Insurance - Performance Pipeline Technologies, Inc - 2020-08-05PERFOA OP ID: 01
CERTIFICATE OF LIABILITY INSURANCE
DA08105/2020TE )
08/0512020
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
ton Pacific Ins. Agency
Huntington g y
7901 Professional Circle
CONTACT
NAME: Mark Heberden
PHONE FAX
LAic2 No, Ext):714-841-6283 _ __ (vq, No}: 714-842-2538_
Huntington Beach, CA 92648
Mark Heberden
a DRE SS: mark@huntpaeificinsurance.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSURERA :AXIs Surplus Insurance Company'
INSURED Performance Pipeline Technologies, Inc
Sanitation S
a stems
Gene Glassburner
INSURERB :Oregon Mutual Insurance Co. 14.907
INSURER C :MERCER INSURANCE COMPANY r
INSURER D : Liberty Mutual Insurance Co. / 123043
5292 System Drive
INSURER
Huntington Beach, CA 92649
INSURER F :
COVERAGES CERTIFICATE NUMBER: 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
EFF
POLICY NUMBER I MM DD/YYYY
MMIDDiYYYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,00
A
X C•�h+y�EP�I L Et.iEPAL LIA��..;TY
—� - �_LAit,1 Gi LF X 01_1UR
X Pollut Liability
X
EMP18000111-02 11/21/2019
EMP18000111-02 1 11/21/2019
11/21/2020
11/21/2020
DAMAGE TO PFNTED
pPEtvtI3ES (Eaoccurrence)
--
MED ESP 4Anv on,? per;;) I)
PEP;-7,NAI A u INJUPY C
$ 104,000
$ 10000
$ 1,000,00
X
Prof Liab
GENIEPAL AuGPEGA.TE
2,000,00
EMP18000111-02 1 11/21/2019
11/2112020
C EI 'L ' -RELATE LI^,J1T.AF1PUE_ -EP
PRODUCTS- _ hJ1F';OF ,G
$ 21000,00
E
P,�LICY X PRJECT�- Li}C
I
$
B
AUTOMOBILE
LIABILITY
AN"If, ,"I T�)
ALL v +1NED �X SCHEDULED
AUTOS AUTn�
I
CAC5007909613 11 /21 /2019
11 /21 /2020
COMBINED SIN, -'LE LIMIT
a accidents
2 00Q 0�
,
-t
B �)DILY iN JlJ per �.Rt =ant
BODIL 1NJURr(Per ac..i_,e.nt;'
_
l $
$
X
N0H 01,A4,1ED
HirEID A U T 0 S X , AUTOS
�
PP.OPEFTY DA1`,4AGE.
('EF' ACCjDEN 7)
i $
$
C
X
UMBRELLA LIAB
EXCESS LIAB
X 1_fR
CLA11S M/\DE
27305798 11 /21 /2019
11 /21 f2020
EA r �CGl1RRErv-
$ 5,000,000*
51000,000*
$
DED X RETENTION $ none
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PPOPPiETCR;PARTNEFlEXLCHTIVEYJIV
OFFI�._EPfMEMBEC {ClU EL?
(Mandatory in NH) Y
N/A
XWW61203109 04/01/2020
04/01/2021
X I `n/C S T ,Tk I i TH
TIJRY LIM1. ER
�_E.L EACH ACCIDE�dT
$ 1,000,00
E.L DISEASE -EA EPfl?_'-YEE
$ 1,000,00
if yes describe uncer
DESCPiF I t jN OF OPERATIONS beiwv
E.L CISEASE POLICY LIMIT
$ 1,000,000
I
i
I
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Costa Mesa Sanitary District, their elected and appointed officials, agents,
officers, volunteers, and employees listed as Additional Insured with
respects to the General Liability per attached endorsement. Any other
insurance maintained by the Costa Mesa Sanitary District shall be excess and
non-contributing with the insurance provided by this policy.
CaK I II-IL:A It: HULUtK (.;ANUhLLA I lL)N
CMSD001
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Costa Mesa Sanitary District THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
290 Paularina Avenue
�t�wj ACCORDANCE WITH THE POLICY PROVISIONS.
Costa Mesa, CA 92626 AUTHORIZED REPRESENTATIVE
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
Policy Number EMP18000111-02
COMMERCIAL
GENERAL LIABILITY
CG 20100704
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -- OWNERS, LESSEES OR
COhJlF -SCHEDULED ED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organ ization(s): Location(s) Of Covered Operations
Any person(s) or organization(s) whom the Named
Insured agrees, in a written contract, to name as an
Additional insured. However, this status exists only
for the project specified in that contract.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or
organization(s) shown in the Sohedule, 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 oromissions; or
2. The acts or omissions of those acting on your behalf;
inthe performance ofyour ongoing operations for the additional imsured(s)atthe location(s)
designated above.
B. With respect to the insurance afforded to these additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury" or "property damage" occurring after,
1 All wmrh, including materia|s, pads or equipment furnished in connection with such wmrk, on
the project (other than semino, 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
intended use by any person or organization other than another contractor or subcontractor
engaged in performing operations for a principal as a part of the same project.
Policy number: EMP18000111-02
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):
Location And Description Of Completed
Operations
Any person(s) or organization(s) whom the Named
Insured agrees, in a written contract, to name as
an additional insured. However, this status exists
only for the project specified in that 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 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".
CG 20 37 07 04
O ISO Properties, Inc., 2004
Policy number: EMP18000111-02 COMMERCIAL
PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT
This endorsement changes the Policy. Please read it carefully,
SCHEDULE
Name of Person or Organization:
Any person(s)morganbotion(dwhom the Named Insured agrees, inawritten
contract., to provide Primary and/or Non-contributory status of this insurance.
However, this status exists only for the project specified in that contract.
|nconsideration of the premium charged, bishereby agreed that this policy shall be considered primary
to any similar insurance held by third parties in respect to work performed by you under any written
contractual agreement with such third party. It iufurther agreed that any other insurance which the
person(s) or organization(s) named in the schedule may have is excess and non-contributory to this
insurance.
P0>iELO2OO21O Page 1oY1