Loading...
Insurance - Pacific Data Electric - 2017-03-2017ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/ODIYYYY) TYPE OF INSURANCE 3/17/2017 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). PRODUCERBolton & Company p 3475 E. Foothill Blvd., Suite 100 Pasadena, CA 91107 CONTACT NAME: PHONE Eat 6267ss-7000 we Ho: 626 583-2117 EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC it EACH OCCURRENCE $ 1,000,000 INSURERA: Associated Industries Insurance Co Inc 23140 WWw.boltonco.com 0008309 INSURED PDE Total Energy SoluINSURER 9970 Bell Ranch Driverive,, Steto 109 INSURERS: Zurich American Insurance Company 27855 C: Aspen American Insurance Company 43460 INSURER D: Santa Fe Springs CA 90670 INSURER E, B INSURER F; LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIREDNON-OWNED AUTOS ONLY ✓ AUTOS ONLY laiePJ4 ZT-110 1q:4119[Ntd1:1' 011111-1=1: 1 N:0 G9 U77.111,J,1*4 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR /' POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD/YYYY LIMITS A r/ COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR ✓ ✓ AES1034037 3/1/2017 3/1/2018 EACH OCCURRENCE $ 1,000,000 A S (RENTED PREMISES Ea occurrence) $ 100,000 MED EXP (Anyone person) $ Excluded PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT � LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE ✓ LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIREDNON-OWNED AUTOS ONLY ✓ AUTOS ONLY SAP 551374902 10/1/2016 10/1/2017 (ED aBINEDISINGLE LIMIT $ 1000000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Par accid C ✓ UMBRELLA LIAB EXCESS LIAB �/ OCCUR CLAIMS,MADE CX005A217 3/1/2017 3/1/2018 EACH OCCURRENCE $ 8,000,000 AGGREGATE $ 8,000,000 DEO I I RETENTION$ I $ B WORKERS COMPENSATION AND EMPLOYERT LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVEE.L. OFFICE RIMEMBEREXCLUDED't FN (Mandatory in NH) If es, describe under DESCRIPTION OF OPERATIONS below N/A WC551374802 10/1/2016 10/1/2017PER OTH- STATUTE ER EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space 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 HOI nFR CANCFI I ATInN Operations of the Named Insured Costa Mesa Sanitary District rY 290 Paularino Avenue / Costa Mesa CA 92626 vp 3�1 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 34703526 1 PACIDAT-01 I GL,XS 03-1-17-18 AL,WC 16-17 1 Tina Adams 1 3/17/2017 2:11:5] 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 B. With respect to the insurance afforded to these include as an additional insured any person or or- additional insureds, the following additional exclu- ganization for whom you are performing opera- sions apply: tions when you and such person or organization This insurance does not apply to: have agreed in writing in a contract or agreement that such person or organization be added as an 1. "Bodily injury", "property damage" or "personal additional insured on your policy. Such person or and advertising injury" arising out of the ren - organization is an additional insured only with re- dering of, or the failure to render, any profes- spect to liability for "bodily injury", "property dam- sional architectural, engineering or surveying age" or "personal and advertising injury" caused, services, including: in whole or in part, by: a. The preparing, approving, or failing to pre - 1. Your acts or omissions; or pare or approve, maps, shop drawings, 2. The acts or omissions of those acting on your opinions, reports, surveys, field orders, change orders or drawings and specifica- behalf; tions; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. A person's or organization's status as an addi- 2, "Bodily injury" or "property damage" occurring tional insured under this endorsement ends when after: your operations for that additional insured are completed. 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 34903526 1 PACSUAT-01 [ GL,XS 03-1-17-18 AL, WC 16-17 [ Time Adams 1 3/17/2017 2:11:57 PM (PUT) I Page 2 of 2 Page 1 of 1 ❑