Loading...
Project 183- 2 - Nikola Corp. - 2010-09-29 CORD CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDD Y Y,- 09/29/2010 PRODUCER (714)524-4949 FAX (714)524-4940 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Commercial Associates Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4226E La Palma Avenue HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Anahaim, CA 92807 1 (� INSURERS AFFORDING COVERAGE NAIC# IN ED Nikola Construction Corpor 1 (53Q V 19 INSURER A: Netherlands Insurance Company 18012 Cowan #290 NSURER -- Irvine CA 92614 x (I O INSURER C' L vT I INSURER D: .. „INSURER ' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TI IE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWI I HS IANDIN, ANY REQUIREMENT '1 ERM UR CUNUI I ION 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 ADD'L rypE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR N R[ DATE IMM/DD/TYI DATE(MM/DDR'YI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PRFMIC S(Fa r irenr-I CLAIMS MADE OCCUR MED EXP(Any a person) $ PERSONALS ADV INJURY 5 GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS COMP/OP AGG $ 7 POLICY n IT A: n LOC AUTOMOBILE LIABILITY BA8096362 12/19/2009 12/19/2010 COMBINED SINGLE LIMIT ANY AUTO (Ea accident $ 1,000,000 ALL OWNED AUTOS BODILY INJURY A •X SCHEDULED AUTOS (Pe person) X HIRED AUTOS -- BODILY INJURY X NON-OWNED AUTOS (Pe olden') PROPERTY DAMAGE (Pe oldent) GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 7 OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY TORY IIMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E L.DISEASE EA EMPLOYEE $ If yes,de cribs under -_ SPECIAL PROVISIONS below E.L.DISEASE POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS to Operations usual to the named insured re #183-2 Bristol Street Sewer Replacement N/O Randolph St _osta Mesa Sanitary District is named as additional insured as respects the auto liability as •equired by written contract per GECA701 01/07 endorsement attached 10 days notice of cancellation for non-payment of premium CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL Costa Mesa Sanitary District 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, attn Joan Revak BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 628 W 19th Street 26 HFRIZE REPRESN TATIV R�TS AGENTS ORREyRBSENT TIV S. Costa Mesa CA 92627 2716 AUTHORIZED REPRESENTATIV ���!//`♦p{ [r(.R([_ ACORD 25(2001108) ©ACORD CORPORATION 198: SECTION IV BUSINESS AUTO CONDITIONS A. LOSS CONDITIONS Item 2 a. and b. are replaced with 2. Duties In The Event of Accident, Claim, Suit, or Loss a You must promptly notify us Your duty to promptly notify us is effective when any of your executive officers, partners, members, or legal representatives is aware of the accident, claim, 'suit' or loss. Knowledge of an accident, claim. 'suit or loss, by other employee(s) does not imply you also have such knowledge b. To the extent possible, notice to us should include (1) How when and where the accident or loss took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the accident or loss. The following is added to 5. We waive any right of recovery we may have against any additional insured under Coverage A. 1 Who Is An Insured g. but only as respects loss arising out or the operation, maintenance or use of a covered 'auto' pursuant to the provisions of the 'insured contract' written agreement, or permit B. GENERAL CONDITIONS 9 is added 9. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Your unintentional failure to disclose any hazards existing at the effective dare of your policy will not prejudice the coverage afforded. However we have the right to collect additional premium for any 'such hazard COMMON POLICY CONDITIONS 2.b. is replaced by the following. b. 60 days before the effective date of cancellation if we cancel for any other reason GEC.70I(01/07) Includes cooyneheed mate al of Insu e Services Offic Inc with its perm on P2 4 It 'loss esults from the total theft of a covered 'auto' of the private passenger type, we will pay under this coverage only that amount or your rental reimbursement expenses which is not already provided under paragraph 4. Coverage Extension 7 Lease Gap Coverage If a long-term leased 'auto is a covered 'auto' and the lessor is named as an Additional Insured Lessor In the event of a total loss, we will pay your additional legal obligation to the lessor for any difference between the actual cash value of the 'auto' at the time of the loss and the 'outstanding balance' of the lease 'Outstanding balance' means the amount you owe on the lease at the time 01 loss less any amounts representing taxes; overdue payments; penalties, interest or charges resulting from overdue payments, additional mileage charges, excess wear and tear charges, and lease termination fees B EXCLUSIONS The following is added to Paragraph 3 The exclusion for 'loss' caused by or resulting from mechanical or electrical breakdown does not apply to the accidental discharge of an airbag. Paragraph 4 is replaced with the following' 4 We will not pay for 'loss to any of the following. a. Tapes, records, disks or other similar audio, visual or data electronic devices designed for use with audio visual or data electronic equipment. b. Equipment designed or used for the detection or location of radar c. Any electronic equipment that receives or transmits audio, visual or data signals. Exclusion 4-c does not apply to (1) Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed solely for the reproduction of sound, if the equipment is permanently installed in the covered 'auto' at the time of the 'loss' and such equipment is designed to be solely operated by use of the power from the 'auto's' electncal system, in or upon the covered 'auto' or (2)Any other electronic equipment that is (a) Necessary for the normal operation of the covered auto or the monitoring of the covered auto's operating system; or (b) An integral part of the same unit housing any sound reproducing equipment described in (1) above and permanently installed in the opening of the dash or console of the covered 'auto normally used by the manufacturer for installation of a radio. D. DEDUCTIBLE The following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. GELS 101(01/07) Includes copyristhted ma al his Services Offices,Inc with its perm sion Pa e 3 of 4 2. COVERAGE EXTENSIONS a. Supplementary Payments. Subparagraphs (2)and (4) are amended as follows (2) Up to $2500 ful cost 01 bail bonds (including bonds for related traffic law violations) required because of an 'accident'we cover We do not have to furnish these bonds (4)All reasonable expenses incurred by the 'Insured' at our request, including actual loss of earning up to$500 a day because of time off from work. SECTION III PHYSICAL DAMAGE COVERAGE A. COVERAGE The following is added: 5. Hired Auto Physical Damage a. Any 'auto' you lease hire, rent or borrow from someone other than your employees or partners or members of their household is a covered 'auto' for each of your physical damage coverages. b. The most we will pay for 'loss' in any one 'accident' Is the smallest or (1) $50,000 (2) The actual cash value of the damaged or stolen property as of the time of the 'loss' or (3) The cost or repairing or replacing the damaged or stolen property with other property or like kind and quality If you are liable for the 'accident" we will also pay up to$500 per 'accident' for the actual loss of use to the owner of the covered 'auto' c. Our obligation to pay for, repair return or replace damaged or stolen property will be reduced by an amount that is equal to the amount of the largest deductible shown for any owned 'auto' for that coverage However any Comprehensive Coverage deductible shown in the Declarations does not apply to 'loss' caused by fire or lightning. d. For this coverage, the insurance provided is primary for any covered 'auto you hire without a driver and excess over any other collectible insurance for any covered auto' that you hire with a driver 6. Rental Reimbursement Coverage We will pay up to$75 per day for up to 30 days, for rental reimbursement expenses incurred by you for the rental of an 'auto' because of 'loss' to a covered 'auto Rental Reimbursement will be based on the rental or a comparable vehicle which in many cases may be substantially less than $75 per day and will only be allowed for a period of time it should take to repair or replace the vehicle with reasonable speed and similar quality up to a maximum or 30 days. We will also pay up to$500 for reasonable and necessary expenses incurred by you to remove and replace your materials and equipment from the covered 'auto' GEGI 701(01/07) Includes nyr anted mate al of Insu nce Services Ofnces,Inc ith Its permission of 4 COMMERCIAL AUTO GOLD ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM SECTInN II LIABILITY COVER 4■OF A. COVERAGE 1 WHO IS AN INSURED The following is added: d. Any organization, other than a partnership or joint venture, over which you maintain ownership or a majority interest on the effective date of this Coverage Form, if there is no similar Insurance available to that organization e. Any organization you newly acquire or form other than a partnership or joint venture, and over which you maintain ownership of a majority interest. However coverage under this provision does not apply (1) If there is similar insurance or a self-insured retention plan available to that organization;or (2) To 'bodily injury or "property damage' that occurred before you acquired or formed the organization. f. Any volunteer or employee of yours while using a covered 'auto' you do not own, hire or borrow in your business or your personal affairs. Insurance provided by this endorsement is excess over any other insurance available to any volunteer or employee g. Any person, organization, trustee, estate or governmental entity with respect to the operation, maintenance or use of a covered 'auto' by an insured, if: (1) You are obligated to add that person, organization, trustee, estate or governmental entity as an additional insured to this policy by' (a) an expressed provision of an 'insured contract' or written agreement or (b) an expressed condition of a written permit issued to you by a governmental or public authority (2) The 'bodily injury' or 'property damage' is caused by an accident' which takes place after (a)You executed the 'insured contract' or written agreement, or (b)the permit has been issued to you. GECA 70I(01/07) Includes copy:ghted matervn oflnsur Senn es Of ices.Inc ith is permis Pa 1 of 4 IMPORTANT If the certificate holder is an ADDITIONAL INSURED the policy(ies)must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer and the certificate holder nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001108)