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Project 130 - Insurance - Irvine Pipeline - 1993-12-22 A001:11. CERTIFICATE OF INSURANCE ISSUE DATE OA M/DD/YY) n12/22/93 PRODUCER! THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Goldware & Taylor Insurance CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE 8310 Magnolia Avenue DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE LJ POLICIES BELOW. Suite 100 Riverside CA 92504 COMPANIES AFFORDING COVERAGE ��� COMPANY A CNA Insurance Co s V �� 0 LETTER f '7' I If � COMPANY B Royal Indemnity �G� INSURED Irvine Pipeline Co Inc COMPANY C \ 5959 Jasmine Street LETTER ��S }� Riverside, CA 92504 COMPANY D LETTER COMPANY E LETTER COVERAGES • . THIS IS TO CERTIFY THAT 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 UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY POLICY T TYPE OF INSURANCE POLICY NUMBER OATEN M/D DT/YY) DATE(M M/D 0T/YY) LIMITS A GENERAL LIABILITY IA121337929 06/01/93 06/01/94 GENERAL AGGREGATE $ 1, 000, 000 © OMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OPAGG. $ 1, 000, 000• ®-C LAIMS MADE X OCCUR. PERSONAL&ADV INJURY $ 1, 000, 000 ©•WNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ 1, 000, 000 - FIRE DAMAGE(Any II e) $ 50, 000 MED EXPENSE(Any one person) $ 5, 000 A AUTOMOBILE LIABILITY A121337932 06/01/93 06/01/94 COMBINED SINGLE $ 1, 000 000 LIMIT X ANY AUTO FORM' ALL OWNED AUTOS AppRO ED AS TO BODILY INJURY $ SCHEDULED AUTOS ` (Fe Pe n) HIRED AUTOS V–_,_�-- BODILY INJURY $ NON-OWNED AUTOS PIP 21 ATTO �SL*( FOR D1STRIf (Pe itlen t) PROPERTY DAMAGE $ H A EXCESS LIABILITY A121337946 06/01/93 06/01/94 EACH OCCURRENCE $ 2, 000, 000 X UMBRELLA FORM AGGREGATE $ 2, 000, 000 OTHER THAN UMBRELLA FORM . A WORKER'S COMPENSATION PWC121337963 06/01/93 06/01/94 X STATUTORY LIMITS AND EACH ACCIDENT $ 1, 000,000 EMPLOYERS'LIABILITY DISEASE-POLICY LIMIT $ 1, 000, 000 DISEASE-EACH EMPLOYEE $ 1, 000, 000 B OTHER RHA200451 12/17/93 06/01/94 Each Occurrence Excess Liability $2, 000 , 000 Aggregate $2 , 000, 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS 10 day notice of cancellation for non payment of premium applies Costa Mesa Sanitary District, its elective board, officers, agents and (See Attached Schedule . ) CERTIFICATE HOLDER CANCELLATION - - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL ENDEAVOR TO Costa Mesa Sanitary District MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 234 E 17th Street #205 LEFT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Costa Mesa CA 92627 LIABILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPR ES TATIVE ACORD 25-s(7)90}.1 of 2 413048 0 ACORD Con Ttot41990 DESCRIPTIONS (Continued from page 1.) employees are recognized as additional insureds as respects General Liability coverage per form G-17957-A attached RE Project - Recontructing force main for elden pump station, phase I Project # 1112100-130 APPROVED AS TO FORM: 0¢T_-n 7 A ORINEY tISGEM 25,2(7/$O)2 of 2 #13048 � :...0..„ate' THIS ENDORSEMENT CHANGES THE POUCY PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization (caned additional insured) whom you are required to add as an additional insured on this policy under a written contract or agreement currently in effect or becoming effective during the term of this policy provided that a certificate of insurance showing that person or organization as an additional insured has been issued. The insurance provided to the additional insured is limited as follows: 1. That person or organization is only an additional insured with respect to liability arising out of a Premises you own, rent.lease.-or occupy or b. 'Your wort" for that additional insured by or for you. 2. The limits of insurance applicable to the additional insured are those specified in the written contract or agreement or in the Declarations for this policy whichever are less. These limits of insurance are inclusive of and not in addition to the limits of insurance shown in the Declarations. The insurance provided to the additional insured does not apply to 'bodily injury" property damage personal injury or advertising injury' arising out of an architect's. engineers, or surveyor's rendering of or failure to render any professional services including: 1. The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; and 2. Supervisory inspection, or engineering services. APpOVED AS TO FORM. AT PORN.. � DIST,g1 T This ENDORSEMENT tS A PART OF YOUR POLICY AND TAKES EFFECT ON THE EFFECTIVE DATE OF YOUR POLICY UNLESS ANOTHER EFFECTIVE DATE IS SHOWN BELOW. POLICY CHANGE NO. EFFECTIVE DATE OF THIS POLICY CHANGE 12-22-93 COUNTERSIGNED DATE AL7ED RE ATIVE C-17957-A (ED. 02/92)