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Project 187 - Insurance - Wright Constructors - 2009-10-28 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID A2 DATE(MM/DD/YYYY) HOWAR-2 10/28/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gallagher Construction Svcs ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CA License# 0726293 HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1 Market St Spear Tower #200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Francisco CA 94105 Phone 800-500-7202 Fax 415-391-1882 INSURERS AFFORDING COVERAGE NAIL# INSURED R EC E qvSy�LR V u cb tenor Insure co INSURER ACE Property & Casualty 20699 Howard S Wright Constructors LP NOV - 21�D 1901 Placentia CA Circle tt D. Placentia CA 92870 COSTA M€SA SAM-I I CT 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 INSR ADD''UU POLICY NUMBER UA ICY EFFECTIVE POLICY % TION LIMITS LTR INSRO TYPE OF INSURANCE (MMIDD/YY) DATE(MMIDDIYY) GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 -TAMALE IURENTED A X COMMERCIALGENERALUABILITY GL04277092-05 11/01/09 11/01/10 PREMISEB(Eaoccurenca) $ 1 000,000 CLAIMS MADE X OCCUR MED EXP(Any pe n) $ 10,000 PERSONAL 8 ADV INJURY F27000,000 GENERAL AGGREGATE `$ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG $ 4,000,000 —1 POLICY I) l PE I LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANY AUTO BAP4277093-05 11/01/09 11/01/10 (EaadeM) $ 1 000 000 o ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Pe pe n) X HIRED AUTOS BODILY INJURY X NON.OWNED AUTOS (Pe accdenl) PROPERTY DAMAGE (Pe acodent) GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 10,000,000 $ X ( OCCUR I I CLAIMS MADE X00 G23891645 11/01/09 11/01/10 AGGREGATE $ 10,000,000 DEDUCTIBLE _$ RETENTION $ $ vVC SIAIU- UIH- WORKERS COMPENSATION AND X TORY LIMITS ER EMPLOYERS'LIABILITY A WC4277091-06 11/01/09 11/01/10 EL EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE EA EMPLOYEE$ 1,000,000 S yes,CAL PROVISIO EL DISEASE POLICY LIMIT $ 1,000 000 SPECIAL PROVISIONS below t OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS *10 days notice for nonpayment of premium RE HSW Job #68519-Costa Mesa Sanitary District - New Corporate Yard Additional Insured(s) Costa Mesa Sanitary District and its employees and agents GL/Auto/WC Waiver of Subrogation applies CERTIFICATE HOLDER CANCELLATION COSTAM2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING INSURER WILL=MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFTIaYn=flak Costa Mesa Sanitary District 628 W 19th Street Costa Mesa CA 92627 AUTHORIZED REPRESENTATIV . �ACORD 25(2001/08) 0.. o A D CORPORATION 1988 POLICY NUMBER: GL04277092-05 COMMERCIAL GENERAL LIABILITY CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Costa Mesa Sanitary District and its employees and agents. RE. HSW Job#68519-Costa Mesa Sanitary District New Corporate Yard (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II — Who Is An Insured is amended to (1) All work, including materials, parts or include as an insured the person or organization equipment furnished in connection with shown in the Schedule, but only with respect to such work, on the project (other than liability arising out of your ongoing operations service, maintenance or repairs) to be performed for that insured. performed by or on behalf of the addi- B. With respect to the insurance afforded to these tional insured(s) at the site of the cov- additional insureds, the following exclusion is ered operations has been completed; added: or 2. Exclusions (2) That portion of 'your work' out of which the injury or damage arises has been This insurance does not apply to 'bodily in- put to its intended use by any person or juy or 'property damage' occurring after organization other than another con- tractor or subcontractor engaged in performing operations for a principal as a part of the same project. PRIMARY INSURANCE. It is further agreed that such insurance as is afforded by this policy for the benefit of the above Additional Insured(s) shall be primary insurance as respects any claim, loss or liability arising out of the Named Insured's operations, and any other insurance maintained by the Additional Insured(s)shall be excess and non-contributory with the insurance provided hereunder CG 20 10 10 01 © ISO Properties, Inc. 2000 Page 1 of 1 ❑ POLICY NUMBER GLO4277092-05 COMMERCIAL GENERAL LIABILITY CG 20 37 10 01 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following- COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Costa Mesa Sanitary District and its employees and agents. Location And Description of Completed Operations: RE. HSW Job#68519-Costa Mesa Sanitary District New Corporate Yard Additional Premium: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II — Who Is An Insured 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' at the location designated and described in the schedule of this endorsement performed for that insured and included in the 'products-completed operations haz a rd' PRIMARY INSURANCE. It is further agreed that such insurance as is afforded by this policy for the benefit of the above Additional Insured(s) shall be primary insurance as respects any claim, loss or liability arising out of the Named Insured's operations, and any other insurance maintained by the Additional Insured(s)shall be excess and non-contributory with the insurance provided hereunder CG 20 37 10 01 ©ISO Properties, Inc 2000 Page 1 of 1 ❑ 0 Waiver Of Subrogation (Blanket) Endorsement ZURICH Policy No Elf Date of Pol Exp. Date of PoL Eff Date of End, Producer Add'I Prem Return Prem. GL04277092-05 11/1/09 11/1/10 11/1/09 5 $ THIS ENDORSEMENT CHANCES THE POLICY PLEASE READ IT CAREFULLY This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: If you are required by a written contract or agreement,which is executed before a loss, to waive your rights of recovery from oth- ers,we agree to waive our rights of recovery This waiver of rights shall not be construed to be a waiver with respect to any other operations in which the insured has no contractual interest. U-GL-925-D CW(12/01) Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed.4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED,EXECUTED PRIOR TO THE ACCIDENT OR LOSS,THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND OR ORGANIZATON. This endorsement changes the policy to which it Is attached and is effective on the date issued unless othervnse stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 11-01-09 Policy No. WC4277091-06 Endorsement No. Insured: Premium$ Company: Countersigned By WC 00 03 13 �� (Ed.4-84) Copyright 198:1 National Council on Compensation Insurance. AGENT COPY ZURICH Waiver Of Transfer Of Rights Of Recovery Against Others To Us Policy Nt EIT Dale of Pul Epp Date of Pol EIT Date of End Agency No Addl.Prent Rem Pro BAPb277093-u., 1III/U9 11;1110 1 01'09 This endorsement is issued by the company named in the Declarations. It changes the policy on the effective date listed above at the hour stated in the Declarations. THIS ENDORSEMENT CHANCES THE POLICY PLEASE READ IT CAREFULLY Named Insured: Address(including ZIP code) This endorsement modifies insurance provided under the Business Auto Coverage Form Truckers Coverage Form Garage Coverage Form Motor Carrier Coverage Form SCIIEDULE Name of Person or Organization: ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED EXECUTED PRIOR TO THE ACCIDENT OR LOSS.THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY We waive am right of recovery 1we map, have against the designated person or organization shown in the schedule because of payments we make for injury or damage caused by an accident' or 'loss' resulting from the ownership, maintenance. or use of a covered auto' for which a Waiver of Subrogation is required in conjunction with work performed bs you for the designated person or organization. The waiver applies only to the designated person or organization shown in the schedule. Countersigned. Date Authorized Representative U-CA-320-R(2W(4'94) Pige 1 of I CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of San Francisco On October 28, 2009 before me, Sharon D Mitchell, Notary Public personally appeared * * * * * * * *Aaron Cosgrove * * * * * who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or SHARON D. MRCHELL the entity upon behalf of which the person(s) f Commission# 1683976 7 acted, executed the instrument. kill' Notary Public California 5 San Francisco County • My Comm.Expires Jul 25,201 I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph.is true-and correct. WITNESS my hand and official seal. li /.7L/r �i. i/ . Signature of Notary