Loading...
Insurance - Pacific Data Electric - 2015-09-17 (2)A� �® CERTIFICATE OF LIABILITY INSURANCE DAT9/17/2D,s Y' 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 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 CONTACT NAME: PHONE FAX A/c No Ezt: 626 799-7000 ac No: 626 583-2117 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC k 3/1/2015 INSURERA: Associated Industries Insurance Co Inc 23140 www.boltonoo.com 0008309, ,; INSURED PDE Total Energy Solutions 9970 Bell Ranch Drive, Ste 109 SEP 2 INSURER B: Zurich American Insurance Company 27855 INsuRERc: Torus National Insurance Company 25496 INSURER D: Santa Fe Springs CA 90670 i,AA MESA SANITARY 01SiRIC1 INSURER E: INSURER F: S CUVERAGES CER11FICATF NIIMRFR' 9RA97nAg PIPWRIUN Nil IMRRR- 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 rypE OF INSURANCE ADOL S BR POLICY NUMBER POLICY EFF MWOD POLICY EXP MMIDDIYYYY LIMITS COMMERCIAL GENERALLIABILITY CLAIMS-MADEDAMAGE ✓ OCCUR ✓ AES1034037 3/1/2015 3/1/2016 EACH OCCURRENCE $ 1,000,000 TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ Excluded PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOG OTHER: GENERAL AGGREGATE $ 2,000,000 2,000,000JECT S B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS ✓ AUTOS BAP 5513749-01 10/112015 10/1/2016 OMBINeDL SINGLE LIMIT $ 1000000 ✓ BODI LY INJURY (Per person) $ BODILY INJURY (Per $ er accitlen[ ) ✓ PROPERTY DAMAGE $ Per accitlen( $ C UMBRELLA LIAB EXCESS LIAB ✓ OCCUR CLAIMS -MADE 72946M150ALI 3/1/2015 3/1/2016 EACH OCCURRENCE $ 8,000,000 ✓ AGGREGATE $ 8,000,000 DED I I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC 5513748-01 10/1/2015 10/1/2016 ✓ STER ATUTE OERH EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 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 contractlagreement. Job: Operations of the Named Insured. Additional Insured(s): Costa Mesa Sanitary District and its officers, agents and employees. Costa Mesa Sanitary DIStfICt SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE rY yi 'nf^/� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: General Manager P/ I ACCORDANCE WITH THE POLICY PROVISIONS. 628 West 19th Street Costa Mesa, CA 92627 AUTHORIZED REPRESENTATIVE Chau Tran ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 26457046 1 PACIDAT-01 I GL,XS 03-1-15-16 AL,WC 15-16 1 Nancy Cadwallader 19/17/2015 10:15:23 AN IPDT) 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 include as an additional insured any person or or- ganization for whom you are performing opera- tions 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 insured on your policy. Such person or organization is an additional insured only with re- spect to liability for "bodily injury", "property dam- age" 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. A person's or organization's status as an addi- tional insured under this endorsement ends when your operations for that additional insured are completed. CG 20 33 07 04 B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the ren- dering of, or the failure to render, any profes- sional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: 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. © ISO Properties, Inc., 2004 26457046 1 PACIDAT-01 I GL,XS 03-1-15-16 AL,WC 15-16 1 Nancy Cadwallader i 9/17/2015 10:15:23 AN (PDT) I Page 2 of 2 Page 1 of 1 ❑