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Insurance - Nikola - 2007-03-16 ACORD CERTIFICATE OF LIABILITY INSURANCE OPID CA DATE(MM/DD YYYV) NICHO-1 03/16/07 PRODUCER IR If—' - - I A, I}-T�' CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION OfN�(LY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CLARICE MARINE INSURANCE OLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 245 FISCHER AVENUE, SUITE D-8 MAR 2 1 2(O?ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COSTA MESA CA 92626 Phone 714-444-2679 Fax 714-444-01 VSTAMESA JAM IA NI mops AFFORDING COVERAGE NAIC# INSURED INSURERA Gemini Insurance Company Nikola Construction INSURER B: state Compenea ms. Fund Corporation INSURERC QBE Specialty DBA: Nikola Corporation 18012 Cowan Suite 290 INSURER EP united onal a ce Irvine CA 92614 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 —DY EFFCE POLICY L SRD TYPE OF INSURANCE OLICY NUMBER DATE I M TII EXPIRATION) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X X COMMERCIALGENERALLIABILITY VCGP013092 08/15/06 08/15/07 UMA U n e) $50,000 CLAIMS MADE X OCCUR MEDEXP(Anyo pe n) $ 5,000 X Blanket Addl Insd PERSONAL 8ADV INJURY $ 1,000,000 X Waiver of Subro GENERAL AGGREGATE $2,000,000 �GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 )Ill POLICY PRO- JECT JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per pe n) HIRED AUTOS BODILY INJURY $ 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/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 C X OCCUR CLAIMSMADE FCX0004019 03/15/07 06/05/07 AGGREGATE $ 5,000,000 $ DEDUCTIBLE $ X RETENTION $10,000 $ WORKERS COMPENSATION AND X O TORY LIMITS ER B EMPLOYERS'LIABILITY 046-12549-2005 12/24/06 12/24/07 E.L EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E L.DISEASE EA EMPLOYEE $ 1,000,000 If yes,describe under E.L.DISEASE POLICY LIMIT $ 1,000,000 SPECIAL PROVISIONS below OTHER C Leased, Borrowed 2598480 07/10/06 07/10/07 Contrs EQ $100 000 Rented Equipment 2% ded $5,000 max DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holders and its officers agents and employees are named as additional insured per the Blanket Additional Insured Endorsement VE0182 03 04 with respect to Costa Mesa Sanitary District Project #181 - Newport Blvd Sewer at 19th St & Placentia Avenue Sewer at 18th Street Waiver of Subrogation Endorsement applies *except 10 day notice for non payment CERTIFICATE HOLDER CANCELLATION COSTAME SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Costa Mesa Sanitary District DATE THEREOF THE ISSUING INSURER WILL I' IV�f1`TZ9 MAIL 30* DAYS WRITTEN Joan Revak, Board Secretary NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,`8g'OENWBEnTINICK$XAVX FAX 949-650-2253 ( 2 ditXtrraaCINIug90xrn rNelS 628 W 19th Street &44TX, Costa Mesa CA 92627 A ED REPR T I ACORD 25(2001108) ©ACORD CORPORATION 1988 Policy Number VCGP013092 VE 0182 03 04 Insured Name: NIKOLA CONSTRUCTION CORP DBA. NIKOLA CORPORATION Number 32 Effective Date:08/15/2006 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Section II—Who is An Insured is amended to include as an insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy Such person or organization is an additional insured but only with respect to liability caused by your ongoing operations performed for that insured. A person's or organization's status as an insured under this endorsement ends when your operations for that insured are completed. This insurance does not apply to liability caused by the sole negligence of any additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions applies: This insurance does not apply to: 1 The preparing, approving, or failing to prepare and approve, maps, shop drawings, opinions,reports, surveys, field orders,change orders or drawings and specifications; and 2. Supervisory inspection, architectural or engineering activities. V E 0182 03 04 Page 1 of 1 Policy Number. VCCP013092 CG 24 04 10 93 Insured Name:NIKOLA CONSTRUCTION CORP DBA.NIKOLA CORPORATION Number 33 Effective Date: 08/15/2006 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCI-lEDULE Name of Person or Organization: AS REQUIRED BY 'WRITTEN CONTRACT (If no entry appears above, information required to complete this endorsement will be shown to the Declarations as applicable to this endorsement) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition(Section 1v-COMMERCIAL GENERAL LIABILITY CONDITIONS)is amended by the addition of the following We •aive an} right of recovery we ma\ hav 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 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 Scheduli above. CG 24 04 10 93 Copyright. Insurance Services Office. Inc 1992 Page 1 of 1 0