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Insurance -Pacific Data - 2011-08-10 / PACIDAT-01 PATRA2 AC-0Ra CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) klelim—■ 810/2011 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 License#0008309 CONTACT Bolton 8 Company PHONE 626 799-7000 FAX P.O.Box 6030 ANC,N Ertl'( ) (NC,Noy(626)441-3233 Pasadena,CA 91102-6030 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL a INSURER A:Interstate Fire 8 Casualty Co 22829 INSURED INSURER B:Allmerica Financial Benefit Insurance Co. .Pacific Data Electric,Inc.dba:PDE Total Energy Solutions INSURER C:National Union Fire Ins.Co. 9970 Bell Ranch Drive,Ste 109 INSURER D:Insurance Company of the West Santa Fe Springs, CA 90670 INSURER E. 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. INSR ADDL'SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYY) (MMDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE I$ 1,000,0001 A X COMMERCIAL GENERAL LIABILITY X SGL1002599 3/1/2011 3)1/2012 DAMAGE TO RENTED 50,000 PREMISES occ nce) $ , CLAIMS-MADE X OCCUR MED EXP()thy one person) $ X Per Project CG250303 PERSONAL&ADV INJURY $ 1,000,000, GENERAL AGGREGATE S 2,000,0001 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S 2,000,000, POLICY I LJE8 L. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 808.808 (Ea amdeng 5 B X ANY AUTO X AWF9052407 3/1)2011 3/1/2012 BODILY INJURY(Per person) 5 — ALL OWNED SCHEDULED BODILY INJURY(Pe amdent) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS (Pe accident) S UMBRELLALIAB I X OCCUR EACH OCCURRENCE I$ 10,000.0001 C X EXCESSLIAB 1 CLAIMS-MADE BE021387007 3/1/2011 3/1/2012 AGGREGATE S 10,000,000 DED I X I RETENTIONS S WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS'LIABILITY X TORYLIMITS ER Y/N D ANYPROPRIETORARTNER/EXECUTIVE /P X WVE500590900 3/1/2011 3/1/2012 i EL EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N/A — I (Mandatory In NH) E L DISEASE EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS bebw E L.DISEASE POLICY LIMIT I$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,AddiUanal Remarks Schedule,N more space is requIred) Subject to policy terms,conditions,limitations and exclusions. Job:Costa Mesa Sanitary District,Study and Preliminary Drawings for generators.Costa Mesa Sanitary District,its directors,officials,officers,employees, agents and volunteers named GL&Auto Blanket Additional Insured Per CG2010 11185 and VCA2010205 attached,only if required by written contract/agreement.GL Primary Wording applies per ICB-8016 06-05 attached.WC Waiver of Subrogation applies per WC040306 attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ry ACCORDANCE WITH THE POLICY PROVISIONS. 628 West 19th Street Costa Mesa,CA 92627 AUTHORIZED RREEPREPRESE� 'NTA TIVVEJt' Se-et ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: SGL1002599 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - (FORM B) This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: My person or organization for whom you are performing operations when you and such person or organization Lave agreed in writing in a contract or agreement that such per- son or organization be added as an additional Insured an your policy. It is further agreed that such Insurance that Is afforded by this policy for The benefit of the above Additional Insured(s) shall be primary inwiance as respects any claim, loss or liability arising out of me Named Insured(s)operations and any other insurance maintained by the Additional Insured(s( shall be excess and noncontributory with the insurance provided hereunder. (If no entry appears above,Information required to complete this endorsement wit be shown in the Declarations as applicable to this endorsement) WHO IS AN INSURED (Section II)is amended to include as an insured the person or organization shown In the Schedule,but onywith respect to liability arising out cif"your work"for that Insured by or for you. CL 246(11/85) CG 20 10 11 85 elec.eps Copyright Insurance Services Office,Inc. 1884 Page 1 of 1 ❑ Policy Number:AWE 9052407 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY @VANTAGE FOR AUTOMOBILE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The following schedule lists the coverage extensions provided by this endorsement Refer to the individual provi- sions to determine the extent of your coverage. SCHEDULE OF COVERAGE EXTENSIONS 1 Additional Insured By Contract 11. Extra Expense—Broadened Coverage 2. Airbag Discharge 12. Fellow Employee Exclusion 3. Auto Theft Reward 13. Glass Repair—Waiver of Deductible 4. Blanket Waiver of Subrogation 14. Hired Auto Physical Damage Coverage 5. Bodily Injury Redefined—Mental Anguish 15. Hired Auto—Worldwide Coverage Territory 6. Broad Form Named Insured 16. Lease Gap Coverage 7 Communications Equipment 17 Liability Coverage—Supplementary Payments 8. Drive Other Car—Executive Officers 18. Newly Formed or Acquired Organizations 9. Duties In The Event of Accident,Claim,Suit or Loss 19. Physical Damage—Transportation Expenses 10. Employees As Insureds 20. Towing—Any Auto 1 ADDITIONAL INSURED BY CONTRACT The Who Is An Insured provision under SECTION II— LIABILITY COVERAGE is amended to include as an additional insured any person or organization with whom you agreed in a written contract,written agreement or permit,to provide insurance such as is afforded under this Coverage Form Such person or organization is an insured only with respect to liability for 'bodily injury or property damage' caused, in whole or in part by your maintenance,operation of use of your covered 'autos' With respect to the insurance afforded to these additional insureds,this insurance does not apply a. Unless the written contract or agreement has been executed or the permit has been issued prior to the 'bodily injury or 'property damage' b. To any person or organization included as an insured by endorsement or in the Declarations,or c. To any,lessor of autos' when their contract or agreement with you for such leased auto' ends. 2. AIRBAG DISCHARGE If you purchased physical damage coverage for a covered "auto" under this policy we will pay to reset or re- place an airbag that accidentally discharges without the vehicle being involved in an accident. No deductible applies to this additional coverage. However this coverage only applies if the airbag is not covered under a manufacturer's warranty and you did not intentionally cause the airbag to discharge. 3. AUTO THEFT REWARD We will pay up to a $2,000 reward in the event of a covered loss,for information leading to the arrest and con- viction of anyone stealing a covered 'auto' A reward will not be paid to you, a family member employee or any public official while performing their duty 4. BLANKET WAIVER OF SUBROGATION The Transfer Of Rights Of Recovery Against Others To Us condition under SECTION IV—LOSS CONDI- TIONS is replaced by the following: We will waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of the operation of a covered 'auto when you have assumed liability for such 'bodily injury' or "property damage' under an 'insured contract" provided the contract is in writing and executed prior to the 'bodily injury"or 'property damage' 5. BODILY INJURY REDEFINED—MENTAL ANGUISH The definition of 'bodily injury"under SECTION V—DEFINITIONS is replaced by the following: 'Bodily injury" means bodily injury sickness, or disease sustained by a person, including mental anguish or death resulting from any of these at any time VCA 201 02 05 Include copyrighted material of Insurance Services Office.Inc Page 1 of 4 Copyright 2004,i'!'!!'!'!!'!i 11!' 11!'1'1!'1'1'll'1"1' 9"i, @ @ @ @ @@@@ @ @ @ @ @ @ @ @ @ @@ @@ 6. BROAD FORM NAMED INSURED a. The Who Is An Insured provision under SECTION II — LIABILITY COVERAGE is amended to include the following: Any organization which is a legally incorporated entity in which you own a financial interest of more than 50% of the voting stock on the effective date of this Coverage Form will be a Named Insured until the 180th day or the end of the policy period whichever comes first, provided there is no other similar insurance avail- able to that organization. b. Paragraph a. of this provision 6. does not apply to 'bodily injury or 'property damage for which an "insured' is also an insured under any other automobile policy or would be an insured under such a policy, but for its termination or the exhaustion of its limit of insurance. 7 COMMUNICATIONS EQUIPMENT a. The exclusion for electronic equipment under Exclusions of SECTION III—PHYSICAL DAMAGE COVERAGE does not apply to loss of any permanently installed, non-removable communications equipment designed for use as a: 1 Citizen's band radio; 2, Two-way mobile radio or telephone; 3. Scanning monitor receiver or 4. GPS Navigation System including its antenna and other accessories. b. No Deductible applies to this additional coverage. c. The most we will pay for this coverage is$2,000 per occurrence. 8. DRIVE OTHER CAR—EXECUTIVE OFFICERS a. The Who Is An Insured provision under SECTION II—LIABILITY COVERAGE is amended to include: If you are designated in the Declarations as: 1 An individual;you and your spouse. 2. A partnership;your partners and their spouses. 3, An organization other than an individual or a partnership; you"executive officers' and their spouses. b. SECTION II—LIABILITY COVERAGE and SECTION III—PHYSICAL DAMAGE COVERAGE are extended to include 'autos you don't own, hire, lease or borrow while in the care, custody or control of an insured listed in 8.a,This does not include any 'auto' 1. Owned by any insured listed in 8.a. or any member of their household,including any such auto' that is owned but not insured; 2. Used by an insured listed in 8.a.while working in the business of selling servicing, repairing or parking autos;or 3. Insured under another policy of insurance. If Medical Payments, Uninsured/Underinsured Motorist, Personal Injury Protection or other compulsory coverages required by the governing jurisdiction are covered on this policy, then insureds listed in 8.a. above and family members residing in the same households are 'insureds' while: 1 Occupying as a passenger,or 2. A pedestrian when struck by any auto you do not own, hire, lease or borrow except any auto owned by that insured listed in 8.a, their family members or an auto insured under any other policy c. The limits and deductibles applicable to this provision will be the largest applicable to any owned auto' for the specific insurance. d. The following definition is added to SECTION V—DEFINITIONS of the policy' "Executive officer"means a person holding any of the officer positions created by your charter, constitu- tion, by-laws or any similar governing document. e. The Other Insurance Condition, under SECTION IV — BUSINESS AUTO CONDITIONS,does not apply to the provisions of this Drive Other Car endorsement. There is no 'other insurance' applicable to this en- dorsement. Page 2 of c Includes copyrighted material of Insurance Services Office,Inc VCA 201 02 05 Copynght 2004! 'Immo in ipnl, ,nn 9. DUTIES IN THE EVENT OF ACCIDENT CLAIM,SUIT OR LOSS Under SECTION IV — BUSINESS AUTO CONDITIONS — the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is amended as follows: The requirements that you must a. notify us of an accident' claim, 'suit' or 'loss"and b. send us documents concerning a claim or 'suit' apply only when such accident' claim, 'suit"or"loss"is known to: a. You, if you are an individual; b. A partner if you are a partnership; c. An executive officer of the corporation or insurance manager if you are a corporation;or d. A manager if you are a limited liability company 10. EMPLOYEES AS INSUREDS The Who Is An Insured provision under SECTION II — LIABILITY COVERAGE is changed by adding the following: Any employee of yours while using a covered auto you don't own, hire or borrow in your business or your personal affairs.This coverage is excess over any other collectible insurance. 11 EXTRA EXPENSE—BROADENED COVERAGE Under Paragraph A.of SECTION III—PHYSICAL DAMAGE COVERAGE,the following Coverage is added: We will pay for the expense of returning a stolen covered 'auto' to you subject to Paragraph C Limit Of Insurance. 12. FELLOW EMPLOYEE EXCLUSION The Fellow Employee exclusion under SECTION II — LIABILITY COVERAGE does not apply if the 'bodily injury' results from the use of a covered 'auto you own or hire.This coverage is excess over any other in- surance 13. GLASS REPAIR—WAIVER OF DEDUCTIBLE Under Paragraph D. Deductible — of SECTION III — PHYSICAL DAMAGE COVERAGE, the following is added' No deductible applies to glass damage it the glass is repaired rather than replaced. 14. HIRED AUTO—PHYSICAL DAMAGE COVERAGE If hired 'autos' are covered 'autos" under SECTION II — LIABILITY COVERAGE and if Comprehensive, Specified Causes of Loss, or Collision coverages are provided under this policy for any auto' you own, then SECTION ill— PHYSICAL DAMAGE COVERAGE is extended to autos' you hire, subject to the fol- lowing limit. The most we will pay for 'loss' to any hired 'auto' is the lesser of: a. $50,000, b. The actual cash value, or c. The cost of repairing or replacing it with other property of like kind or quality The deductible will be equal to the largest deductible applicable to any owned 'auto' for that coverage. No deductible applies to 'loss' caused by fire or lightning. Hired Auto Physical Damage coverage is excess over any other collectible insurance. Subject to the above limit,deductible and excess provisions,we will provide coverage equal to the broadest coverage applicable to any covered 'auto' you own. We will also cover loss of use of the hired"auto"if the following conditions are met: a. it results from an accident, b. you are legally liable,and c. the lessor incurs an actual financial loss. The most we will pay for this loss of use coverage is$1,000 per accident" VCA 201 02 DS Includes copyrighted material of Insurance Services Office,Inc Page 3 of 4 Copyright 2004,n unplugs lnnq'lnPPIffiltpgq 15. HIRED AUTO—WORLDWIDE COVERAGE TERRITORY The definition of coverage territory in General Conditions—Policy Period,Coverage Territory—of SEC- TION IV—BUSINESS AUTO CONDITIONS is amended to add: Anywhere in the world for autos hired for 30 days or less, provided that any suit' is brought in the United States of America(including its territories and possessions),Puerto Rico or Canada. 16. LEASE GAP COVERAGE Under Paragraph C. Limit of Insurance—of SECTION III PHYSICAL DAMAGE COVERAGE,the follow- ing is added: We will also pay the difference between the actual cash value of a covered 'auto at the time of loss"and the remaining balance on your lease if the following conditions are met: a. The 'auto' has a long term lease and is covered on this policy. b. The lessor is added as an Additional Insured in a written lease agreement. c. You are legally obligated for the remaining balance. We will not pay for any amounts representing excess wear and tear charges; additional mileage charges; taxes; overdue payments:penalties,interest or charges resulting from overdue payments; or lease termina- tion fees. 17 LIABILITY COVERAGE EXTENSIONS—SUPPLEMENTARY PAYMENTS Under SECTION II—LIABILITY COVERAGE,the Coverage Extension for Supplementary Payments is re- vised as follows: a. The limit for the cost of bail bonds is amended to$3,500. b. The limit for reasonable expenses incurred by the 'insured"is amended to $500 a day 18. NEWLY FORMED OR ACQUIRED ORGANIZATIONS a. The Who Is An Insured provision under SECTION II—LIABILITY COVERAGE is amended to include as an insured"any organization that is formed or acquired by you and over which you maintain majority ownership. b. Paragraph a.of this provision 18.does not apply to any organization: 1. That is a joint venture or partnership, 2. That is an"insured"under any other policy 3. That has exhausted its Limit of Insurance under any other policy,or 4. 180 days or more after its acquisition or formation by you, unless you have given us notice of the acquisition or formation. c. Paragraph a. of this provision 18. does not apply to "bodily injury' or 'property damage' that results from an 'accident that occurred before you formed or acquired the organization. 19. PHYSICAL DAMAGE—TRANSPORTATION EXPENSES COVERAGE Under SECTION III—PHYSICAL DAMAGE Coverage Extensions,the limit for Transportation Expenses is amended to$75 per day and the maximum is amended to$1,800. 20. TOWING—COVERED AUTOS Under SECTION III—PHYSICAL DAMAGE COVERAGE,Coverage for Towing is amended as follows: a. This coverage applies to any covered auto' for which a premium charge for towing and labor is shown in the Schedule or in the Declarations. b. The limit is$100. Page 4 of 4 Includes copyrighted malerial of Insurance Services 011ice,Inc. VCA 20102 05 Copynght 2004,1P U' gnmtlq Policy Number SGL1002599 AMENDMENT OF OTHER INSURANCE CONDITION - PRIMARY INSURANCE FOR AUTOMATIC STATUS ADDITIONAL INSURED THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART If required under a written 'insured contract"with you, paragraph a. Primary Insurance in SECTION IV— COMMERCIAL GENERAL LIABILITY CONDITIONS,4. Other Insurance is amended by adding the following paragraph: Not withstanding the foregoing, the insurance afforded to any person or organization who has been added to this policy by an Automatic Status Additional Insured Endorsement is primary and non- contributory insurance, but only as respects "bodily injury" or "property damage" liability arising out of your sole negligence in performance of"your work" after the effective date of this policy under a written contract between you and such person or organization that requires you to maintain primary and non- contributory insurance and to include such person or organization as an additional insured thereunder All other terms and conditions of this policy remain unchanged. 1 ICB-8018 06-05 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA We have the right to recover our payments from anyone Gable for an Injury covered by this policy. We will not enforce our right against the person or organization named in the Sdiedule.(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 2 % of the CaMfomia workers' compensation premium otherwise due on such remuneration. Schedule person or Ownniveting Job Description Au(tunalui status e here required by re linen mtrart. II This endoisemert is executed by the Everest National Insurance Company 18996 Premltm$ 88 She Dare 3/01/2011 Expiration Dee 3/01/2012 For attachment to Pofioy No. 76000049391 II I Gournerslgnod by Authorized Representative Er .Send No. WC 0403 06 Page 1 of 1 ED:4/1984