Project 181 - Insurance - Nikola - 2007-03-05 ACORD CERTIFICATE OF LIABILITY INSURANCE OPID CA
DATE(MMDD YYV)
NICHO-1 03/05/07
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 EIVED
Phone 714-444-2679 Fax 714-4410i4;E V L INSURERS AFFORDING COVERAGE NAIC#
INSURED 7 2007 INSURERA Gemini Insurance Company
Nikola Construction MAR - U INSURERS Coupon atso . Fund
Corporation
DBA: Nikola Corporation INSURER C. QBE Specialty
18012 Cowan Suite 290' INSURERD united Natio al Ineu nee co
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
1NDNVwUy POLICYE FECT Pt—POLICYEAPIRATION
LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DDM') DATE(MM/DD/YY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
UAMAtat I O HtN 1 tU
A X X COMMERCIAL GENERAL LIABILITY VCGPO13092 08/15/06 08/15/07 PREMISES(Eaoccurence) $ 50,000
CLAIMS MADE X OCCUR MED EXP(Any o person) $ 5,000
X Blanket Addl Insd PERSONAL AADV INJURY $ 1,000,000
X Waiver of Subro GENERAL AGGREGATE $ 2,000,000
�GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OPAGG $2,000,000
n l POLICY n jECT n LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY
NON.OWNED AUTOS (Pe accident)
PROPERTY DAMAGE $
(Pe amdent)
GARAGE LIABILITY AUTO ONLY EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY' AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $2,000,000
C X I OCCUR 1 CLAIMS MADE FCX0004019 09/05/06 06/05/07 AGGREGATE $2,000,000
DEDUCTIBLE $
X RETENTION $10,000 $
WORKERS COMPENSATION AND X O LIMITS I ER-
TORY LMITS S ER
B
EMPLOYERS'LIABILITY 046-12549-2005 12/24/06 12/24/07 EL.EACHACCIDENT $ 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L.DISEASE EA EMPLOYEE $ 1,000,000
If yes,desaibe under
SPECIAL PROVISIONS below E.L.DISEASE POLICY LIMIT $ 1,000,000
OTHER
C Leased Borrowed, 2598480 07/10/06 07/10/07 Contrs EQ $100 000
Rented Equipment I 2% ded $5,000 max
DESCRIPTION OF OPERATIONS/LOCATIONS I 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 s 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 INSURERWILLX IWdIMMAIL 30* DAYS WRITTEN
Joan Revak, Board Secretary NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,NM PGTCORKS0211O010N1$04
FAX 949-650-2253 tripUilielcc42614342VaiENInxakirKowootaitkixthstauxectaansmcc
628 w 19th Street
Costa Mesa CA 92627
A ED REPR TqE, n
ACORD 25(2001/08) �4/e��Y m ACORD CORPORATION 1988
Policy Number- VCGP011324
VE01820304
Insured Name:NIKOLA CONSTRUCTION CORP
DBA. NIKOLA CORPORATION Effective Date: 08/15/2005
Number. 32
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
ply to`�lttlillitycaused by the sole negligence of any additional insured.
Wittmespe-eito"ttte'in Urapce afform ed o ese additional risure s, the ollo4ng additior al
tke cluslons applies : Nat s u
ThAinsurance does no .appty to.
*S,,i e,H' .77:> . .sty c
I 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.
VE01820304 Page 1of1
Policy Number VCGP013092 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
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.
CG 24 04 10 93 Copyright. Insurance Services Office. Inc 1992 Page 1 of 1 ❑