BACKFLOW APPARATUS & VALVE COMPANY

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N • 2016. 2to ►`o�R�® CERTIFICATE OF LIABILITY INSURANCE DAT1JMWD018 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 have ADDITIONAL INSURED provisions or 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 United Agencies, Inc. 23421 S. Pointe Drive Ste. 190 NAME CT United Agencies Inc. PHONE 626-214-7902 ac No: Laguna Hills, CA 926�3 E-MAIL ADDRESS: kdumatol uniteda encies.com INSURERS AFFORDING COVERAGE NAIC N INSURERA: Travelers Property Casualty Co of America 25674 OG23764 INSURED Backflow Apparatus & Valve Company BAVCO INSURER B INSURER INSURERD: 20435 S. Susana Road Long Beach CA 90810 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: A99R9977 RFVISInM NIIMRFR- 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 TR OF INSURANCE ADDLISUBRTYPE INSD WVD POUCYNUMBER MMIDOPOLICY/YYYY EFF MWDDM%V LIMITS A ,� COMMERCIAL GENERAL LIABILITY ✓ 630-8J664090 10/31/2018 10/31/2019 EACH OCCURRENCE $1000000 CLAIMS -MADE �✓ OCCUR DAMA GETO RENTED PREMISES Ea occurrence $100 000 MED EXP(Any one person) $5000 PERSONAL & ADV INJURY $1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,090.099 POLICY L-7/]jEO ElLOD PRODUCTS-COMP/OP AGG $2000000 $ OTHER: A AUTOMOBILELIABlUTY BA-8J664090 10/31/2018 10/31/2019 COMBINED itSINGLE LIMIT $1000000 BODI LY INJURY (Per person) $ ✓ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) -- $ ✓ AUTOS ONLY ✓ AUTOS ONLY Per acoidenDAMAGE $ $ A UMBRELLALIAB V OCCUR CUP-9J209005 10/31/2018 10/31/2019 EACH OCCURRENCE $5,000,000 ✓ EXCESS LUIS CLAIMS -MADE AGGREGATE I $5,000000 DELI I ✓ I RETENTION$0 I $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNERIEXECUTIVE YIN OFFICERIMEMBEREXCLUDEDF FYI NIA UBOL941578TIL18 8/27/2018 8/27/2019 SPER TATUTE ERH E.L. EACH ACCIDENT $1,000.000 E.L. DISEASE -EA EMPLOYEE $1 (Mandatory in NH) If yes, descriUe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1000000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of Santa Ana and its officers, employees, agents, volunteers and representatives are named as additional insureds in respects to the general liability policy only per the attached forms. Primary/non-contributory is included in the general liability policy on] form. xI I g r:FRTIFICATF Nnl nFR r:A Nf:FI I ATInN Ci Olt of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE S. Daisy AVB. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana CA 92703 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Gary Champlin V U 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 45262577 1 18-19 GL, Auto, Omb, WC I Katherine Du atol 1 11/6/2018 1:32::41 PM (PST) I Page 1 of 11