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Insurance - Performance Pipeline Technologies, Inc - 2023-12-05PERFO-1 OP ID: MG CERTIFICATE OF LIABILITY INSURANCE DATE(M5/20 12/05/20 3 23 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 Huntington Pacific Ins. A Agency y 7901 Professional Circle CONTACT NAME: Mark Heberden (A/CC PHONE Ext); 714-841-6283 FAX No): 714-842-2538 Huntington Beach, CA 92648 Mark Heberden E-MAILE DSS: mark@huntpacificinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # 11/21/2024 11/21/2024 11/21/2024 INSURERA:AXIs Surplus Insurance Company DAMAGE TO RENTEU- PREMISES Ea occurrence $ 100,00 INSURED Performance Pipeline Technologies, Inc dba Sanitation Systems GCHB Enterprises, LLC INSURER B: Oregon Mutual Insurance Co. 14907 INSURER C: Carolina Casualty Insurance Co 10510 INSURER D : Gene Glassburner 5292 System Drive PRODUCTS - COMP/OP AGG $ 2,000,000 Huntington Beach, CA 92649 INSURER E : INSURER F: LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 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. I LTR TYPE OF INSURANCE DDL UBR POLICY NUMBER MM/DDPOLICYEFF POLICY EXP MM DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_� OCCUR X Pollut Liability X X EMP18000111-06 EMP18000111-06 EMP18000111-06 11/21/2023 11/21/2023 11/21/2023 11/21/2024 11/21/2024 11/21/2024 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTEU- PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 10,00 PERSONAL &ADV INJURY $ 1,000,00 X Prof Liab GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: JECPOLICY X PRO T LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS X X CMC CAC 5030922248 11/21/2023 11/21/2024 COMBINED SINGLE LIMIT 2,000,000 Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ PER ACCIDENT A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE X EMX21000773-04 11/21/2023 11/21/2024 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,00 DED X I RETENTION $ none $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYTORY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A X BNUWC0159639 04/01/2023 04/01/2024 X I WC STATU- I OTH- LIMITS ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: #336 American Ave., Sewer Repair - SD Liner. Costa Mesa Sanitary District, its officers, officials, employees and agents are additional insured as required by written contract or agreement per attached blanket endorsements. Any other insurance maintained by the Costa Mesa Sanitary District shall be excess and non contributory with the CERTIFICATE HOLDER CANCELLATION CMSD001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District 290 Paularino Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa .Mesa, CA 92626 AUTHORIZED REPRESENTATIVE M C.DX- t ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Policy Number: Eli P1 000 t_t -06 OWNERS,ADDITIONAL INSURED - IN CONTRACTORS ; ORGANIZATION This endorsement modifies insurance provided under the forlo.,ing: SCHEDULE Name Of Additional insured Per on 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. Hw.#ever, this status exists only for the proiect s eciied it that contract. riformation required to complete this Schedule, ;f not shown above, will be shown in the Declarations. ASection 11 — 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 liadilrtfor "bodily intur ", "property damage" or :persona= and advertising iniurv' caused, in whole or In part, y: t . Your acts or ornissions: or 2, The acts or omissions of those acting on your behalf: In the ce ormance o -F yr?ur ngraing aper tionis s r the ddst ori ? insured(s) at the location(s) designated ado=re. With respect to the insurance afforded to these additional insureds. the following additional exclusions appy: This i surae e does riot apply to „bodily injury" or "property darnage" occurring after: . Ali 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 z. That portion of fyour work" o.ot of which the in;:iry 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 or the same project. This endorsement changes the Policy. Please read it carefully. If this policy is cancelled prior to the expiration date, we will mail 30 (thirty) days written notice to: Costa Mesa Sanitary District, its officials, employees, and agents 29OPau|ehnoAvenue Costa Mesa, CA 92626 If this policy is cancelled for non-payment of premium, we will mail 10 (ten) days written notice. Failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or All other policy terms and conditions remain unchanged. PGI EL 049 0718 Page 1 of 1 This endorsement changes the Policy. Please read it carefully. Fd.Wfff IBM Any peroon(s)ororganization(s)whom 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. 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 to work 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 to this insurance. PGI EL 020 0210 Page 1 of 1 Policy number: EMP18000111-06 This endorsement rn difies insurance provded under the following: Z SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s): Operations Any person(si or or0ariizations_ whorn the Named Insured agrees: in a written contract, to name as ars addjt rial insured, However, this status exists only for the project specified ire that contract. Inciorrnation re aired to corn lete this Schedule, if not shown above, will be shown in the Declarations. Section If -- Who Is An insured is amended to include as an additional insured the peers n( or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage` caused, in whole or it 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", Policy number ENIP1 000111- 06 COMMERCIAL 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 ,4-14CF4 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 E'• 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. CG 24 04 10 93 Insurance Services Office, Inc., 199.),