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Insurance-Pacific Data Electric - 2014-02-27ACORV CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODM'YY) 2127/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER Bolton & Company 3475 E. Foothill Blvd., Suite 100 Pasadena, CA 91107 CONTACT PHONE 626 799 -7000 FAX No: 626- 583 -2125 EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC If 3/112014 INSURER A: HDI-Gerling America Insurance Co EACH OCCURRENCE www.boltonco.min 0008309 INSURED Pacific Data Electric, Inc. INSURER B: Scottsdale Insurance Company $ 100,000 MED ENE (My one person) PDE Total Energy Solutions 9970 Bell Ranch Drive, Ste 109 Santa Fe Springs CA 90670 INSURER C: 1 INSURER D: $ 1,000,000 INSURER E GENERALAGGREGATE NSURERE: PRODUCTS - COMP /OP AGO $ 2,000,000 COVERAGES CERTIFICATE NUMBER: 19360028 REVISION NUMRER: 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF ADDLSUBR POLICY NUMBER POLICY Err MM /DD/YVVY POLICY EXP MMIDO/VYyy LIMITS A ✓ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR ✓ EGGCC000126714 3/112014 3/1/2015 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occu ante $ 100,000 MED ENE (My one person) $ PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 0 JERO [__] LOC OTHER: GENERALAGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGO $ 2,000,000 $ A AUTOMOBILE ✓ ✓ LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -0WNEO HIRED AUTOS ✓ AUTOS ✓ EAGCC000126714 3/1/2014 3/1/2015 CEOMBIINtlEEDtSINGLE LIMIT $ 1,000,00 BODILY INJURY (Per person) $ eracctlent BODILY INJURY (Per accident) ) $ PROPERTY DAMAGE Per accident $ B ✓ UMBRELLA LIAB EXCESS LIAB r/ OCCUR CLAIMS -MADE XLS0092059 I 3/112014 3/1/2015 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DIED I III RETE $ A AND EMPLOY RS'LIABILIITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below' NIA ✓ —7— EWGCC000126714 3/1/2014 3/1/2015 ,/ STATUTE ERH E. L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,OOQ000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Job: Costa Mesa Sanitary District, Study and Preliminary Drawings for generators. Costa Mesa Sanitary District, its directors, officials, officers, employees, agents and volunteers named GL & Auto Blkt Additional Insured per attached, only if required by written contract/agreement. GL Primary Wording applies per attached. WC Waiver of Subrogation applies per Costa Mesa Sanitary District 628 West 19th Street Costa Mesa C 9 627 31�0� ACORD 25 (2014101) �] /� `_' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RE C E I ED ACCORDANCE WITH THE POLICY PROVISIONS EXPIATION WILL BE DELIVERED IN MAR0 5 2014 AUTHORIZED REPRESENTATIVE WAMLSASANIIAMDI MCI Kim Sautter-Ramos ©1988 -2014 ACORD CORPORATION- All rights rr4ser. The ACORD name and logo are registered marks of ACORD CENT NO.: 19360025 CLIENT COPE: PACIDAT -01 Nancy Cadwallader 2/27/2014 11:31;29 AN Page 1 of 6 POLICY NUMBER: EGGCC000126714 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to 'bodily injury" or "property damage" occurring after: 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 2. 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 All work, including materials, parts or equipment fumished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. © Insurance Services Office, Inc., 2012 CENT NO.: 19360028 CLIENT CODE: PACIOAT-01 Nancy Cadwallader 2/27/2019 11:31:29 AM Page 2 of 6 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 CERT NO.: 19360028 CLIENT CODE: PACIDAT -01 Nancy Cadwallader 2/27/2019 11:31:29 AM Page 3 of 6 EGGCC000126714 COMI%fERCIAL GENERAL LIABILITY EN Al PNC 04 11 THIS ENDORSEMENT CHANGES THE POLICY - PLEASE READ IT CAREFULLY ADDITIONAL INSURED - PRIMARY AND NON - CONTRIBUTORY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Person(s) or Organization(s) Where required by written Contract This insurance shall be excess over any other insurance naming the scheduled additional insured as an insured on a primary, excess, contingent, or on any other basis unless: A written contract or agreement specifically requires that this insurance be primary and noncontributory. 2. The written contract is signed and executed by the named insured and additional insured prior to any "bodily injury", "property damage" or "personal and advertising injury ". 3. This policy does not apply for defense or indemnity of the additional insured if state or federal law does not permit indemnification of the additional insured by the Named Insured for the claim of a third party. 4. This insurance does not apply to the additional insured's liability to indemnify, defend or hold harmless a third party. EN Al PNC 04 11 Page 1 of I CENT NO.: 19360028 CLIENT CODE: PACIOAT -01 Nancy Cadwallader 2/27/2014 11:31:29 AM Page 4 of 6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (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 Where required by Written contract 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 in issued subsequent to preparation of the policy.) Endorsement Effective: 3/1/2014 Policy No. EWGCC000126714 Endorsement No. Premium $ Insurance Company HDI Getting America Insurance Co Countersigned by WC 00 03 13 (Ed. 4 -84) Copyright 1983 National Council on Compensation Insurance. Hean Foruss &Services Reorder No. 14-4888 CERT NO.: 19360028 .CLIENT CODE: PACIDAT -01 Nancy Cadwallader 2/27/2014 11:31:29 AM Page I or 6 EAGCC000126714 COMMERCIAL AUTO EN Al 50 57 09 11 THIS ENDORSEMENT CHANGES THE POLCIY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. WHO IS AN INSURED, under SECTION II — LIABILITY COVERAGE, A. COVERAGE, is amended to include as an "insured ", any person or organization you are required to add as an additional insured on this policy under a written contract, agreement or permit which must be: a. Currently in effect or becoming effective during the term of the policy; and b. Executed prior to an "accident" for which coverage provided to an additional insured under this endorsement applies. The insurance provided to this additional insured is limited as follows: 1. That person or organization is an additional insured only with respect to liability arising out of your operations performed for that additional insured as specified in the written contract, agreement or permit. 2. The limits of insurance applicable to the additional insured are those in written contract, agreement, permit or in the Declarations for this policy, whichever are less. These limits of insurance are inclusive of and not in addition to the Limit of Insurance for Liability Coverage shown in the Declarations. 3. Coverage is not provided for "bodily injury" or "property damage' arising out of the sole negligence of the additional insured. Any coverage provided hereunder will be excess over and other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary. When this insurance is in excess, we will have no duty to defend the additional insured against any "suit" if any other insurer has a duty to defend the additional insured against that "suit." If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insurer's rights against all those other insurers. All other terms and conditions of this policy remain unchanged. EN Al 50 57 09 11 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc. CENT NO.: 19360028 CLIENT CODE: PACIDAT -01 Nancy Cadwallader 2/27/2019 11,31:29 AN Page 6 of 6