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Insurance - Performance Pipeline - 2016-12-12 ------""11 PERFO-1 OP ID:01 AC-COREY CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DONYYY) r`,� 12/12/2016 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(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 CONTACT Robin Hatfield Huntington Pacific Ins.Agency PHONE 'FAX 7901 Professional Circle INC.N0.ExD;714-841 6283 (AIC,No):714-842-2538 Huntington Beach,CA 92648 E-MAIL robin@huntpacifiicinsurance.com Mark Heberden INSURERS)AFFORDING COVERAGE : NAIL# INSURER A:Rockhill Insurance Company INSURED Gene Glassburner INSURER B:Allied P&C Ins.Co. / 42579 dba:Performance Pipeline INSURER C:FINANCIAL PACIFIC • Technologies 5305 Industrial Drive INSURER D:NorGUARD Insurance Co.' 31470 Huntington Beach,CA 92649 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. MSR 1DOL SUBR POLICY EFF POLICY EXP I LIMITS LTR TYPE OF INSURANCE NSW R VD POLICY NUMBER (MMIDDIYYYY) IMM!ODIYYYYI GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A X COMMERCIAL GENERAL LIABILITY X ENVP015155-01 11/21/2016 11/21/2017 DAMAGETO RENTED 50,000 PREMISES(Ea uaurrerx;e) S CLAIMS-MADE X I OCCUR MED EXP(Any one person) S 5,000 X Pollut Liability ENVP015155-01 11/21/2016 11/21/2017 PERSONAL&ADV INJURY S 1,000,000 X Prof Liab ENVP015155-01 11/21/2016 11/21/2017 GENERAL AGGREGATE S 2,000,000 GEM_AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S 2,000,000 POLICY /t rT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLELIMIT 1,000,000 (Ea accident) S B X ANY AUTO ACP 7843941718 03/19/2016 03/19/2017 BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS OWNED PROPERTY DAMAGE S X HIRED AUTOS X NON AUTOS (PER ACCIDENT) S UMBRELLA UAB X :OCCUR ? EACH OCCURRENCE S 1,000,000 C X EXCESS LIAB i CLAIMS-MADE 27305798 11/21/2016 11/21/2017 AGGREGATE S 1,000,000 DED X RETENTIONS none S WORKERS COMPENSATION X WC STATU- 0TH- AND EMPLOYERS'LIABILITY TORY LIMITS ER D ANY PROPRIETOR/PARTNER/EXECUTIVE Y� GEWC700249 05/25/2016 05/25/2017 E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED, I I N I A (Mandatory in NH) E L DISEASE-EA EMPLOYEE S 1,000,000 It yes,describe under .---� DESCRIPTION OF OPERATIONS below L DISEASE-POLICY LIMIT S 1,000,000 I� jI i 1 i i DESCRIPTION OF OPERATIONS I LOCATIONS!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. CERTIFICATE HOLDER CANCELLATION C MSD001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. 290 Paularino DrivVil e Costa Mesa,CA 92626 I GI I///���� AUTHORIZED REPRESENTATIVE MQ - 1k,' L 1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: ENVPOI5I55-OI 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): Location(s)Of Covered Operations 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 complete thise Schedule if not shown,will be shown in the Declarations. A. Section II—Who Is An Insured is amended to include B. With respect to the insurance afforded to these as an additional insured the person(s)or additional insureds,the following additional exclu- organization(s)shown in the Schedule,but only with sions apply: respect to liability for"bodily injury","property damage" This insurance does not apply to"bodily injury"or or"personal and advertising injury"caused, in whole or "property damage"occurring after: in part, by: 1. All work, including materials, parts or equip- 1. Your acts or omissions;or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project(other than service, maintenance behalf; or repairs)to be performed by or on behalf of the additional insured(s)at the location of the in the performance of your ongoing operations for the covered operations has been completed; or additional insured(s) at the location(s)designated above. 2. 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. CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 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 am 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 II-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 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 Friday,October 21, 2016 at 3:21:33 PM Pacific Daylight Time Subject: Re:#314 Phase 5 Date: Friday, October 21, 2016 at 10:57:02 AM Pacific Daylight Time From: Jeff Rubio To: Phyllis Beck CC: Rob Hamers,willie duarte Phyllis, Spoke with bonding company it's ready I am having them sent over to you directly. Thank you, Jeff Rubio Sent from my iPhone On Oct 21,2016,at 10:50 AM, Phyllis Beck<pbeck@robhamers.com>wrote: Hi Jeff, I received the signed contract for the$47,226. You forgot to include the Labor and Material Bond. We cannot get this signed without that. Please provide as soon as you can. Thank you. Phyllis D. Beck I Robin B. Hamers & Associates, Inc. CIVIL ENGINEERS I PLANNERS I SURVEYORS 234 E. 17th Street, Suite 205, Costa Mesa, CA 92627 phone (949) 548-1192 I fax (949) 548-6516 Irvine office email: rhamers@robhamers.com I Costa Mesa office email: pbeck@robhamers.com Page 1 of 1