ULTRASYSTEMS ENVIRONMENTAL, INC.

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ULTRENV-01 JRUSSELI ACoizo CERTIFICATE OF LIABILITY INSURANCE OnrE13120 19 3/1/209 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 Roger Stone Insurance Agency 5015 Birch Street Newport Beach, CA 92660 CONTA ME:CT PHONE FAX (A/C, No, Ezt): (949) 757-0270 ,AX No :(949) 757-0375 AAA,,. customerservice@stoneins.com INSURERS AFFORDING COVERAGE NAIC If INSURER A : Admiral Insurance CO. 24656 INSURED INSURER B:Republic Indemni Company 22179 INSURER C : U Itrasystems Environmental Inc. INSURER D: 16431 Scientific Way Irvine, CA 92618 INSURER E NSURER 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 CONTRACTOR 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 ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FK OCCUR Contr Poll Liability X FEIECC1110706 11110/2018 1111012019 EACH OCCURRENCE $ 5,000,000 DAMAGE TO RENTED^. PREMISES (Ea c)X $ 50,000 GEN'L X MED EXP (Any one Ptnaml $ 5,000 PERSONAL B ADV INJURY 5,000,000 AGGREGATE LIM IT APPLIES PER: POLICY El m1:1 LOC OTHER: GENERAL AGGREGATE $ 5,000,000 PRODUCTS - COMP/OP AGO 5,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO AUUTEOS ONLY AUUTO{SSU�ED AUTOS ONLY X AUTOS ONtfD FEIECC1110706 lllIO12018 11110/2019 COMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY Per erson $ BODILY INJURY Peraoatlenl $ X f�er0aw�'tle^I SAGE $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE DED RETENTION$ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN AA{1NY PROPRIETO��Rg�jPARTNER ECUTIVE ❑ (ManJERIMEMNH) EXCLUDED? se be under under1,000,000 DESCRIPTION OF OPERATIONS below NIA 16319316 91112018 9/112019 X PERETH- E.L. EACH ACCIDENT 1,OO 1 E.L. DISEASE - EA EMPLOYE 1,000,000 $ E.L DISEASE - POLICY LIMIT $ A A Professional Liab Professional Liab FEIECC1110706 FEIECC1110706 11/1012018 11/1012018 11110/2019 11110/2019 Each Occurrence Aggregate 5,000,000 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) RE: Environmental consulting - BASE Contract City of Santa Ana On -Call Environmental 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 primary/non-contributory. 3( Y2hlIP�'�- f"CP, City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ff ACORD 25 (2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD