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Project 129 - Insurance - Howard Wright Construction - 2009-09-23 • • ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDMYYYY) 09/23/09 PRODUCER LTC $0726293 1-415.391 1500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gallagher construction ervic s/ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE EXTEND OR 1 Market J Gallagher. Sp ea & Co Insurance Brokers of CA Inc HOLDER.TER THIS CERTIFICATE DOES NOT AFFORDED BY THE POLICIIES BELOW. 1 Market St. Spea Tower 0200 San Franc sop, CA 94105 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A.ZURICH AMERICAN INS CO 16535 [IRVj Howard S Wright Constructs. LP INSURER B.ACB PROP & CAS INS CO 20699 - 1901 Nancita Circle INSURERC _ Placonti CA 92870 INSURER D: 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. NSR •OD' POUCY EFFECTIVE 'POLICY EXPIRATION I UM1itTS LTR sRr ..• .1 c., POLICY NUMBER DATE IMMRJOrrYI DATE MM•D GENERAL LIABILITY GL09277092-04 i 11/01/08 11/01/09 EACHOCCURRENCE 52,000,000 • r D © COMMERCIALGENERALLIABIUTY PREMISES Eaoccurence' $1,000,000 .■ CLAIMSMADE III OCCUR MEDEXP(Alryoneperson) $10,000 . PERSONALSADVINJURY $2 000 000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER' PRODUCTS-COMP/OPAGG $4,000,000 POLICY 1311 JFCT I I LOG AUTOMOBILE LIABILITY HAP4277093-04 11/01 105 11/01/09 COMBINEDSINGLELIMI $1,000 000 (Ea accident) X. ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Perperson) SCHEDULED AUTOS —' —" ® HIREDAUTOS BODILY INJURY g NON-O'NNEOAVTOS (PS Went) I PROPERTY DAMAGE $ (Pe accldenll GARAGE LIABILITY AUTOONLY-EAACCIDENT $ ■ ANYAUTO OTHER THAN EAACC $ AUTO ONLY: AGG S IExCESMBRCLLBIUTY 100 G24650571 [9X-] 11/01/08 11/01/09 EACH OCCVRRENCE g5,000,000 © OCCUR Si CLAIMS MADE AGGREGATE $5,000 000 S ■ DEDUCTIBLE $ . RETENTION $ WORKERS COMPENSATION AND WC4277D91-O9 11/O1/08 11/01/09 x .0 STATU- ■OTH- EMPLOYERS'LIABILITY EL.EACH ACCIDENT 51,ODO 000 ANY OFFlCERIMEM ER EXCLUDED ECIITNE EL DISEASE-EAEMPLOYEE $1,000,000 Il yes,tlascnbe under EL,DISEASE-POLICY LIMIT 51,000,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS(LOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS NSW Job 068529 RE: Costa Mesa Sanitary District New Corporate Yard ADDITIONAL INSURED(S) Costa Mesa Sanitary District and its employees and agents CERTIFICATE HOLDER CANCELLATION 10 Day Notice for Non-Payment of Premium HSW Job TI68519 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Costa Mesa Sanitary District DATE THEREOF THE ISSUING INSURER WILL LJ[ `fi MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,giTh*TL $MT�'L% XFcgaRZ ffi CYARWSN1¢X3iW:W5%WNMXMIXXX • F,Prit JtSMJ % 628 W 19th Street Xp g (X'1OCXXXXXX XXXXXXXXXXXX XXXXXXXXXXXXXXX Costa Mesa, CA 92627 AUTHORIZED REPRESENTATNE� USA ACORD 25(2001/08)ranehargc ©ACOR ORPORATION 1988 13085203 • • IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer and the certificate holder, nor does it affirmatively or negatively amend, extend or after the coverage afforded by the policies listed thereon. ACORD 25(2001/08) • • ZURICH Waiver Of Transfer Of Rights Of Recovery Against Others To Us Policy No Eft. Date of Pol Exp Date of Pot Eff Date of End. Age cyNo. Addl.P em Return Prem. BAP4277093-04 I1/1106 11/1/09 11/1108 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 CHANGES 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 SCHEDULE 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 TITIS POLICY We waive any right of recovery we may 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 by 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-B CW(4;94) Page of 1 II S 0 Additional Insured — Automatic — Owners, Lessees Or ZURICH Contractors Policy No. Exp. Date of Pol. ER Date of End. Age cy No Addl. Prem. Return Pr t GLO 4277092-04 IL 11/1/09 1111/08 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. Section II—Who Is An Insured is amended to include as an insured any person or organization who you are re quired to add as an additional insured on this policy under a written contract or written agreement. B. The insurance provided to the additional insured person or organization applies only to 'bodily injury' 'property damage or 'personal and advertising injury covered under SECTION I Coverage A Bodily Injury And Property Damage Liability and Section I Coverage B Personal And Advertising Injury Liability but only with respect to liability for 'bodily injury' 'property damage' or 'personal and advertising injury caused,in whole or in part,by I. Your acts or omissions,or 2. The acts or omissions of those acting on your behalf;and resulting directly from: a. Your ongoing operations performed for the additional insured,which is the subject of the written contract or written agreement;or b. 'Your work' completed as included in the 'products-completed operations hazard' performed for the ad- ditional insured,which is the subject of the written contract or written agreement. C. However,regardless of the provisions of paragraphs A.and B. above: 1. We will not extend any insurance coverage to any additional insured person or organization: a. That is not provided to you in this policy or b. That is any broader coverage than you are required to provide to the additional insured person or organiza- tion in the written contract or written agreement;and 2. We will not provide Limits of Insurance to any additional insured person or organization that exceed the lower of: a. The Limits of Insurance provided to you in this policy or b. The Limits of Insurance you are required to provide in the written contract or written agreement. D. 'Ile insurance provided to the additional insured person or organization does not apply to: Includes copyr glued medal of In prance Sen. Off; In oh its perms ion U-CI:1175-B CW loofd • • 'Bodily injury' 'property damage' or "personal and advertising injury arising out of the rendering or failure to render any professional architectural,engineering or surveying services including: I. The preparing,approving or failing to prepare or approve maps,shop drawings,opinions,reports,surveys, field orders,change orders or drawings and specifications;and 2. Supervisory inspection,architectural or engineering activities E. The additional insured must see to it that: I. We are notified as soon as practicable of an occurrence' or offense that may result in a claim; 2. We receive written notice of a claim or 'suit' as soon as practicable;and 3. A request for defense and indemnity of the claim or 'suit' will promptly be brought against any policy Issued by another insurer under which the additional insured may be an insured in any capacity This provision does not apply to insurance on which the additional insured is a Named Insured, if the written contract or written agreement requires that this coverage be primary and non-contributory F For the coverage provided by this endorsement: 1. The following paragraph is added to Paragraph 4.a. of the Other Insurance Condition of Section IV—Com- mercial General Liability Conditions: This insurance is primary insurance as respects our coverage to the additional insured person or organization, where the written contract or written agreement requires that this insurance be primary and non-contributory In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured person or organization is a Named Insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV—Com- mercial General Liability Conditions: This insurance is excess over: Any of the other insurance,whether primary excess,contingent or on any other basis,available to an additional insured, in which the additional insured on our policy is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same 'occurrence claim or 'suit' This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional Insured on a primary and non-contributory basis. G. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured Any provisions in this Coverage Part not changed by the terms and conditions of this endorsement continue to apply as written. Include opynghted 'Mena(of h mine Semi ow In with its perm set U-GL-1175 B CW(3'2007) Page 2 of 2 • • Waiver Of Subrogation (Blanket) Endorsement ZURICH Policy No. Eft. Date of Poi. Exp. Date of PoL I El Date of End, Producer Add'l,hem Rehm Prem. GLO4277092-04 11/1/08 11/1/09 11/1/08 S S THIS ENDORSEMENT CHANGES 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 Lights 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-II CW(12/0 q Page I of 1 • • WC 00 0313 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY W (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 POLIO( 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 otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation No.of the policy.) Endorsement Effective 1111108 Policy No. we 4270o1-O5 Premium$ Company: Insured: Countersigned By C WC 00 03 13 (Ed.4-84) Copyright 198:1 National Council on Compensation Insurance. AGENT COPY 4111 4111 SUPPLEMENT�p p� CERTIFICATE INSURANCE/w DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 09/23/09 NAME OF INSURED: (law) Howard S. Wright Constructors, LP Addtwnai Description of Operations/Remarks from Pagel. Additional Information. GENERAL LIABILITY *Additional Insured Required by Written Contr ct per UGLI175BCW *Coverage is Primary and Non-Contributory required by written contr et per UOL1175BCW *Waiver of Subrogation when required by written contr et per UGL925BCW AUTO LIABILITY *Waive of Subrogation When squired by written contract per UCA320B WORKERS COMPENSATION: *Waive of Subrogation Form Wc00031.. SUPP(05/04) • • CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of San Francisco On September 23 2009 before me, Sharon D Mitchell,Notary Public personally appeared * ^ * * * *AaronCos rove* * * * * 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 the entity upon behalf of which the person(s) acted, executed the instrument. 1 certify under PENALTY OF PERJURY raider SHARON D.MRCHELL the laws of the State of California that the .at Commission#1683976 3 Notary public California foregoing paragraph is true and correct. • vr. San Francisco County My Comm,Expires Jul 25,2010 WITNESS my hand and official seal. ,a' Signature o Notary