Loading...
HomeMy WebLinkAboutGRISSOM AND JOHNSON, INC. - SIGNAL MAINTENANCE, INC. - CertiTHE ST. PAUL INSURANCE COMPANIES 4 wAffmis Serving you around the world... around the clock ENDORSEMENT #1 It is hereby understood and agreed that effective the ........... 3Qthh.day of --------- APr l----------------219.72...., this Bond is made to cover on behalf of_____________ SIGNAL_ MAINTENANCE,__ INC_•________-______-_-_-__._ instead of on behalf of-------- U• .,I9 TS4 --- Co.* --- -------------------------------------------------------------------------------- as heretofore. Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, provisions, agreements or limitations of the undermentioned Bond, other than as above stated. Attached to and forming part of Bond No. ------- 404--B$-_6321................... issued by St. Paul Fire and Marine Insurance Company, on behalf of----- ----- E.--D..---JOWSON--�--C9.----------------------------------------------- ----------------------- and in favor of.-_-_._--._.CITY--OF.-HUNTINGTON.-BEACH------------------------- Executed this ---------- Und ------- day of --- -------- 14y ---------------- ---------- 19... 72_.. N.N�e­dles ------------ ------------------------------- 11037 sns 7-6s 2M Ed.2=56 PrintedinU.S.A. Billie Attorney -in -Fact INSURANCE COMPAtiY OF NORTH AMERICA _. AND --- �, PACIFIC f 'LOYERS GROUP OF INSURANCE Ct PANIES CERTIFICATE OF INSURANCE' (This Certificate of Insurance neither affirm;,- .>ly nor negatively amends, extends or alters the coverage, limits, terms or car,:; -:ons of the policies it certificates.) this is to (gerti£g to CITY OF HUNTINGTON BEACH CIVIC CENTER 5th STREET AND ORANGE AVENUE COMPANY CODES Z ALLIED INSURANCE CO. Q PACIFIC EMPLOYERS INDEMNITY CO. Q PACIFIC EMPLOYERS INSURANCE CO. L HUNTINGTON BEACH, CALIFORNIA INSURANCE COMPANY OF NORTH AMERICA that the following described policy or policies, issued by The Company as coded be!=N, providing insurance only for hazards checked by "X" below, hove been issued to: Name and Address SIGNAL MAINTENANCE, INCORPORATED of Insured— 1166 Kraemer Place, Anaheim, California covering in accordance with the terms thereof, at the following location(s): TYPE OF POLICY HAZARDS CO. CODE POLICY HUMBIR POLICY PERIOD LIMITS OF LIABILITY (a) Standard Workmen's 4-17-72 statutory C. Compensation & ® ® GWC 039793 to $ One Accident and Employers' Liability 4 —1 — 3 Aggregate Disease (b) General Liability Premises --Operations (including "In- cidental Contracts" as defined below) ® ® AGP 1156�4 4-17-72 $ 100, OOOEach Person Elevators c ❑ ElS until cancelled ❑ Accident $ 300, 000Each ,, Independent Contractors ® ® )® Occurrence o Completed Operations/Products X❑ co Contractual, (Specific type as de- in footnote below) ❑ $ 3 0 0 , 0 0 OAggregate---Completed scribed _ _ _❑ _ _ _ Operations/Products Premises - Operations, (Including "Incidental Contracts" as defined 0 © ® AGP 115654 4-17T72 S ❑ Accident $ lOO, 000Eath � INOccurrence below) llritll o Elevators ❑ ❑ cancelled $ 100, 000Aggregate—Prem./oper. «' Independent Contractors X $ 10 0 , 0 0 OAggregate—Protective o Completed Operations/Products X 9. 1 $ O 0 r 0 0 OAggregate---Completed a Contractual, (Specif:c type as de- footnote ❑ ❑ Opera tions/Products scribed in �elew) $-------,Aggregate--Contractual W Automobile Liability Owned Automobiles � ® 4 —17 —7 2 $ 100, O 0 OEach Person � .? Hired Automobiles © 9 AGP 115634 until $ 300, O O OEach El Accident Non -owned Automobiles cancelled_ (((© Occurrence to Owned Automobiles � a AGP 115654 4-17-72 ❑ Accident caL o? Hired Automobiles X❑ ® until $ 100, OOOEach [� Occurrence ao Non -owned Automobiles 9 cancelled (d)FIREMAN'S FUND 4-17-72 Difference between XLB1067301 to Primary Limits and EXCESS LIABILITY 4-17-73 $1,000,000 Combined Sin le Limits Contractual Footnote: Sub;ect to all the policy terms applicable, specific contras: -;al liability coverage is provided as respects ❑ a contract / ❑ purchase order agreements / � all contracts (check applicable blocks) between the Insured and: Name of Other Party:_._ I - Dated (if applicable;:___ Co --:•act No. (if any): Description (or Job):__— c Definitions: "Incidental contract" means any written (1) lease of premises (2) ea:ament agreement, except in connection with construction or demoliticn operations on or adjacent to a railroad, (3) undertaking to indemnif. a municipality required by iu ordinance, e t in connection with work for the municipality, (4) sidetrack agreement, or (5) elev_-:r maintenance agreement. It is the intention of the company that in the event of cancelation of the polity or policies by the company, ten (10) days' written notice of such LEE SMITH & CO. cancelation will be given to you at the address stated above. -- I c.i aao. lnna,f a.ao vrn IN 11 C 1 Authorized Representative " ADDITIONAL NAMED INSURED ENDORSE14ENT Named Insured SIGNAL MAINTENANCE, INCORPORATED AGP 11 56 54 4-17-72 Effective Date 4-17-72 Policy No. Policy Period of Endorsement Issued by Insurance Company of North America (Name of Insurance Company) The above is required to be completed only when this endorsement is issued subsequent to the preparation of the policy. In consideration of the premium charged, City of Huntington Beach is added as an Additional Insured with respect to all liabilities arising out of work performed by or on behalf of the named insured. It is agreed that coverage is extended as respects liability assumed by the named insured under contracts or agreements with City of Huntington Beach. The inclusion of more than one named insured under this policy shall not operate to impair the rights of one insured against another insured and the coverages afforded by this policy shall apply as though separate policies had been issued to each insured. The inclusion of more than one insured shall not, however, operate to increase the limit of the company's liability. It is understood and agreed that any other insurance carried by City of Huntington Beach, whichimay be applicable, shall be deemed excess and the named 1-:sured's insurance primary notwithstanding any confliction pro- visions in the insured's_ polii:cy to the contrary. The City of Huntington Beach shall not, by reason of its inclusion under this pDlicy, incurr liability or payment of premium for this policy. In the event of reduction in coverage or cancellation of the insurance, the Cc.pany agrees to mail thirty (30) days advance notice of such reduction or cancellation to the City of Huntington Beach, Civic Center, 5th Street and Orange Avenue, Huntington Beach, California. LEE SMITH & COa Authorized Agent ly, grissfoin & lohnson 111ce ELECTRICAL CONTRACTORS P.O. Box 10040 • 17182 Armstrong Ave. • Santa Ana, Calif. 92711 • (714) 540-9570 May 26, 1972 City of Huntington Beach Civic Center 5th St. & Crange Ave. Huntington Beach, Calif. Subject: Traffic Signal Maintenance Gentlemen: Enclosed herewith are copies of Insurance Certificates and Bond Endorsements for Signal Maintenance, Inc. Very truly yours, GRISSOM & JOHNSON, INC. Rex M. Grissom RMG : if � acei 37- 4OW MUM i► MAY 01972 Nuoylvainzeft.CI* . CERTIFICATE OF INSURANCE DATE: 3/25/71 CERTIFICATE HOLDER: NAME OF INSURED: CITY OF HUNTINGTON BEACH GRISSOM & JOHNSON, INC. P.O. BOX 190 P.O. BOX 10040 HUNTINGTON BEACH, CALIF. 92648 SANTA ANA, CALIF. 92711 TRAFFIC SIGNAL MAINTENANCE THIS CERTIFIES THAT GRISSOM & JOHNSON, INC. IS INSURED FOR: COMPREHENSIVE GENERAL LIABILITY INSURING ALL OPERATIONS INCLUDING AUTOMOBILE UNDER THE FOLLOWING POLICIES COVERING THE LIABILITY IMPOSED BY LAW OR ASSUMED UNDER CONTRACT FOR BODILY INJURY TO PERSONS OR DAMAGE TO PROPERTY OF OTHERS. POLICY NUMBER: COVERAGES AND LIMITS: mml�CL-A-A-2365-33 BODILY INJURY LIABILITY EACH PERSON $ 250,000. EACH OCCURRENCE $ 1,000,000. AUTOMOBILE PROPERTY DAMAGE LIABILITY EACH OCCURRENCE $ 250,000. PROPERTY DAMAGE LIABILITY OTHER THAN AUTO. EACH ACCIDENT $ 100,000. AGGREGATE $ 100,000. CL-A-A-8148-020 UMBRELLA COMBINED SINGLE LIMIT $ 2,000,000. EXCESS OVER & ABOVE PRIMARY POLICIES WORKMEN'S COMPENSATION WCP A19-1144-96 STATUTORY, STATE OF CALIFORNIA TERM OF INSURANCE: APRIL 1, 1971 TO APRIL 1, 1972 DESCRIPTION OF OPERATIONS: ALL OPERATIONS OF NAMED INSURED. IF THE ABOVE POLICIES ARE CANCELED OR CHANGED DURING THE PERIOD OF COVERAGE AS STATED HEREIN IN SUCH A MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE WILL BE MAILED TO THE PARTY NAMED ABOVE FOR WHOM THIS CERTIFICATE IS ISSUED. i! I EJ ,AMERICAN EMPLOYERS' INSURANCE COMPANY 'h BY le � PRES., MICHAEL LUBY INSURANCECORP. POLICIES ARRANGED THROUGH MICHAEL LUBY INSURANCE CORPORATION 801 PACIFIC AVENUE, LONG BEACH, CALIFORNIA 90813 CERTIFICATE OF INSURANCE DATE: 4/1/71 CERTIFICATE HOLDER: NAME OF INSURED: CITY OF HUNTINGTON BEACH GRISSOM & JOHNSON, INC. ENGINEERING DEPARTMENT P.O. BOX 10040 P.O. BOX 190 SANTA ANA, CALIF. 92711 HUNTINGTON BEACH, CA. 92648 THIS CERTIFIES THAT GRISSOM & JOHNSON, INC. IS INSURED FOR: COMPREHENSIVE GENERAL LIABILITY INSURING ALL OPERATIONS INCLUDING AUTOMOBILE UNDER THE FOLLOWING POLICIES COVERING THE LIABILITY IMPOSED BY LAW OR ASSUMED UNDER CONTRACT FOR BODILY INJURY TO PERSONS OR DAMAGE TO PROPERTY OF OTHERS. POLICY NUMBER: CL-A-A-2365-33 CL-A-A-8148-020 COVERAGES AND LIMITS: BODILY INJURY LIABILITY EACH PERSON $ 250,000. EACH OCCURRENCE $ 1,000,000. AUTOMOBILE PROPERTY DAMAGE LIABILITY EACH OCCURRENCE $ 250,000. PROPERTY DAMAGE LIABILITY OTHER THAN AUTO. EACH ACCIDENT $ 100,000. AGGREGATE $ 100,000. UMBRELLA COMBINED SINGLE LIMIT $ 2,0001000. EXCESS OVER & ABOVE PRIMARY POLICIES WORKMEN'S COMPENSATION WCP A19-1144-96 STATUTORY, STATE OF CALIFORNIA TERM OF INSURANCE: APRIL 1, 1971 TO APRIL 1, 1972 DESCRIPTION OF OPERATIONS: ALL OPERATIONS OF NAMED INSURED. IF THE ABOVE POLICIES ARE CANCELED OR CHANGED DURING THE PERIOD OF COVERAGE AS STATED HEREIN IN SUCH A MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE WILL BE MAILED TO THE PARTY NAMED ABOVE FOR WHOM THIS CERTIFICATE IS ISSUED. IT IS AGREED THAT THE CITY OF HUNTINGTON BEACH IS HEREBY INCLUDED AS AN ADDITIONAL INSURED, BUT ONLY WITH RESPECT TO OPERATIONS PERFORMED BY THE NAMED INSURED UNDER CONTRACT WITH THE CITY OF HUNTINGTON BEACH. ,AMER KAN EMPLOYERS' INSURANCE COMPANY BYE-..�_..v� PRES., MICHAEL LUBY INSURANCE CORP. POLICIES ARRANGED THROUGH MICHAEL LUBY INSURANCE CORPORATION 801 PACIFIC AVENUE, LONG BEACH, CALIFORNIA 90813