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Insurance - Pacific Data Electric 2016-02-26A� o® CERTIFICATE OF LIABILITY INSURANCE DAM A (MMD"s ) 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 91107c CONTACT CONE; PHONE FAX Ne E,n: 626 799-7000 INC Np: 626 583-2117 EMNL ADDRESS: INSURERS AFFORDING COVERAGE NAICN ✓ INSURER A: Associated Industries Insurance Co, Inc 23140 www.boltonco.com 0008309 INSURED Pacific Dataorgy Solutions PDE Total Energy So INSURER B: Zurich American Insurance Company 27855 ruti. INSURER c: Tows National Insurance Company 25496 WSURER D: 9970 Bell Ranch Drive, Ste 109 Santa Fe Springs CA 90670 WSURER E: INSURER F: ■Kn9 a:clq �- " QI:A 11 a(Rr_\ 1 Z111 2 III ",I :I QIZ UJ Vky{! :J�96YIndNalu AJ:Itlr� 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 DDL INSR UBR Arun POLICY NUMBER POLICY EFF MM/DD POLICY EXP MUMD LIMITS A ✓ COMMERCIALGENERALLIABILITY ✓ AES1034037 3/1/2016 3/1/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS�MAOE [71 OCCUR DAMAGE TO RENTED PR ES Ea occurtence $ 100,000 MED EXP (Any one person) $ Excluded PERSONAL& ADV INJURY S 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERA -AGGREGATE 5 2,000,000 POLICY M JEo F-1 LOC PRODUCTS - COMP/OP AGG S 2,000,000 $ OTHER B AUTOMOBILE LUV3ILITY BAP 5513749-01 10/1/2015 10/1/2016 CEOMBINEEDtSINGLE LIMIT $ 1,000,000 BODILY I NJURY(Per Person) $ ✓ ANY AUTO AOSCHEDULED AUTOS BODILY INJURY (Per accident) $ ✓ NON-OAUTOS ED HIRED AUTOS AUTOS PROPERTY DAMAGE Per amdent S S C UMBRELLA UAB / OCCUR 72946M161ALI 3/1/2016 3/1/2017 EACH OCCURRENCE S 8,000,000 AGGREGATE $ B4O00,OOO ✓ EXCESS LIAB CLAIMS -MADE OED I I RETENTION $ B WORKERS COMPENSATION BI AND EMPLOYERS' UALRY Y I N ✓ WC 5513748-01 10/1/2016 10/1/2017 V PET UTE ETH E EACH ACCIDENT $ 1,000,000 ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑N NIA E . DISEASE -EA EMPLOYEE S 1,000,000 (Mandatory In NH) If rs. describe under DE SCRIPTION OF OPERATIONS b low EL DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ADDRD 701, Additional RemarSs Schedule, may be attached B more apace is required) Job: 1/140674 GL Addifional Insured applies per CG20330704 & CG20370704 attached, only if required by written contract/agreement. GL PrimaryWording applies per NXGL0090809 attached. WC Waiver of Subrogation applies per WC040306 attached. Additional Insured(s): The Costa Mesa Sanitary District, its directors, officials, officers, employees, agents and volunteers. Subject to Policy Terms, Conditions, Limitations and Exclusions. Costa Mesa Sanitary District 628 W 19th Street VAA0 Costa Mesa, CA 92627 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 T- 1988-2014 ACORD CORPORATION. All ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD GB ISif]9 1 PACT -1,7 -ill CL,RS 03-1-'E-11 AL,XC 25-16 1 Llisa Lopez 1 21222f/20SE 5._... _3 PH (BST) I Peq=_ '_ c5 . POLICY NUMBER: AES1034037 COMMERCIAL GENERAL LIABILITY CG 20 37 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 SCHEDULE Name of Additional Insured Person(s) or Organization(s): Locations and Description of Covered Operations As Required By Written Contract As Required By Written Contract 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 person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily in;ury" or "property dam- age" caused, in whole or in part, by "your work' at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products -completed operations hazard." CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 2l51979 IEhCI ]ni-RI GL, ZS .b1-_6-19 AL, WAC 15-16 1 }_ll— Lope- I Z. 2&1Z'd1G 5.v_ -s Ftd 1?371 1 Fage 2 of 5 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- daring 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 beer. 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 2315'i3'r£ IF 1Jr.'-0: EL, Y.P. .J-1-16-1'1 AL,WC 15-16 1 Al— Lopez 12(2€/2110 5;28-3 ffid (251_) I Ea,. 3 0° 5 Page 1 of 1 ❑ POLICY NUMBER: AES1034037 COMMERCIAL GENERAL LIABILITY NX GL 009 08 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTING INSURANCE (THIRD -PARTY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Third Party: All persons or organizations where required by written contract with the Named Insured. (Absence of a specifically named Third Party above means that the provisions of this endorsement apply as required by written contractual agreement with any Third Party for whom you are performing work.) Paragraph 4. of SECTION IV: COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance: With respect to the Third Party shown above, this insurance is primary and non-contributing. Any and all other valid and collectable insurance available to such Third Party in respect of work performed by you under written contractual agreements with said Third Party for loss covered by this policy, shall in no instance be considered as primary, co-insurance, or contributing insurance. Rather, any such other insurance shall be considered excess over and above the insurance provided by this policy. NX GL 009 08 09 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission 2281319 1 PP_=1-B1 1 GL,%5 C3-1--'6-17 AL,F= 11-16 1211 Le,._ 1 2123!M6 528:33 FN (PST) I Page 4 c WC 5513748-01 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0% % of the California workers' compensation pre- mium otherwise due on such remuneration. Schedule Person or Organization Job Description ALL PERSONS OR ORGANIZATIONS WHEN REQUIRED BY WRITTEN CONTRACT WC 252 (484) WC 04 03 06 (Ed. 4.84) 28"159439 1 PAUCAT 11 I .L,z3 53-616-17 AL,1C 15-16 Al— !.1— f 2/26/2016 5:29:13 Fe (oeT) I Page 5 0_ 5 Page i of 1