa CA.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
COSTA01 DATE THEREOF 1HEISSUNG INSURER WILL ENDEAVOR TO MAIL 300. DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO SO 50 SHALL
Costa Mesa sanitary District IMPOSE NO COLIC I ON OR IABI a ANY HIND UPONTIIE INSURER ITS AGENTS OR
Attn Mr Rob Flamers REPRESENTATIV
234 E 17th Ste 205 AUTHORIZED REPR A.ENTATIVE •
Costa Mesa CA 92627 'r1--
AGGRO 25(2008101) c)1085-207! ACORD •RPORATION. All rights reserved.
The ACORD name and logo arc registered marks of ACORD
COMMERICAL GENERAL LIABILITY
POLICY NUMBER: 6807507L722 ISSUE DATE05 d5 10
THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY
ADDITIONAL INSURED
(ARCHITECTS, ENGINEERS AND SURVEYORS)
Tins endorsement modifies insurance provided under the following.
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
NAME OF PERSON(S)OR ORGANIZATION(S):
Costa Mesa Sanitary District
234 E 17th Suite 205
Costa Mesa Ca 92627
PROJECT(LOCATION OF COVERED OPERATIONS:
Sewer Line Improvement , South Coast Drive @ Harbor Blvd
Costa Mesa
PROVISIONS
A. The following is added to WHO IS AN INSURED The i i uran a provided to such additional insured
(Section II): is
The person or organization shown in the Schad- d, This insurance does not apply to the render-
ule above is an additional insured on this Cover- ing of or failure to render any 'professional
age Part,but only with respect to liability for"bed- services
Ily injury" "property damage' or "personal injury" e. The limits of insurance afforded to the addi-
caused,In whole or in part, by your acts or orris- Lionel insured shall be the limits which you
sions or the acts or omissions of those acting on agreed In that "contract or agreement requir-
your behalf: ing Insurance" to provide for that additional
a. In the performance of your ongoing opera- t Insured, Part!whichever aae
bons;
less. This endorsement does not increase t e
b. In connection with premises owned by or
limits of insurance stated in the LIMITS OF
rented to you;or INSURANCE (Section III) for this Coverage
c. In connection with "your work" and included Part.
within the 'products-completed operations B The following is added to Paragraph a. of 4.
hazard" Other Insurance in COMMERCIAL GENERAL
Such person or organization does not qualify as LIABILITY CONDITIONS(Section IV):
an additional Insured for "bodily injury" "property However if you specifically agree in a"contract or
damage'or o' a zationnal injury" for which that per- agreement requiring insurance' that, for the addi-
tract or organization has assumed liability in a con- Lionel insured shown in the Schedule, the insur-
ance or agreement. ance provided to that additional insured under this
CG 03 82 09 07
W 2007 The Travelers Companies.Inc Page 1 of 2
Includes the copyrighted malarial at Insurance Services Office,Inc with its permssmn
COMMERICAL GENERAL LIABILITY
Coverage Part must apply on a primary basis, or injury'arising out of"your work on or for the pro-
a primary and non-contributory basis, this insur- ject, or at the location, shown in the Schedule
ance is primary to other insurance that is avail- above, performed by you, or on your behalf, un-
able to such additional insured which covers such der a 'contract or agreement requiring insurance'
additional insured as a named insured, and we with that additional insured. We waive these
will not share with the other insurance, provided rights only where you have agreed to do so as
that: part of the"contract or agreement requiring insur-
(1) The 'bodily injury' or 'property damage' for ance" with that additional insured entered into by
which coverage is sought occurs;and you before, and In effect when, the "bodily injury'
or"property damage' occurs, or the 'personal in-
(2) The "personal injury' for which coverage is fury offense Is committed.
sought arises out of an offense committed;
after you have entered into that "contract or D. The following definition is added to DEFINITIONS
(Section V):
agreement requiring insurance' for such addi-
tional 'Contract or agreement requiring insurance"
insured. But this insurance still is excess
over valid and collectible other insurance, means that part of any contract or agreement un-
whether primary, excess, contingent or on any der which you are required to include the person
other basis, that is available to the additional in- or organization shown in the Schedule as an ad-
sured when the additional insured is also an addi- ditlonal Insured on this Coverage Pan, provided
tional insured under any other Insurance. that the"bodily injury" and"property damage"oc
C. The following Is added to Paragraph 8. Transfer curs, and the"personal injury'is caused by an of-
9 tense committed:
Of Rights Of Recovery Against Others To Us
in COMMERCIAL GENERAL LIABILITY CON- a. After you have entered into that contract or
DITIONS(Section IV): agreement;
We waive any rights of recovery we may have b. While that part of the contract or agreement is
against the additional insured shown in the in effect; and
Schedule above because of payments we make c. Before the end of the policy period.
for 'bodily injury' 'property damage' or'personal
Page 2 of 2 ®2007 The Travelers Companies.Inc CO D3 82 09 07
Include^the copyrighted material of Insurance Services Cthco.Inc via its perm ssi