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Insurance - Pacific Data Electric - 2013-11-11A� ° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 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 Bolton & Company 3475 E. Foothill Blvd., Suite 100 Pasadena, CA 91107 RECEIVEDINSURERS w tonco.com 0008309 CONTACT NAME: PHONE E t: 2 7 ac No: 626-583-2125 E -MAIL ADDRESS: AFFORDING COVERAGE NAIC # INSURER A: Great American Comoany ✓ SURER INSURED NOV 14 2013 Pacific Data Electric, Inc. PDE Total Energy Solutions 9970 Bell Ranch Drive, Ste 109 COSTA MESA SANITARYRISTRIC Santa Fe Springs CA 90670 INSURER B: Samsung Fire & Marine Insur Company 3/1/2013 INSURER C: Scott dale Insurance Company EACH OCCURRENCE INSURER O: In m n West INSURER E, INSURER F: CERTIFICATE NUMBER: 1Ragl ROo 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. INSR LTR TYPE OF INSURANCE ADDL N SUER POLICY NUMBER MWDDYEFF POLICY IDNYY LIMITS ({ GENERAL LIABILITY ✓ GLP4647809 3/1/2013 311/2014 EACH OCCURRENCE $ 1,000,000 ✓ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Anyone person) $ CLAIMS-MADE lil OCCUR PERSONAL &ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ✓ PROT LOG PRODUCTS - COMP /OP AGO $ 2,000,000 I If B AUTOMOBILE LIABILITY CPP000067500 3/1/2013 3/1/2014 COMBINED eBINEDtSINGLE LIMIT $ 1,000,00 ✓ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS ✓ PROPERTY DAMAGE Peraccident $ $ G ✓ UMBRELLA LIAB EXCESS LAB ✓ OCCUR CLAIMS -MADE XLS0087025 3/1/2013 3/1/2014 EACH OCCURRENCE $ 10,000000 AGGREGATE $ 10 000,000 DED LJ RETENTION$ $ D WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY y/N ANY PROPRIETORJPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? FN NIA. ✓ WVE500590902 311/2013 3/1/2014 WCSTATU- OTH- ✓ TORY LIMITS ER E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Subject to Policy Terms, Conditions, Limitations and Exclusions GL Additional Insured applies per CG2033 0704 & CG2037 0704 attached, only if required by written contractlagreement. GL Primary Wording applies per GAC3649CG 11/06 attached. WC Waiver of Subrogation applies per WG990634 attached. Job: #134480, #196 -D, Irvine Pump station Generator. Additional Insured : The Costa Mesa San i a District its directors, officials, officers employees, a ents and volunteers. CERTIFICATE HOLDER CANCELLATION #134480 Costa Mesa Sanitary District 1 ta Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa, CA 92627 ' AUTHORIZED REPRESENTATIVE 1 JI Kim Sautter -Ramos © 1988 -2010 ACORD CORPORATION. All rights reserved, ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD CEAT NO.: 19331599 CLIENT CODE: PACIDAT -01 Bolton Certificate Processing 11/11/2013 3:01:91 PM Page 1 of 5 GLP4647809 CG 20 37 (Ed. 07 04) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Additional Insured Person(s) or Organization(s): Any person or organization that "you" and such person or organization . have agreed in writing in a contract that such person or organization be added- as an addi- tional insured on "your" policy, but only for "your non - residential work" performed during this policy per i o.d'. Schedule Location and Description of Completed Operations: "Your non. - residential work" Performed during this policy period. Additional Premium: Included. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. SECTION II - WHO IS AN INSURED is amended to include as an Additional Insured the persons) or organization(s) :shown in the Schedule, but only with respect to.. liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that Additional Insured and included in the "products- completed operations hazard" Copyright, ISO Properties, Inc., 2004 CG 20 37 (Ed. 07/04) PRO (Page 1 of 1) CEAT NO.: 18331599 CLIENI CODE: PACIDAT -01 Holton Certificate Processing 11/11/2013 3:07:41 PM Page 2 of 5 GLP4647809 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 33 (Ed. 07 04) 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 'include as an Additional Insured 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 that such person or organization be added as an Additional In- sured on your policy: Such person or or- ganization is an Additional Insured only with respect to liability for 'bodily injury," "prop- erty damage' or "personal and advertising in- jury" 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 oper- ations for the Additional Insured. A person's or organization's status as an Ad- ditional Insured under this endorsement ends when your operations for that Additional In- sured are completed.. B. With respect to the insurance afforded to these Additional Insureds, the following addi #ional exclusions apply: This insurance does not apply to: 1. "Bodily injury," "property damage" or "per- sonal and advertising injury" arising out of the rendering of; or the failure to render, any professional architectural, engineering or surveying services; including: a. the preparing, approving, or failing to prepare or approve, maps, shop- drawings, opinions, reports; surveys, field orders, change orders or draw- ings and specifications; or b. supervisory, inspection, architectural or engineering activities. 2. "Bodily injury," or "property damage" oc- curring after: a. all work, including materials, parts or .equipment 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 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 an- other contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project CG 20 33 (Ed. 07/04) XS Copyright, ISO Properties; Inc_ 2004' CERT NO.; 18331599 CLIENT CODE: PACIDAT -01 Bolton Certificate Processing 11/11/2013 3:01:41 PM Page 3 of 5 GLP4647809 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY NON - CONTRIBUTORY INSURANCE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM GAC 3649CG (Ed. 11 06) This insurance is primary to any other insurance held by third parties with respect to work performed 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 3649CG (Ed. 11/06) XS CENT NO.: 18331599 CLIENT CODE: PACIDAT -01 Holton Certificate Processing 11/11/2013 3:07:91 IN Page 4 of 5 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 ORG 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 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 o Endorsement No. Insured PACIFIC DATA ELECTRIC INC Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. 8 -00) INSURED CERT NO.: 18331559 CLIENT CODE: PACIDAT -01 Bolton Certificate P—o. —in9 11/11/2013 3:01:1.1 PM Page 5 of 5 Premium $ INCL.