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304303
<br />AC PIJ" CERTIFICATE OF LIABILITY INSURANCE
<br />DAT6IYYYY)
<br />ILTR TYPE OF INSURANCE Lj AM66LBR--POLICYNUMBR "_.._...._. Wn�YYVj MMLD.CYYYY LIMITS
<br />6/227/207/2018
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed,
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s).
<br />PRODUCER
<br />NAME Jonathan Allen
<br />Commercial Lines -213-253.6700
<br />1,213.337-6350 FX
<br />.Ric No: 610-637-2253
<br />F1
<br />USI Insurance Servloes National, Inc. - CA LICA: OD08408
<br />-M L onathan.allen@usl.com
<br />RR
<br />AOOREas: )
<br />777 South Flgueora St, Ste 2100
<br />5,000
<br />INSURER(S) AFFORDING COVERAGE
<br />rvalc P
<br />Los Angeles, CA 80017
<br />Nautilus Insurance Company
<br />INSURERA; p y
<br />17370
<br />INSURED
<br />INSURER B: Great Divide Insurance Company
<br />25224
<br />Ocean Blue Environmental Services., Inc.
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRO-
<br />POLICY X JECT ........_ LOC
<br />GENERAL AGGREGATE_
<br />$
<br />INSURERC:
<br />925 West Esther Street
<br />.._____,.,._._�__—.-----..._---_—..------..._.__...--._—
<br />INS
<br />INSURERD:
<br />_— _2,000,000
<br />$ 2,000,000
<br />...... ...._._._.._.
<br />Long Beach, CA 90813_
<br />,.._._._...._.._...._..
<br />INSURE F•
<br />COVERAGES CERTIFICATE NUMBER: 13233814 REVISION NUMBER: See below
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOW_ N_MA_Y_HAV_E_ BEEN REDUCED BY PAID CLAIMS_,
<br />ILTR TYPE OF INSURANCE Lj AM66LBR--POLICYNUMBR "_.._...._. Wn�YYVj MMLD.CYYYY LIMITS
<br />A
<br />TOOMMERCIAL GENERAL LIABILITY
<br />....
<br />CLAIMS -MADE X OCCUR
<br />._–
<br />X
<br />ECP2018650-12
<br />07/01/2018
<br />07!01/2079
<br />FZIIOCCURRENCE
<br />'Y5AMAE'Wtl7tENY"EfS__._..__......._.._..._._.._......_..__._.._.
<br />_P.P.FMLs.86.�sstgvl.¢aecel........$
<br />S 1,000,000
<br />100,000
<br />5,000
<br />PERSONAL &ADV INJU RY_
<br />$ 1,00000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRO-
<br />POLICY X JECT ........_ LOC
<br />GENERAL AGGREGATE_
<br />$
<br />PRODUCTS - COMPIOP AGG
<br />......__....,._..._.,......_..._..._.,..._..._.._._._.._.._.._....__.__._..__
<br />_— _2,000,000
<br />$ 2,000,000
<br />XOTHER; Slfll $20000
<br />$
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />BAP2018652-12
<br />07/01/2018
<br />07/01/2019
<br />COMBINED SINGLE LIMIT
<br />Ramomoc—
<br />$ 7000,000
<br />X
<br />ANYAUTO
<br />ODDLY INJURY (Par person)
<br />$
<br />X
<br />OWNED SCHEDULED"----`—""--
<br />AUTOSONLY AUTOS
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUT090NLV
<br />BODILY INJURY (ParawltlanU
<br />$
<br />P OPE TY DA AO
<br />era, Ida 1
<br />$
<br />X
<br />MCS -90
<br />is
<br />A
<br />UMBRELLALIAS
<br />x
<br />_
<br />OCCUR
<br />FFX2018651.12
<br />07/01/2018
<br />07/01/2019
<br />EACHOCCURRENCE _
<br />$ 9,000,000
<br />X
<br />EXCESS Line
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$ 01000,000
<br />DED I
<br />I RETENTION$
<br />$ SIR - NIA
<br />B
<br />WORKERS MPLOYE S'LIAILIT YIN
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETORIPARTNER/EXECUTIVEE
<br />OFFICERIMEMBEREXCLUOtc? C
<br />(Mandatory In NH)
<br />If nye, denoribe under
<br />DE6 SORPTION OFOPERATIONS below
<br />NIA
<br />WCA2018653-12
<br />_
<br />07/01/2018
<br />07/01/2019
<br />X ,,LX ER
<br />UBL&H
<br />L. EACH ACCIDENT
<br />$ 11000,000
<br />E.LDISEA$E-EAEMPLOYRE
<br />$ 1,000,000
<br />E. L. DISEASE - POLICY LIMIT
<br />S 1,000,000
<br />A
<br />Pollution Liability
<br />ECP2078650-12
<br />0701!2018
<br />'07/01/2019
<br />Limits:$1,000,00 Each Ooourrenae
<br />Ded:$20,000; Ocourenca Form
<br />DESCRIPTION OFOPERATIONS/ LOCATIONS I VEHICLES (ACGRD 101, Additional Remark, Schedule, maybe attached 11 more spaou to requires)
<br />RE:RFP# 16-144 Certificate Holder is named as additional Insured as It relates to general liability In accordance with the terms and conditions of the policy.
<br />RF_�IIEWED BY:yy, x...yy,3 , EUNICE H6REDIA (FOPQFI�
<br />City of Santa Ana
<br />Attn: Public Works Department
<br />20 Civic Center Plaza M-22
<br />Santa Ana, CA 92702-0000
<br />ACORD name and logo are registered marks
<br />ACGRD 25 (2016103)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />All rinhta
<br />
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