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06-0913_APA ENGINEERING, INC._Insurance To: APA Engineering, Inc.: Ali or 5 From: Joanna Mendoza • 9-13-06 5:20pm p. 2 of 5 • ACORO CERTIFIGdT FF LIABILITY IN§t11 �1e� �m s/13/zoo6 Producer Joanna Mendoza THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, Wood GLAmann&Bogart Insurance Brokers THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE 15901 Red Hill Ave., Suite 100 COVERAGE AFFORDED BY THE POLICIES BELOW. Tustin CA 92780 INSURERS AFFOR6(I 714 505.7000 INSURER CNA Insurance Co www.wgbib.com License No. 0679263 INSURER Fireman's Fund Insurance Co. Insured INSURER Houston Casualty Co APA Engineering, Inc. INSURER 23282 Mill Creek Dr. Ste 160 Laguna Hills CA 92653 INSURER E _!,,RAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA ED. ,r 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. POLICY POLICY NSR EFFECTIVE EXPIRATION LTR IYPE OF INSURANCE POLICY NUMBER M DATE M DATEYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ iuuuuuu A COMMERCIAL GENERAL UAB 2084362383 6/29/2006 6/29/2007 FIRE DAMAGE(Any me fire % CLAIMS MADE F4DccuR MED EXP(An,ore ewn) $ 10000 PERSMAL&ADV INJURY R Incl GENERAL AGGREGATE $ GEN'L AEG LIMB ASSPER PRODUCTS LOMP/DP AGG $ POLICY ROJECT LOC $ AUTOMOBILE LIABILITY A ANY AUTO 2090773732 8/26/2006 8/26/2007 COMBINED SINGLE LIMIT x 1000000 ALL OWNED AUTOS BODILY INJURY SCHEWLED AUTOS (PerP—N $ HIRED AUTOS BODILY INJURY NON-0WNEO AUTOS (Per areiaenq $ PROPERTY DAMAGE (Per eecldent) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC$ AUTO ONLY: AGG$ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR R CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION$ g WORKERS'COMPENSATION& STATUTORYUMIT HER EMPLOYERS'LIABILITY EL EACH ACGIDENi $ EL DISEASE.EA EMPLOYEE $ EL DISEASE POLICY UMIT $ cec n (neer Per aim2 000 000 Professsiona Liab CLAIMS MADE Aggregate�,00b,000 DESCRIPTION OFOKIIONLDCATIONSIVEHICLES/EXCLUSIONSAI)DEDBY END R MENT E IALPR VII N City of San Juan Capistrano is named as additional insured with respect to the General Liability policy per attached G 134844 A 09 99. CER,IFICAT HOLDER (,.AN t LL A DAI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of San Juan Capistrano EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE. 32400 Paseo Adelanto SENTATIVES. 10Days forNon-PaynuntofPremlum San Juan Capistrano, CA 92675 AUTHORIZED REPRESENTATIVE J�JWA'vlu—P.L �V V Peter Barsky � (J A -st7ka7g , . ; aASQRDa RaaraneNIeaa;,. To: APA Engineering, Inc.: Ali or 5 • From: Joanna Mendoza • 9-13-06 5:20pm p. 3 of 5 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 endasement(s). If SUBROGATION IS WAIVED, subject to the tends 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 fond 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 alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) created at www.e CertsONLINE.com To: APA Engineering, Inc.: Ali or S From: Joanna Mendoza • 9-13-06 5:20pm p. 9 of 5 911312006 APA Engineering, Inc. 2084362383 3-1 34844-A CNA (Ed.09/99) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ R CAREFULLY. NONCONTRACTOR'S BLANKET ADDITIONAL INSURED ENDORSEMENT This andomo ent modifies insurance provided under the following: BUSINESS ACCOUNT PACKAGE POLICY SUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESS ACCOUNT PACKAGE POLICY BUSINESSOWNERS COMMON POLICY CONDITIONS A. WHO W AN INSURED (Section C. of the (2) This insurance applies only with respect Sualriassaamsrs Liability Covsrago Form) is to operations performed by you or on your amended to include as an Insured any person or behalf for which the state or political organization (celled additional trauma) described in subdivision has Issued a permit. paragraphs 2.s. through 2.g. below whom you are required to add as an additional Insured on this policy This Insurance does not appy to 'bodily under: injury; "property damage" or "personal and advertising Injury' arising out of operations 1. A written contract or agreement;or performed for the state or municipality. 2. An oral contract or agreement where a cortiflrate b. Any paaons or organizations with a of Insurance showing that parson or organization controlling interest in you but only with respect as an additional Insured has been Issued;but to their liability arising out of: the wrlften or oral contract or agreement must be: (1) Their finandai control of you;or 1. Currently in effect or becoming effective during the (2) Promises they own, maintain or control term of this policy;or while you lease or occupy these 2. Executed prior to the 'bodily Injury; "property premises. damage" or "personal injury and advertising This Insurance does not apply to structural Injury;but aheraftis, new construction and demolition Only the following persons or organizations are operations Performed by or for such additional additional Insureds under this endorsemem and insured. coverage provided lo such additional insureds is a A manager or lessor of premises but only with Ilmfred as provided herein: reaped to Itablily arising out of the ownership, a. A state or political subdivislon subject to the maintenance or use of that specific part of the following provisions: prendses leased to you and subject to the following additional exclusions: (1) This Insurance applies only with respect to the following hazards for which this This insurance does not appy to: state or political subdivision has Issued a (1) Any"oonurtence which takes place after permit In conneofion with premises you you oases to be a tenant In that premises; own, rent, or control and to which this or Insurance applies: (a) The existence, maintenance, repair, ) d�alfe ration now construction by or construction, erection, or removal of behalf of such additional irtomred by or on tart advertising signs.Mmirngs,csnopies, oefisr entratraas cost holes d. A mortgages, assignee or receiver but only driveways, manholes, marquees, with rasped to their Liability as mortgages, seem holstaway openings, sldewafir vaults, assignee, or receiver and arising out of the street banners, or d000rstions and tomership,maintenance,or use ol a promises similar exposures;or by you, This Insurance does not!!!� (b) The construction, erection, or apply to structural removal of elevators;or alterations, raw construction or demolition operations (c) The ownership, maintenance, or use Insured performed by or for such additional any elevators covered by this insurance. s, An owner or otter interest from whom land inhas been leased by you but only with respect to l ablilty arising out of the ownership, G-134844-A Page 1 of 2 (Ed.09/88) To: APA Engineering, Inc,: Ali or 5 From; Joanna Mendoza • 9-13-06 5:20pm p. 5 of 5 G-1 34844-A (Ed.09199) maintenance or use of that specific per[of the does not appy to 'bodlly Injury" or 'property lend leased to you and subject to the following damage" included within the "products-completed additional exclusions: operations hazard". This Insurance does not appy to: S. As respects the coverage provided under this (1) Any'occurrence'which takes place after endorsement, Section H. OTHER INSURANCE, of you casae to lease that land;or the Buslinesaowrusrs Common Policy Conditions is deleted and replaced with the following: M Structural alterations,now construction or H. Other IlIm ants demolition operations performed by or on behalf of such additional Insured. 1. If there is other insurance covering the same L A co-owner of a premises oD-owned by you loss or damage, we will pay only for the and covered under this insurance but ony amount of covered loss or damage In excess with respect to the co-owners liability as oo- of the amount due from that other Insurance owner of such premises. (except as indicated In 2.below),whether you can collect on it or not. But we will not pay Ill. Any person or organization from whom you more than the applicable Limit of Insurance. lease equipment.Such person or organization 2. This insurance is excess over. Is insured only with respect to their liability arising out of the maintenance, operation or Any other valid and collectible Insurance use by you of equipment leased to you by available to the additional insured whether such person or organization, A person's or primary, excess, contingent or on any other organization's stature as an Insured under this basis unless a contract or agreement endorsement ends when their contract or specifically requires that this insurance be agreement with you for such teased either primary or primary and noncontributing. equipment ends. Where required by contract or agreement,we With respect to the Insurance afforded these will consider any other insurance maintained additional Insureds, the following additional by the additional Insured for injury or damage exclusion appy: covered by this endorsement to be excess and noncontributing with this insurance. This insurance does not appy; S. When this Insurance is excess, we will have (1) To any "occurenea' which takes place no duty under Business Account Package atter the equipment lease expires;or Policy Liability Coverage to defend any claim (2) To "bodily Injury or 'property damage! or"sutr that any other insurer has a duty to arising out of tits sole negligence of such defend. If no other insurer defends, we will undertake to do so; but we will be entitled to additional insured. Ire Insu ed's rights against all those other Any Insurance provided to an additional Insured Insurers. designated under paragraphs a through S.above 0-134844-A Page 2 of 2 (Ed.0999) CERTHOLDER COPY SG STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION I N SUFtANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 09-13-2006 GROUP: POLICY NUMBER: 1700166-2008 CERTIFICATE ID: 80 CERTIFICATE EXPIRES: 07-11-2007 07-11-2008/07-11-2007 CITY OF SAN JUAN CAPISTRANO SG JOB:PROJECT X COB-024 ATTN: MARIA GUEVARA 32400 PASEO ADELANTO SAN JUAN CAPISTRANO CA 92675-3603 CA This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon30 days advance written notice to the employer. We will also give you 30days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms. exclusio'n's,Aand conditions, of such policy. �11CRIZEDREPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - ALI PAKZAD PRESIDENT - EXCLUDED. ENDORSEMENT #1600 - PAMELA PAKZAD SECRETARY TREAS - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-11-2004 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER APA ENGINEERING, INC SG 23282 MILL CREEK OR STE 160 LAGUNA HILLS CA 92853 [CMJ,CS] IREV.Y-05I PRINTED : 09-13-2006