Loading...
Insurance - Performance Pipeline Technologies, Inc - 2021-02-10PERFOA OP ID: 01 CERTIFICATE CIF LIABILITY INSURANCE 1 DATE(M0120 021112021 1 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 CONTACT Mark Heberden NAME Huntington Pacific Ins. Agency 7901 Professional Circle PHONE Ext}: 714-841-6283 1 (AIC, No): 714-842-2538 Huntington Beach, CA 92648 E-MAIL ADDRESS: markhuntpacificinsurance.com Mark Heberden INSURER(S) AFFORDING COVERAGE NAIC_# iNSURERA :AXIS Surplus Insurance Company/ _ INSURED Performance Pipeline Technologies, Inc _ INSURERB :Oregon Mutual Insurance Co." �'14907 dba Sanitation Systems Gene Glassburner _ _ _ INSURERc :Kinsale Insurance Company or 38920 5292 System Drive INSURERD : Liberty Mutual Insurance -Co.-®-------- -_ 23043 Huntington Beach, CA 92649 INSURERE : I NSURER 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. INSR-----POLICYEFF POLIICYEXP—� — --- ----- - -- ----- LTR i TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMI� DDIYYYY I LIMITS I GENERAL LIABILITY 1,000,00 X _h �_=. _�; �� t, X X EMP18000111-03 11212020 1112112021 ! t r�t� E E, 100,000 G X �� t ,�� 10,000 XPollut Liability � 1 x 1,400,00 Pr f Liab X o EMP18000111 03 11/21/2020 -- 0 11/21/2021 r _t _. __ �� T_ 2,o4a,o - _ 1_=1iLI°,11T r F�!� � � r: � r � , �� � 1_ _. . �� � � 2,000,00 AUTOMOBILE LIABILITY j tEli E �.,, � 2,400,00 I B :; ;�. T ; XCAC5007949613 11 /2112020 �, 11 /21 /2021 r_ �Fr - 77 -- X 1F t � h c� 7 ��rF1'tI�n�y- _v l UMBRELLA LIAB ,- Inc 5,000,000 X EXCESS LIAR I , : I I-- 0100133659-0 j 11 /232020 11 /2112021 1_ 5,004,400* [ -L, 1 X TEI,TF_ I, 1� none; - j WORKERS COMPENSATION I ( X ( 1 AND EMPLOYERS LIABILITY YIN D X �� ,, N IA- I XWW61203109 04/01/2020 r 04/01/2021 I EL E� At:: F T 1,000,00 - -- — (Mandatory in NH) I I E D E I t; E FI f 1,000,00 > >f, 4; _ cl E - r _ � � ' �, -T � 1,044,40 _ _ I I I DESCRIPTION OF OPERATIONS I 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 employee listed as additional insured with respects to the auto and general liability per attached endorsements. This insurance is primary & Non-contributory. Waiver of Subrogation applies. Job name: CMSD #328 DIP Rehab Phase 1 CEK III-l(:AI E HULUEK CANCELLATION CMSDO01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 290 Paularino Avenue Costa Mesa, CA 92626 vo AUTHORIZED REPRESENTATIVE O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and log© are registered marks of ACORD Policy Number: EMP18000111-03 COMMERCIAL GENERAL LIABILITY 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): 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 Schwduhe, but only with respect to liability for "bodily injuryr. "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1.Your acts oromissions; m 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) 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" nr"property damage" occurring after: 1. All work, including mateda|a, pans orequipment furnished in connection with such work, on the project (other than eervice, maintenance or repairs) to be performed by or on behalf mfthe 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 2 part of the same project. This endorsement changes the Policy, Please read it carefully, Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to provide Primary and/or Non-contributory status of this insurance. However, this status exists only for the project specified in that contract. In consideration of the premium charged, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third parties in respect towork performed by you under any written contractual agreement with such third party. It is further agreed that any other insurance which the person(s) or organization(s) named in the schedule may have is excess and non-contributory tothis insurance. POLICY NIUMBER: EMPI.800011 t-03 COMMERCIAL GENERAL LIABILITY CG 24 04 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to provide a waiver of subrogation. However, this status exists only for the project specified in that contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement), The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CO 24 04 10 93 has-u:rmice SerNices Office, Inc., 1992 CAC 503700OC13 PERFORMANCE PIPELINE EFFECTIVE: 1 i/21/2020 PROCESSED; 10/10/2O20 aji �o, OREGON MUTUAL INSURANCE COMPANY M2362A (C,12) COMMERICAL AUTO DESIGNATED INSURED INCLUDING WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement identifies person(s) or organizations(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: PERFORMANCE PIPELINE Endorsement Effective Date: 11/21/2020 SCHEDULE Name(s) Of Person(s) Or Organization(s): Costa Mesa Sanitation n4 -+-r, r+- I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. � Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. M2,32A (5-12) �D- insurance Services Office, Ins., 2009 122141.FR4 WORKERS CO 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 apinst the peronor organization named in the Schedule. (This agreement applies only to the extent that you perform work urn er 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 en- gaged in the work described in The Schedule. The additional premium for this endorsement is $ Schedule MMMS Person or Organization TT "*1:1oFf7-ZMUT*1 10- This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. JThe information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Endorsement No. 0008 Policy Effective 04101/2020 Premium state Policy No. XWW (21) 61 20 31 09 Insured PERFORMANCE PIPLEINE TECHNOLGIES, INC Insurance Company West American Insurance Company 11676 Countersigned by WC 99 06 79 (Fd ()1-1-i) 0 20-13 Liberty Mutual insurance Includes copyrighted material of WC113Bwith its permission,