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Project 181 - Insurance - Nikola - 2007-03-30 ACORD, CERTIFICATE OF LIABILITY INSURANCE OPID CA GATE(MM/DD YYYY NICHO-1 03/30/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE •CLARKE MARINE INSURANCE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 245 FISCHER AVENUE, SUITE D-8 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COSTA MESA CA 92626 Phone 714-444-2679 Fax 719-444 3C E I V I_ ® INSURERS AFFORDING COVERAGE NAIC# /(F33 INSURED INSURERA Gemini Insurance Company /41, _(/ y ,V�//�//' Nikola Construction APR - 2 2007 INSURER B ompen ad /� X//f>//1/J, Corporation INSURER C QBE Specialty J�,Q X N/fCo DEA: Nikola Corporatio I n , 18012 Cowan, Suite 290bOSTAMESASANITARYDISTRIC INSURER D ed AP /J( Stith 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 1N5 u POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSRD TYPE OF INSURANCE DATE(MMIDDIYY) DATE(MM/DD/YY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 UAMAGE IU HEN ItU 550,000 A X X COMMERCIAL GENERAL LIABILITY VCGP013092 08/15/06 08/15/07 PREMISES(Ea occurence) CLAIMS MADE X OCCUR MED EXP(Any pe n) 5 5,000 X Blanket Addl Insd PERSONALBADV 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 POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea Sent)ANV AUTO ALL OWNED AUTOS BODILY INJURY 5 SCHEDULED AUTOS (Pe Pe n) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Pe °dent) PROPERTY DAMAGE $ (Pe accident) GARAGE LIABILITY AUTO ONLY EA ACCIDENT 5 ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $5,000,000 C X OCCUR CLAIMS MADE FCX0004549 03/15/07 06/01/07 AGGREGATE $ 5,000,000 DEDUCTIBLE $ _ X RETENTION $10,000 $ WORKERS COMPENSATION AND X TORY LIMITS ER B EMPLOYERS'LIABILITY 046-12549-2005 12/24/06 12/24/07 EL EACHACCIDENT 181,000,000 ANY PROPRIETORIPARTN CUTIVE OFFICER/MEMBER EXCLUDED' E L DISEASE EA EMPLOYEE $ 1,000,000 if yes,de cnbe 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 I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holders & its officers agents and employees are named as additional insured per the Blanket Additional Insured Endorsement CG2010 11/85 as respect to Costa Mesa Sanitary District Project #181-Newport Blvd Sewer at 19th St & Placentia Ave Sewer at 18th Street Waiver of Subro- gation Endorsement applies *except 10 days for nonpay REPLACES PRIOR CERT CERTIFICATE HOLDER CANCELLATION COSTAMC, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Costa Mesa Sanitary District DATE THEREOF THE ISSUING INSURER WILLENn""OR-T-0MAIL 30* DAYS WRITTEN Joan Revak, Board Secretary NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,,IIT cm 11RP Tn n050 SHALL FAX 949-650-2253 628 W 19th Street Costa Mesa CA 92627 r. A ED REPR T ACORD 25(2001/08) ©ACORD CORPORATION 1988 POLICY #• VCGP013092 COMMERCIAL GENERAL LIABILITY INSURED. NIKOLA CONSTRUCTION CORPORATION THE ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Costa Mesa Sanitary District Its Officers, Agents and Employees 628 W 19th Street Costa Mesa, CA 92627 Re Project#181-Newport Blvd. Sewer at 19th Street & Placentia Avenue, Sewer at 18th Street. (If no entry appears above information required to complete this endorsement would be shown in the Declarations as applicable to this endorsement.) WHO IS INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of 'your work' for that insured by or for you CG 20 10 11 85 • Policy Number VCGP013092 CG 24 0410 93 Insured Name:NIKOLA CONSTRUCTION CORP DBA:NIKOLA CORPORATION Number 33 Effective Date:OR/1512006 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 SCHEDULE Name of Person or Organization: AS REQUIRED BY WRITTEN CONTRACT (If no entry appears above,information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition(Section IV—COMMERCIAL GENERAL LIABILITY CONDITIONS)is amended by the addition of the following: 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. CC 24 04 10 93 Copyright,Insurance Services Office,Inc. 1992 Page 1 of I ❑