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Insurance-PDE Total Energy Solutions - 2016-09-16A� o® CERTIFICATE OF LIABILITY INSURANCE DAT ) TYPE OF INSURANCE E/16/2016 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 have ADDITIONAL INSURED provisions or 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 NAME: CONTACT PHONE 626 799-7000 FAX No: 626 583-2117 MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# EACH OCCURRENCE $ 1,000,000 INSURER A: Associated Industries Insurance Co Incl 23140 www.boltonco.com 0008309 INSURED PDE Total Energy Solutions INSURER B: Zurich American Insurance Company 27855 INSURER c: Torus National Insurance Company 25496 9970 Bell Ranch Drive, Ste 109 INSURER O: Santa Fe Springs CA 90670 INSURER E, AUTOMOBILE LIABILITY ✓ AM AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED ✓ AUTOS ONLY ✓ AUTOS ONLY NSURERF: COVERAGES CERTIFICATE NUMBER- 3tRnszns REVISION NUMBER - 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 WTH 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 Rmo TYPE OF INSURANCE ADOL SUER POLICYNUMBER MOUCY� MMLDDY/YEYYY LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR ✓ AES1034037 3/1/2016 3/1/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED— PREMISES Ea accunence $ 100,000 MED EXP (Any one person) $ Excluded PERSONAL &ADV INJURY $ 1,000,000 GENIE AGGREGATE LIMIT APPLIES PER: POLICY✓❑ JECT [] LOC OTHER: GENERALAGGREGATE $ 2,000,000 PRODUCTS COMPIOP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ✓ AM AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED ✓ AUTOS ONLY ✓ AUTOS ONLY BAP 551374902 10/1/2016 10/1/2017 ECOMBINED DISINGLE LIMIT $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ C UMBRELLALIAB EXCESS LIAB ,/ OCCUR CLAIMS -MADE 72946M161ALI 3/1/2016 3/1/2017 EACH OCCURRENCE $ $000000 AGGREGATE $ 8,000,000 DED I I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNEWEXECUTIVE YIN OFFICERIMEMBER EXCLUDED4 �N (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC551374802 10/1/2016 10/1/2017,/ STATUTE ERH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more spaee is required) GL Blanket Additional Insured applies per attached, only if required by written contract/agreement. Job: Operations of the Named Insured. Additional Insured(s): Costa Mesa Sanitary District and its officers, agents and employees. CFRTIFICATF HOLDER CANCELLATION Operations of the Named Insured Costa Mesa Sanitary DIStfICt rY Attn: General Manager 628 West 19th Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa, CA 92627 IChau AUTHORIZED REPRESENTATIVE Tran ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 33805305 1 PACIDAT-01 I GL,XS 03-1-16-17 AL,WC 16-17 1 Nanty Cadwallader 1 9/16/2016 12:43:50 PM (PDT) I Page 1 of 2 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 II — 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. 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. CG 20 33 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ 31805305 1 PACIOAT-01 1 GL,%5 03-1-16-17 AL, WC 16-17 1 Nancy Cadwallader 1 9/16/2016 12:93:50 PM (PUT) I Page 2 of 2