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Insurance - Pacific Data Electric - 2015-09-17 (3)A� �® CERTIFICATE OF LIABILITY INSURANCE DAT9/17/2D1Ys "t 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(les) 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). PRODUCERCONTACT Bolton &Company 3475 E. Foothill Blvd., Suite 100 Pasadena, CA 91107C (L�� \' / y www.boltonco.com 0008309�ll''�� F_C Et 41 W it 0 NAME: PHONE FAX No Eat: 626 799-7000 AIC No: 626 583-2117 Ef 11_ ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: Associated Industries Insurance Co, Inc 23140 INSURED Pacific Data Electric, Inc. SEP 2 12015 PDE Total Energy Solutions 9970 Bell Ranch Drive, Ste 109C... +„.dt ok :ANiIGRi Ui�C811'I Santa Fe Springs CA 90670 INSURER a: Zurich American Insurance Company 27855 INSURER C: Torus National Insurance Company 25496 INSURER D: INSURER E: INSURER F: CrIVFRAI;FS CFRTIFIr.ATF NIIMfRFR• 9rsn97ncn RF\IICVIN NI HUI 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 POLICYNUMBER POLICY EFF MMIDD POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ✓ OCCUR ✓ AES1034037 3/1/2015 _LMMDDNYYYI 3/1/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ Excluded PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICYE JEo LOC GENERAL AGGREGATE $ 2.000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY BAP 5513749-01 10/1/2015 10/1/2016 COMBINED LSINGLE LIMIT $ 1,000000 BODILY INJURY (Per person) $ ✓ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS ccident $ BODnde_ ✓ NON -OWNED HIREDAUTOS ✓ AUTOS PRO$ Per C UMBRELLA LIAR ,/ OCCUR 72946M150ALI 3/1/2015 3/1/2016 EAC$ 8,000,000 AGG$ 6,000,000DED EXCESS LIAB CLAIMS -MADE RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WC 5513748-01 '10/1/2015 10/1/2016 �/ ERH E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEM ER EXCLUDED ANY ECUTIVE � NIA E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks schedule, may be attached if more space is required) Subject to Policy Terms, Conditions, Limitations and Exclusions GL Additional Insured applies per CG20330704 & CG20370704 attached, only if required by written contract/agreement. GL Primary Wording applies per NXGLOO90809 attached. WC Waiver of Subrogation applies per WC040306 attached. Job: #13448C, #196-D, Irvine Pump Station Generator. Additional Insured(s): The Costa Mesa Sanitary District, its directors, officials, officers, employees, agents and volunteers. Costa Mesa Sanitary District %0 t;(�� 628 W 19th Street 1 1 Costa Mesa, CA 92627 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Chau Tran ©1988-2014 ACORD ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 26457050 1 PACIDAT-01 I GL,XS 03-1-15-16 AL,WC 15-16 1 Nancy Cadwallader 1 9/17/2015 10:15:23 AN (PDT) I Page 1 of 5 All rights reserved. WC 5513748-01 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA NDORSEMENT- CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0% % of the California workers' compensation pre- mium otherwise due on such remuneration. Schedule Person or Organization Job Description ALL PERSONS OR ORGANIZATIONS WHEN REQUIRED BY WRITTEN CONTRACT WC 252 (4-84) WC 04 03 06 (Ed. 4-84) 26457050 I PACIOAT-01 I GL,%S 03-1-15-16 AL,WC 15-16 1 Nancy Cadwallader 19/17/2015 10:15:23 M (POT) I Page 5 Of 5 Page 1 of i POLICY NUMBER: AES1034037 COMMERCIAL GENERAL LIABILITY NX GL 009 08 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTING INSURANCE (THIRD -PARTY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Third Party: All persons or organizations where required by written contract with the Named Insured. lbsence of a specifically named Third Party above means that the provisions of this endorsement apply as I eyuu eu Uy wn aen conuacrua) agreement wan any i mra Tarty Tor wnom you are penorming work.) Paragraph 4. of SECTION IV: COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance: With respect to the Third Party shown above, this insurance is primary and non-contributing. Any and all other valid and collectable insurance available to such Third Party in respect of work performed by you under written contractual agreements with said Third Party for loss covered by this policy, shall in no instance be considered as primary, co-insurance, or contributing insurance. Rather, any such other insurance shall be considered excess over and above the insurance provided by this policy. NX GL 009 08 09 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission 26957050 1 PACIDAT-01 I GL,%S 03-1-15-16 AL,WC 15-16 I Nancy Cadwallader 19/17/2015 10:15:23 AM (PDT) I Page 4 of 5 AES1034037 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 11 — Who Is An Insured is amended to include as an additional insured any person or or- ganization for whom you are performing opera- tions when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with re- spect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. A person's or organization's status as an addi- tional insured under this endorsement ends when your operations for that additional insured are completed. CG 20 33 07 04 B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the ren- dering of, or the failure to render, any profes- sional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sured(s) at the location of the covered operations has been completed; or b. 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 subcon- tractor engaged in performing operations for a principal as a part of the same project. © ISO Properties, Inc., 2004 26457050 1 PACIDAT-01 I GL,XS 03-1-15-16 AL, WC 15-16 1 Nancy Cadwallader 1 9/17/2015 10:15:23 M (PDT) I Page 3 of 5 Page 1 of 1 ❑ POLICY NUMBER: AES1034037 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): Locations and Description of Covered Operations As Required By Written Contract As Required By Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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' or "property dam- age" caused, in whole or in part, by "your work' at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products -completed operations hazard." CG 20 37 07 04 © ISO Properties, Inc., 2004 26457050 1 PACIDAT-01 I GL,XS 03-1-15-16 AL WC 15-16 1 Nancy Cadwallader 1 9/17/2015 10:15:23 AM (PDT) I Page 2 of 5 Page 1 of 1