ULTRASYSTEMS ENVIRONMENTAL, INC.

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M^� ULTRENV-01 JRUSSE c ►Rp CERTIFICATE OF LIABILITY INSURANCE DATE(MM')n4 YY) .....^" nnlnaiona Y 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(les) 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 rlohts to the certificate holder In lieu of such endorsement(s). PRODUCER -' _ Rogger Stone Insurance Agency PAHtOON, No. Extx (gig) 757-0274 ice, No):(940)75T-0375 5015 Birch Street --_ Newport Beach, CA 92660 E . customerserviceCstoneins.com INSURED Uitrasystems Environmental Inc. 16431 Scientific Way Irvine, CA 92618 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 TYPE OF INSURANCE AOOL SUBR POLICY NUMBER X COMMERCIAL GENERAL LIABILITY POLICY EFF POLICY EXPjwAn LIMITS EACH OCCURRENCE 5,000,000 A � CLAIMS -MADE L"IOCCUR X FEIECC1110704 11/10/2016 11I10/201T DAMAGE �50r000 X Contr Poll Liability 5,000 MED EXP An one re n PERSONALS AOV INJURY 51000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERALAGGREGAI "E g 6,0O00 Q0 X POLICY❑J2 LOC 5'000,000 PRODUCTS- MPIOP AGG OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acc'denl) 1000000 ANY AUTO FEIECC1110704 11/1012016 11/10/2017 BODILY INJURY Per person OWNED SCHEDULED AUTOS ONLY AAUTO.00SWW - BODILY INJURY tPergcclden! pp X A�RRS ONLY X ANUOTOSON&LY PROacECSRdTMenf AMAGE UMBRELLA LIAB OCCUR EACH OCCURREN E EXCESS LIAB CLAIMS -MADE 4 AGGREGATE DED RETENTION$ B WORKERS COMPENSATION X OTH- PER AND EMPLOYERTLIABILITY YIN 16319314 0910112016 09101/2017 1,000,000 9TgO��PEA%HCLC UDED? EC E.L. EACH ACCIDENT _ pApNpF�PREROIPPME ❑ NIA In NH) 1,g60,000 tManda. E.L. DISEASE EA EMPLOYEE If yas, describe under 1,OOQ000 DE SCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT A Professional Llab FEIECC1110704 11/10/2016 11/1012017 Each Occurrence 5,000,000 A Professional Liab FEIECC1110704 11110/2016 11/10/2017 Aggregate 5,000,000 DESCRIPIRON OF OPERATIONS I LOCATIONS i VEHICLES (ACORD 101, Addalanai Remarks Schedule, may be attached a mere space Is required) RE: BASE Contract City of Santa Ana On -Call Environmental 2017 The City of Santa Ana, its officers, employees, agents and representatives are named Additional Insured as respects General Liability per form ECC-501.0712 attached. Insurance is primarylnon-contributory. City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHPPEOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ff ACORD 26 (2016103) ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD