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Insurance - Pacific Data Electric Inc - 2012-02-28''� " CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYI') 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 ?LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED EPRESENTATIVE 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 endorsement(s). PRODUCER Bolton & Company 3475 E. Foothill Blvd., Suite 100 Pasadena, CA 91107 www.boltonco.com 0008309 CONTACT NAME: PHONE AC No: E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAICp INSURER A: Interstate F re & Casually Company ✓ INSURED Pacific Data Electric, Inc. POE Total Energy Solutions 9970 Bell Ranch Drive, Ste 109 Santa Fe Springs CA 90670 INSURER B: Allmer ca Financial Benefit Ins 311/2012 INSURER C: National Union Fire Ins Co of P EACH OCCURRENCE INSURER D: InsuranQe QQrnpany DAMAGE RENTED PREMISE Ea occurrence INSURER E: MED EXP (Any one person) INSURER F: PERSONAL& ADV INJURY COVERAGES CERTIFICATE NUMBER: 12492802 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 CONDI PION 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. INSR LTR rypE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM /DD/YYV( POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY ✓ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑✓ OCCUR ✓ SGL1002894 311/2012 3/1/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED PREMISE Ea occurrence $ 50,000 MED EXP (Any one person) $ PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC PRODUCTS - COMP /OPAGG $ 2,000,000 $ AUTOMOBILE ✓ LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS ✓ AWF905240701 3/112012 311/2013 COMBINE SINGLE LIMIT $ 1000000 BODILY INJURY (Per person) $ BODILY INJURY IPeraccitlant ) $ ✓ PROPERTY DAMAGE paraccidenl $ G UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE BE045896334 3/1/2012 3/1/2013 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 OED RETENTION$ $ D WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY OFFICEWMEMBER E %CLUOE09 PROPRIETOWPARTNERIEXECUTIVE (MantlaMr,l l.., NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below NIA ✓ WVE500590901 3/1/2012 3/1/2013 WCaTATU- TIH{ TORY LIMITS OER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1, 000000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (AKach ACORD 101, Additional Remarks Schedule, it 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 CG2010 07104 and VCA2010205 attached, only if required by written contract/agreement. GL Primary Wording applies per ICB -8016 06 -05 attached. WC Waiver of Subrogation applies per WC990634 8/00 CERTIFICATE HOLDER CANCELLATION Cosh Mesa Sanitary District, Study and Preliminary Drawings for �generators Costa Mesa Sanitary District \l � 628 West 19th Street \\\ Costa Mesa CA 92627 \�N (� 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 pdugan ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD PERT NO.: 12492882 CLIENT CODE: PACIDAT -81 Elizabeth Porter - Direct 626 -535 -1433 2/28/2012 3:35:88 PN Page 1 of 8 POLICY NUMBER: SGL1002894 NAMED INSURED: Pacific Data Electric, Inc. 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 s of Covered Operations AS PER CONTRACT OR AGREEMENT Information required to complete this Schedule, if not shown above 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: 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(s) at the location(s) desig- nated above. CG 20 10 07 04 B. With respect to the insurance afforded to these additional insureds, the following additional exclu- ions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, pads or equip- 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. 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 crganization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. © ISO Properties, Inc., 2004 CENT NO.: 12492002 CLIENT CODE: PACIDAT -01 Elizabeth Foster - Direct 626 -535 -1433 2/28/2012 3.35:00 PM Page 2 of 8 Page 1 of 1 Policy Number'SGL1002894 AMENDMENT OF OTHER INSURANCE CONDITION- PRIMARY INSURANCE FOR AUTOMATIC STATUS ADDITIONAL INSURED THISENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART If required under a written "insured contract" with you, paragraph a. Primary Insurance in .SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is amended by adding the following paragraph: Not - withstanding the foregoing, the insurance afforded -to any person or organization who has been added to this poIL -y.by- an Automatic Status Additional Insured 'Endorsement Is primary and non. contributory insurance. but only as respects'$odly injury" -or "property, damage" liability arising out of your sole negligence in performance of °your work" after the effective date of this policy under a written contract between you and such person w, organization that requires you to maintain primary and nor- contributory insurance and to include such person or organization as an additional insured thereunder. All other terms and conditions of this policy remain unchanged. ICB- 601606 -05 - CERT NO 12992802 CLIENT CODE: PACIOAT -01 Elizabeth Foater - Direct 626 - 535 -1433 2/20/2012 3:35:00 PM Page 3 .of 8 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 otherwise due. Person or Organization ANY PERSON OR ORGANIZATION WHEN REQUIRED BY WRITTEN CONTRACT 3 % of the total California Workers' Compensation premium Schedule Job Description ALL CALIFORNIA OPERATIONS This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The infornration below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 3/1/2012_ Policy No.WVE500590901 Insured Insurance Company INSURANCE COMPANY OF THE WEST WC 99 06 34 (Ed. 8.00) Countersigned By NSURm Endorsement No. CEPT NO.: 12492802 - CLIENT CODE: PACIDAT -01 Elizabeth Foster - Direct 626 535 -1433 2/28/2012 0:35:00 PM Page 4 of 8 Premium $ INCL. Policy Number: AWF905240701 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. @VANTAGE FOR AUTOMOBILE This endorsement modifies insurance provided underthe following: BUSINESS AUTO COVERAGE FORM The following schedule lists the coverage extensions provided by this endorsement. Refer to the Individual provi- sions to determine the extent of your coverage. ' SCHEDULE OF COVERAGE EXTENSIONS 1. Additional Insured By Contract 11. Extrafxpense - BroadenedCoverage 2. , Airbag Discharge 12. Feltow.Emplcyee Exclusion 3. Auto Theft Reward 13. Glass Repair- Waiver of Deductible 4. Blanket Waiver of Subrogation 14. Hirad Auto Physical Damage. Coverage 5. Bodily Injury Redefined - MentalAnguish 15. Hired Auto- Woridwide'CoverageTerritory S. Broad Form Named Insured 16. Lease GapCoverage 7. Communicationsfquipment 17. LlabllityCoverage - Supplementary Payments 8. Drive Other Car - Executive Officers 18. Newly Formed or Acquired Organizations 9. DutieslnTheEventofAccidenl , Claim, Suit orLoss 19. Physical Damage - TransportationExpenses 10. Em to eesAs Insureds 20. Towing - Any Auto 1. ADDITIONAL INSURED BY CONTRACT The Who Is'An Insured provision under SECTION II - LIABIUTY'COVERAGE is amended to include as Ian additional insured any person or organization with,whom.you agreed in a written contract, written agreement or permit, to provide insurance such as is afforded under this+Coverage Form. Such person or organization is an insured only with respect to liability for "bodily injury" or "property damage "caused, in whole or in part by your maintenance, operation or use of your covered "autos ". With respect to the insurance afforded to these additional insureds,this insurance does not apply: a.. Unless the written contract or agreement has been executed or the permit has been issued prior to the "bodily fnjury' or "property damage ", b. To any person or organization included as an insured by endorsement or in the Declarations, or c. To any.lessor-of " autos" when their contract or agreement with you for such leased "auto' ends. 2. AIRBAG DISCHARGE If you purchased physical damage coverage -for "a covered "auto" under this policy, we will pay to reset or re place an airbag that accidentally discharges without the vehicle being involved in an accident. No deductible applies to this additional coverage. However, this coverage only applies it the airbag is not covered under a manufacturer's warranty and you did not intentionally cause the airbag to discharge. 3. AUTO THEFT REWARD We will pay up to a $2,000 reward in the event of a covered loss, for information leading to the arrest and.con- viction of anyone stealing a covered "auto ". A reward will not be paid to you, a family member, employee or any j - public official While performing their duty. 4. BLANKET WAIVER OF SUBRDGATION The Transfer Of Rights Of- Recovery Against Others To Us condition under-SECTION IV -LOSS CONDI- TIONS Is replaced by the following: We will waive any right of- recovery we may have against any person or organization because of payments we make for injury or damage arising out of the operation of a covered "auto" when you have assumed liability for such "bodily injury' or "property damage" under an "insured contract", provided the contract is in writing and executed prior to the "bodily Injury" or "property damage ". 5. BODILY INJURY REDEFINED - MENTAL ANGUISH The definition of "bodily injury" under SECTION V -- DEFINITIONS is replaced by the following: "Bodily injury' means. bodily injury, sickness; or disease sustained by a person, including mental anguish or death resulting from any of these at any time. -VCA 207 02 O6 - . includes copyrighted material of Insurance Services Office, Inc - Page 1 o14 Copyright 2004.4 31 ..tiQyx 1:: »�. r.•r " +". '.5.. .'-v, .. -41 -CERT NO.: 12442802 CLIENT CODE: PACIDAT -01 Elizabeth Foster - Diiaer 6261533 -1433 2/28/2012 3:35:00 PM Page 5 of 0. S. BROAD FORM NAMED INSURED a. The Who Is An Insured provision under SECTION II — LIABILITY COVERAGE Is amended to include the following: Any organization which is a legally incorporated entity in which you own a financial interest of more than 50% of the voting stock on the effective date of this Coverage f=orm will be a Named Insured until the 180th day or the and of the policy period whichever comes first, provided there is no other similar insurance avail- able to that organization. b. Paragraph a. of this provision 6. does not apply to "bodily injury" or "property damage" for which an "Insured" is also an insured under any other automobile policy or would be an insured under such a policy, but for its termination or the exhaustion of its limit of insurance. 7. - COMMUNICATIONS-EQUIPMENT a. The exclusion for electronic equipment under.Excluslons of SECTION III — PHYSICAL DAMAGE COVERAGE does not apply to loss of any permanently installed, non - removable communications: equipment designed for use as a: 1. Cifizen5 band radio; 2, Two -way mobile radio or telephone; 3. Scanning monitor receiver, or 4. GPS Navigation System including Its antenna and other accessories_ b. No Deductible applies to this additional coverage. c. The most we will pay for this coverage is $2,000 per occurrence. 8. DRIVE OTHER CAR— EXECUTIVE OFFICERS a. The Who Is An Insured provision under SECTION If — LIABILITY - COVERAGE is amended to include: If you are designated in the Declarations as: 1. An Individual; you and your spouse. 2. A partnership; your partners and their spouses. 3. An organization other than an individual or a partnership; you "executive officers" and their spouses. b. SECTION II - LIABILITYCOVERAGE and SECTION ill — PHYSICAL DAMAGE COVERAGE are extended to include "autos" you don't own, hire, tease or borrow while in the care; custody or control of an insured listed in 8.a. This does not include any "auto ": 1, Owned by any insured listed In B.a., or any member of their household, including anysuch "auto" that Is owned but not insured; 2. Used by an insured listed in 8.a. while working, in the business of selling servicing, repairing or parking autos; or, j 3. Insured under another policy of insurance. If Medical Payments, Uninsured/Underinsured Motorist, Personal Injury Protection or other compulsory coverages required by the governing jurisdiction are covered on this policy, then insureds fisted in 8.a. above and family members residing in the same households afe "insureds" while; 1 Occupying as a passenger, or 2. A pedestrian when struck by any auto you do not own, hire, lease or barrow, except any auto owned by that insured listed in 8.a, their family members or an auto insured under any other policy. c. The limits and deductibles applicable to this provision will be the largest applicable to any owned "auto" for the specific insurance. d. The following definition is added to SECTION V — MVINITIONS of the policy. "Executive officer" means a person holding any of the officer positions created by your charter, constttu- Bon, by -laws or any similar governing document. e. The Other Insurance Condition, under SECTION IV — BUSINESS AUTO. CONDITIONS, does not apply to the provisions of this Drive Other Car endorsement. There is no "other insurance" applicable to this en dorsoment. Page-2 of,l - Includes copyrighted material of InsofanceSemices Office, Inc. VCA 211102 015 Caprtht 2004.: ...xCERT N, - CODE; I .... ;.a E 73 2/ id2DI2 :35; ...M -. CBRT Np.: 12492802 CLIENT CODB: �PACIDAT -01 - EllzabeTH'FO6Ces -, piiect -626- 535 -193J 2/'18/2 p12. 3:35; OOPM Page 6 of 6 - _ 9. 10. 11. 12. 13. 14. DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS Under SECTION IV — BUSINESS AUTO CONDITIONS — the Duties In The Event Of Accident, Claim, Suit Or Loss Condition Is amended as follows: The requirements that you must a. notify us of an "accident" claim, "suit" or "loss" and b. send us documents concerning a claim or "suit" apply only when such "accident" claim, "suit" or'loss" is known to: a. You, 9 you are an individual: b. A partner, if you area partnership; c. An executive officer of the corporation or insurance manager, if you area corporation; or d. A manager, if you area limited liability company. EMPLOYEES AS INSUREDS The Who Is An Insured provision. under SECTION II — LIABILITY COVERAGE is changed by adding the following: Any employee of yours while using a,covered "auto" you don't own, hire or borrow in your business or your personal affairs. This coverage is excess over any other collectible insurance. EXTRA EXPENSE — BROADENED COVERAGE Under Paragraph A. of SECTION III — PHYSICAL DAMAGE COVERAGE, the following-Coverage Is added; We will pay for the expense of returning a stolen covered "auto' to you subject to Paragraph C. Limit Ofinsurance. FELLOW EMPLOYEE EXCLUSION The'FeAcwEmployee exclusion under SECTION II — LIABILITY COVERAGE does not apply if the "bodily injury' results from the use of a covered "auto" you own or hire. This coverage is excess over any other in- surance. GLASS REPAIR— WAIVER OF DEDUCTIBLE Under paragraph D. Deductible'— of SECTION III — PHYSICAL DAMAGE COVERAGE, the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. HIRED AUTO — PHYSICAL DAMAGE COVERAGE If hired "autos" are covered "autos" under SECTION II — LIABILITY COVERAGE and if Comprehensive, Specified Causes of Loss, or Collision coverages are provided under this policy for any "auto" you own, then SECTION III — PHYSICAL DAMAGE COVERAGE Is extended to "autos" you hire, subject to the fol- lowing limit: The most we will pay for "loss" to any hired "auto" is the lesser of: a. $50,000, - - b. The actual cash value, or c. The cost of repairing or replacing it with other property of like kind or quality. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. No deductible applies -to "loss" caused by fire or- lightning. Hired Auto Physical Damage coverage is -excess over any other collectible insurance. Subject to the above limit, deductible and excess provisions, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. We will also cover loss of use of the hired "auto" If the fallowing conditions are met: a. It results from an accident, b. you are legally liable, and c. the lessor incurs an actual financial loss. The most we will pay for this loss of use coverage is $1,000 per "accident ". VCA 20102 06 Includes: copyrighted material of Insurance services Office, Inc. Copyright 2004, .. _. _. CERT NO.: 12492802 CLIENT. CODEI PACIDAT -01 Elizabeth Foster Ditacf 626 535-1433 2/28/2012 3:35.:00 �PM Page 7 .of 8 15. HIRED AUTO- WORLDWIDE COVERAGE TERRITORY The definition of coverage territory in General Conditions - Policy Period, Coverage Territory - of SEC- TION IV - BUSINESS AUTO CONDITIONS is amended to add: Anywhere in the world for autos hired for 30 days or less, provided that any "suit" is brought in the United States of America (including its territories and possessions), Puerto Rico or Canada. 16. LEASE GAP COVERAGE Under Paragraph C. Limit of Insurance - of SECTION III - PHYSICAL DAMAGE COVERAGE, the follow- ing is added: We will also pay the difference between the actual cash value of a covered "auto" at the time of "loss" and the remaining balance on your lease iT the following conditions are met: a. The "auto" has along term lease and is covered on this policy, b. The lessor is added as an Additional Insured in a written lease agreement. c. You are legally obligated for the remaining balance. We will not pay for any amounts representing excess wear and teat charges; additional mileage charges; taxes; overdue payments; penalties, interest or charges resulting from overdue payments; or lease termina- tion fees. 17. LIABIL17Y COVERAGE EXTENSIONS - SUPPLEMENTARY PAYMENTS Under SECTION11- LIABILITY COVERAGE, the Coverage'Extension for-Supplementary Payments is re- vised as follows: a. The limit for the cost of bell bonds is amended to-$3500. In. The limit for reasonable expenses Incurred by the "insured" is amended to $500 a day. 18. NEWLY FORMED OR ACQUIRED.ORGANIZATIONS a. The Who Is An Insured provision under SECTION 11- LIABILITY-COVERAGE is amended to Include as an "insured" any organization that Is formed or acquired by you and over which you maintain majority ownership, b, Paragraph a. of this provision 18. does not apply to any organization: 1. That is a joint venture or partnership, 2. That is an "insured" under any other policy, 3. That has exhausted its Limit of Insurance under any other policy, or 4. 160 days or more after its acquisition or formation by you, unless you have gNen us notice of the acquisition or formation. c. Paragraph a. of this provision 18. does not apply to 'bodily injury" or "property damage" that results from an "accident" that occurred before you formed or acquired the organization. 19. PHYSICAL DAMAGE - TRANSPORTATION EXPENSES COVERAGE Under SECTION III - PHYSICAL DAMAGE Coverage Extensions, the limit for Transportation - Expenses is amended to $75 per day and the maximum is amended to $1.800. 20. TOWING - COVERED AUTOS Under SECTION ifl - PHY=AL DAMAGE COVERAGE, - Coverage for Towing is amended as folio vs: a. This coverage apples to any covered "auto' for which a premium charge for touring and labor is shown in the Schedule or In the Declarations. b. The limit is $100. Page 4of4 Includes oopyriglded material of Insurance Services Office, Inc. VCA ?010206 ,Copyright 2004, CERT NO.: 12492002 CLIENT CODE: PACIDAT -01 Elizabeth Fetter - Direct 626 535-1433 2/20/2012 3:35:00 PM Page 8 .Of 8