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Insurance - Pacific Data Electric - 2013-02-28 RECEIVED- ,-------- ® CERTIFICATE OF LIABILITY INSURANC"ER 0 4 20 3 DATE(MM/DD/YWY) `..� 2/28/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS Obit it74616E4i1M MO'jOLDER. 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 Bolton &Company CONTACT NAME: 3475 E. Foothill Blvd., Suite 100 PHONE IA/C.No.Extl: (626)799-7000 FAX(A/C,No): 626-583-2125 Pasadena, CA 91107 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC a www.boltonco.com 0008309 INSURER A: Great American Assurance Company INSURED INSURER B: Samsung Fire&Marine Insurance Company P . Electric, Inc.PDE Total Energy Soluti ons INSURER C: Scottsdale Insurance Company y 9970 Bell Ranch Drive, Ste 109 INSURER D: Insurance Company of the West Santa Fe Springs CA 90670 INSURERS: INSURER F: _COVERAGES CERTIFICATE NUMBER: 15620133 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. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER JMM/DD//YYW_) (MM/D//YYYY) LIMITS A GENERAL LIABILITY ,/ • GLP46478D9 3/1/2013 3/1/2014 EACH OCCURRENCE _$ • 1,000,000 DAMAGE TO RENTED SO,000 ✓ COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ CLAIMS-MADE ✓ OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY,✓ rT LOC _ $ AUTOMOBILE LIABILITY CPP000067500 3/1/2013 3/1/2014 COMBINED SINGLE LIMIT ii / (Ea accident) $ 1,000,000 AUTOS AUTOS .1 ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ ✓ HIRED AUTOS ✓ AUTOS NON-OWNED (Per acEciident)AMAGE $ $ C ✓ UMBRELLALIAB ✓ OCCUR XLS0087025 3/1/2013 3/1/2014 EACH OCCURRENCE $ 10,000,000 EXCESSLIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ $ $ D WORKERS COMPENSATION WVE500590902 3/1/2013 -3/1/2014 wt:STATUS °R- AND EMPLOYERS'LIABILITY Y/N ✓ ✓ TORY LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Job:Costa Mesa Sanitary District,Study and Preliminary Drawings for generators.Costa Mesa Sanitary District,its directors,officials, officers,employees,agents and volunteers named GL&Auto Blkt Additional Insured per attached,only if required by written contract/agreement.GL Primary Wording applies per attached.WC Waiver of Subrogation applies per CERTIFICATE HOLDER CANCELLATION Costa Mesa Sanitary District,Study and Preliminary Drawings for generators SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 628 West 19th Street r ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa CA 92627 0&\-9 91 AUTHORIZED REPRESENTATIVE IP4', ‘,10.10.40 Patrick Dugan ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CERT NO.: 15620133 CLIENT CODE: PACIDAT-01 Joe Chan 2/28/2013 12:11:40 PM Page 1 of 7 GLP4647809 • CG .20, 31 • (Ecl.''IP: 04 THIS ENDORSEMENT 'CHANGES; THE P,OLICY. PLEASE .READf IT CAREFULLY. ADDITIONAL: INSUREL/ - ;OWNERS, LESSEES .OR CONTRACTORS - AUTOMATIC STATUS WHEN :REQUIREO. IN CONSTRUCTION AGREEMENT WITH YOU ThiS:endorsement;modifies'insurance provided under the'following ONOE.3)0 „LIABILITY COVE,FIA05 PART A. SECTION II — WHO IS AN INS. .WRED i& This:iriS:Orarite dOet"riot:applY:to: amended to include as an Additional Insured any person, or organization for whom you are 1 Bodily injury property damage or "iper : performing operations you and such sonal and:advertising injury arising out of p:orson.Or,organization have agreed in writing the rendering of or failure to render:, . . in 'contract or agreement that person any '.professional architectural!,'engineering or 'or.gariiiation, be added as an Additional In— or surveying services including sured on your Ipolicy Such person or or- ganization. is an ,Additional Insured only With „e: the preparing, apprOving,:Or failing to respect to liability for bodily injury;:'"prop-- prepare or .aPprove, .maps, shop: Oily'damage or "personal and::advertising •drawings, opinions ,surveys-, jury' cauSedin,WnOle,or in bait by field ,'orders.,.. change orders or'draw- ings and:.SpecifiCatiOnS;'.6r: , :supervisory, irispection;„ architectural 1. your acts or omissions.or -or engineering.actiVities 2. 'BiSclify. injury; -or 'prOperty darnage be- 2. the: acts or :omissions of those ,acting on curring'after: your behalf; ;a. all woek, including 'MaterialS, parts or equipment furnished in PonriettiOn. With such=work, on the project (Other, in the performance'per :of' your' ongoing opOr— 001)0 for Additional Insured• than service maintenance or repairSl , „ to be performed, by Or on behalf of • . the:AdditiOnal.Insured(s) at the location perdi,: ;.de organizatiOKS ,status: ,Ad-- of the covered operations has been coiTioretedi,, or ditional Insured under this endorsement ends when your operations for that Additional b; that portion of "your: work 'out of P9790 are completed :which the injury or damage arises has been put to its intended use by any person or oitanizatibh other than an- 43.• With respect to the insurance afforded to other contractor or subcontractor•en—• these Additional Insureds the ;gaged in performing operations for 'a: tip P?.ct100i-01*OPPSIY: piipai ,partqf thë ame PrOlOc't: • C.oPyright,:•ISO ProPerties„inc,,„ 2004 0-G 26••,38 (Ed O7iO4) XS CERT NO.: 15620133 CLIENT CODE: PACIDAT-01 Joe Chan 2/28/2013 12:11:40 PM Page 2 of 7 • GLP4647809 GAC '3649Ca If 00)- 'THIS, ENDORSEMENT CHANGES:THE Roucy. PLEASE READ IT CAREFULLY., PRIMARY NONHCONTRIBUTORY INSURANCE ENDORSEMENT "ThiS:.endorsernent ModifieS frÜàñbë prOVided'ueidee.the:fitillbWir4 COMMERCIAL:GENERAL LIABILITY tOVERAGE FORM :OWNERS AND CONTRACTORS PROTECTIV LIABILITY COVERAGE FORM :0t8Y.ib:thi ahceheI bthiPrtiiewith respect tôl work.per fOrtnecl:by you under written:contractual agreements with such third:parties and any other'insurance,.which may be available,:•-to such third parties:shall be'non—contributory: _ • _ . GAC 3649C0 iEd. 11100 X'S CERT NO.: 15620133 CLIENT CODE: PACIDAT-01 Joe Chan 2/28/2013 12:11:40 PM Page 3 of 7 CPP000067500 COMMERCIAL AUTO EXTENSIVE ENDORSEMENT SS 03 01 01 11 COMMERCIAL AUTO EXTENSIVE ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM (a) an expressed provision of an "insured contract", or written agreement; or SECTION II - LIABILITY COVERAGE (b) an expressed condition of a written A. COVERAGE permit issued to you by a governmental or public authority. 1.WHO IS AN INSURED 2) The"bodily injury" or "property damage" is The following is added: caused by an "accident" which takes place after: d. Any organization, other than a partnership or joint venture, over which you maintain (a) You executed the "insured contract" or ownership or a majority interest on the effective written agreement; or date of this Coverage Form, if there is no similar insurance available to that organization. (b)the permit has been issued to you. e. Any organization you newly acquire or form 2. COVERAGE EXTENSIONS other than a partnership or joint venture, and • over which you maintain ownership of a a. Supplementary Payments, majority interest. However, coverage under this provision does not apply: Subparagraphs (2) and (4) are amended as follows: (1) If there is similar insurance or a self- insured retention plan available to that (2) Up to $2500 for cost of bail bonds organization; or (including bonds for related traffic law violations) required because of an "accident" (2) To "bodily injury" or "property damage" we cover. We do not have to furnish these that occurred before you acquired or formed bonds. the organization. (4) All reasonable expenses incurred by the f. Any volunteer or employee of yours vvhile "Insured" at our request, including actual loss using a covered "auto" you do not own, hire or of earning up to $500 a day because of time borrow in your business or your personal affairs. off from work. Insurance provided by this endorsement is excess over any other insurance available to SECTION III - PHYSICAL DAMAGE COVERAGE any volunteer or employee. A. COVERAGE g. Any person, organization, trustee, estate or governmental entity with respect to the The following is added: operation, maintenance or use of a covered "auto" by an insured, if: 5. Hired Auto Physical Damage (1) You are obligated to add that person, a. Any "auto" you lease, hire, rent or borrow organization, trustee, estate or governmental from someone other than your employees or• entity as an additional insured to this policy partners or members of their household is a by: covered "auto" for each of your physical • damage coverages. SS 03 01 01 11 Includes copyrighted material of Insurance Services Offices, Inc.with its permission Page 1 of 3 CERT NO.: 15620133 CLIENT CODE: PACIDAT-01 Joe Chan 2/28/2013 12:11:40 PM Page 5 of 7 COMMERCIAL AUTO EXTENSIVE ENDORSEMENT • SS 03 01 01 11 b. The most we will pay for "loss" in any one 7. Lease Gap Coverage "accident" is the smallest of: If a long-term leased "auto" is a covered "auto" (1)$50,000 and the lessor is named as an Additional Insured - Lessor, In the event of a total loss, we (2) The actual cash value of the damaged or will pay your additional legal obligation to the stolen property as of the time of the "loss"; or lessor for any difference between the actual cash value of the "auto" at the time of the loss (3) The cost of repairing or replacing the and the"outstanding balance"of the lease. damaged or stolen property with other property of like kind and quality. "Outstanding balance" means the amount you owe on the lease at the time of loss less any If you are liable for the "accident", we will amounts representing taxes; overdue also pay up to $500 per "accident" for the payments; penalties, interest or charges actual loss of use to the owner of the covered resulting from overdue payments; additional "auto". mileage charges; excess wear and tear charges; and lease termination fees. c. Our obligation to pay for, repair, return or replace damaged or stolen property will be B. EXCLUSIONS reduced by an amount that is equal to the amount of the largest deductible shown for any The following is added to Paragraph 3 owned "auto" for that coverage. However, any Comprehensive Coverage deductible shown in The exclusion for "loss" caused by or resulting the Declarations does not apply to "loss" from mechanical or electrical breakdown does not caused by fire or lightning. apply to the accidental discharge of an airbag. • d. For this coverage, the insurance provided is Paragraph 4 is replaced with the following: primary for any covered "auto"you hire without a driver and excess over any other collectible 4. We will not pay for "loss" to any of the insurance for any covered "auto"that you hire following: with a driver. a. Tapes, records, disks or other similar audio, 6. Rental Reimbursement Coverage visual or data electronic devices designed for use with audio, visual or data electronic We will pay up to $75 per day for up to 30 days, equipment. for rental reimbursement expenses incurred by you for the rental of an "auto" because of"loss" b. Equipment designed or used for the to a covered "auto". Rental Reimbursement will detection or iocation.of radar. - • be based on the rental of a comparable vehicle, • which in many cases may be substantially less c. Any electronic equipment that receives or than $75 per day, and will only be allowed for a transmits audio, visual or data signals. period of time it should take to repair or replace the vehicle with reasonable speed and similar Exclusion 4.c does not apply to: quality, up to a maximum of 30 days. We will also pay up to $500 for reasonable and (1) Electronic equipment that receives or necessary expenses incurred by you to remove transmits audio, visual or data signals, and replace your materials and equipment from whether or not designed solely for the the covered"auto". reproduction of sound, if the equipment is permanently installed in the covered "auto" at If"loss" results from the total theft of a covered the time of the "loss" and such equipment is "auto"of the private passenger type, we will pay designed to be solely operated by use of the under this 'coverage only that amount of your power from the "auto's" electrical system, in rental reimbursement expenses which is not or upon the covered "auto"; or • already provided under paragraph 4. Coverage Extension. (2)Any other electronic equipment that is: SS 03 01 01 11 Includes copyrighted material of Insurance Services Offices, Inc.with its permission Page 2 of 3 CERT NO.: 15620133 CLIENT CODE: PACIDAT-01 Joe Chan 2/28/2013 12:11:40 PM Page 6 of 7 COMMERCIAL AUTO EXTENSIVE ENDORSEMENT II/ SS 03 01 01 11 (a) Necessary for the normal operation of contract", written agreement, or permit. the covered "auto" or the monitoring of the covered "auto's"operating system; or B. GENERAL CONDITIONS (b) An integral part of the same unit 9. is added housing any sound reproducing equipment described in (1) above and permanently 9. UNINTENTIONAL FAILURE TO DISCLOSE installed in the opening of the dash or HAZARDS console of the covered "auto" normally used by the manufacturer for installation of Your unintentional failure to disclose any a radio. hazards existing at the effective date of your policy will not prejudice the coverage afforded. D. DEDUCTIBLE However, we have the right to collect additional premium for any such hazard. The following is added: No deductible applies to glass damage if the glass is repaired rather than COMMON POLICY CONDITIONS replaced. 2.b. is replaced by the following: SECTION IV. BUSINESS AUTO CONDITIONS b. 60 days before the effective date of A. LOSS CONDITIONS cancellation if we cancel for any other reason. Item 2.a. and b. are replaced with: 2.Duties In The Event of Accident, Claim, Suit, or Loss a. You must promptly notify us. Your duty to promptly notify us is effective when any of your executive officers, partners, members, or legal representatives is aware of the accident, claim, "suit", or loss. Knowledge of an accident, claim, "suit", or loss, by other employee(s)does not imply you also have such knowledge. b. To the extent possible, notice to us should include: (1) How, when and where the accident or loss took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the accident or loss. The following is added to 5. We waive any right of recovery we may have against any additional insured under Coverage A. 1. Who Is An Insured g., but only as respects loss arising out of the operation, • maintenance or use of a covered "auto" pursuant to the provisions of the"insured SS 03 01 01 11 Includes copyrighted material of Insurance Services Offices, Inc.with its permission Page 3 of 3 CERT NO.: 15620133 CLIENT CODE: PACIDAT-01 Joe Chan 2/28/2013 12:11:40 PM Page 7 of 7 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- BLANKET 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). The additional premium for this endorsement shall be 3 %o of the total California Workers' Compensation premium otherwise due. Schedule Person or Organization Job Description ANY PERSON OR ORG ALL CALIFORNIA WHEN REQUIRED BY OPERATIONS WRITTEN CONTRACT _ _ - - . _ This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 03/01/2013 Policy No. WVE 5005909 02 Endorsement No. Insured PACIFIC DATA ELECTRIC INC Premium $ INCL. Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By • WC 99 06 34 (Ed. 8-00) INSURED CERT NO.: 15620133 CLIENT CODE: PACIDAT-01 Joe Chan 2/28/2013 12:11:40 PM Page 4 of 7