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