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Insurance - Professional Pipe 2016-12-20PERFO-1 OP ID: MG ,�►coRo~ CERTIFICATE OF LIABILITY INSURANCE COVERAGES CERTIFICATE NUMBER: 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 DAM 2120/2 0 1 6 12/20/2016 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 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 endorsements). PRODUCER Huntington Pacific Ins. Agency 7901 Professional Circle g y Huntington Beach, CA 92648 Mark Heherden CONTACT Robin Hatfield NAME: fAIc. a xi:714-841-6283 FAX Ne: 714-842-2538 EMAIL s: robin@huntpacificinsurance.com - INSURERS AFFORDING COVERAGE NAIC# INSURERA: Rockhill Insurance Company INSURED Gene Glassburner dba: Performance Pipeline Technologies 5305 Industrial Drive Huntington Beach, CA 92649 INSURERB:Allled P & C Ins. Co. 42579 INSURER c:FINANCIAL PACIFIC INSURER D: NorGUARD Insurance Co. 31470 INSURER E' INSURER F'. COVERAGES CERTIFICATE NUMBER: 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 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. /NSR LTR TYPE OFINSURANCE DOL POLICY NUMBER POLICVEFF MMIODIYYYY POLICY E%P MMIDO LIMITS GENERALLIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X ENVP015155-01 11121/2016 11/21/2017 AMA ET 50,00 PREMISES Ea acwnenceb CLAIMS -MADE 1K OCCUR MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY S 1,000300 X Poliut Liability ENVP016155-01 11/21/2016 1112112017 X Prof Liab GENERALAGGREGnTE $ 2,000,000 ENVP016165-01 11/21/2016 11/21/2017 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOPAGG $ 23000,00 $ POLICY X PROT F7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 Ea acadent $ BODILY INJURY (Per person) $ B X ANY AUTO ACP 7843941718 0311912016 0311912017 BODILY INJURY (Per accitlenQ $ ALL OWTOSNED SCHEDAUTOSULED X HIRE[ AUTOS X NONMED AUTOS PROPERTY DAMAGE $ PER ACCIDENT UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 13000,00 AGGREGATE $ 1,000,000 C X EXCESS LIAB CLAIMS -MADE 27305798 11/21/2016 11121/2017 DED X RETENTION$ none $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY IN ANY PROPRIETOR/PARTNERIEXECUTIVEY OFFICERJMEMBER EXCLUDED? (Mantlatory In NH) NIA GEWC700249 05125/2016 05125/2017 OTH- WC ,,ST X T RV LIMITS ER E.L. EACH ACCIDENT S 1,000,00 E.L DISEASE- EA EMPLOYES 1,000,00 EL DISEASE - POLICY LIMIT $ 1,000,00 yeetleeell OF ay DDESCRIPTIONOF OPERATIONS bel DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees listed as Additional Insured with respects to the General Liability per attached endorsement. Project: #314 Phase 6. r PPTIFICATF Hr11 nFR CANCELLATION CMSD001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanita ry District 's'/ �/ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1�(, 290 Paularino Drive YY Costa Mesa, CA 92626 AUTHrnORIZE(D1 REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: FNVP015155-01 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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 O erations Any person or organization for whom you are performing In respect to any location where the named insured is operations when you and such person or organization have performing "your work". agreed in writing in a contract or agreement effected prior to the date your operations for that person or organization commenced, that such person or organization be added as an additional insured on your policy. Information required to com fete thise Schedule, if not shown, 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: 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(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to 'bodily injury" or "property damage" occurring after: 1. All work, including materials, parts orequip- ment furnished 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 2. CG 2010 07 04 © ISO Properties, Inc., That portion of "your work' out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. 2004 Page 1 of 1 POLICY NO: ENVP015155-01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: PROFESSIONAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement, effected prior to the date your operations for that person or organization commenced; that such person or organization be added as an additional insured on your policy. (If no entry appears above, information required to complete this endorsement will be shown in the Declaration as applicable to this endorsement.) A. Section 11 — Who Is An Insured is amended to (1) All "professional services', including materials, include as an insured the person or organization parts or equipment furnished in connection with shown in the Schedule, but only with respect to such services, on the project (other than liability caused, in whole or in part, by maintenance or repairs) to be performed by or on "professional services" performed for the behalf of the additional insured(s) at the site of additional insured(s). the covered operations have been completed; or B. With respect to the insurance afforded to these (2) That portion of "your work" out of which the injury additional insureds, the following additional or damage arises has been put to its intended exclusions apply: use by any person or organization other than Exclusions another contractor or subcontractor engaged in performing operations for a principal as a part of This insurance does not apply to any "claim" that the same project. results from injury or damage occurring after: RHIC 6105 (06/11) Includes Copyrighted Material of Insurance Services Office, Inc. Page 1 of 1 with its permission POLICY NO: ENVP015155-01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement effected prior to the date your operations for that person or organization commenced, that such person or organization be added as an additional insured on your policy. (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II — Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability caused, in whole or in part, by your operations performed for the additional insured(s), or premises owned by or rented to you. Includes Copyrighted Material of Insurance Services RHIC 6226 (06/11) Office, Inc. with its permission Page 1 of 1