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kCCiRt3 CERTIFICATE OF LIABILITY INSURANCE
<br />DATE27/2010019 Y,
<br />2/7/9
<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 IN8URER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />Certificate holder in lieu of such endorsement(s),
<br />PRODUCER
<br />HUB International Insurance Services Inc.
<br />Liconse#0767776
<br />3636 American River Drive, Suite 200
<br />Sacramento CA 95664
<br />CONTNAMEACT ROCIO Leon
<br />PHON o ESP. 916-480-4134 FAXa
<br />rc no:916-993-7234
<br />Amt. Rocio.Leon@hublnternational.com
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC d
<br />INOURERA: Greenwich Insurance Company
<br />22322
<br />_
<br />INSURED Ware Disposal Inc, WAREDIB-02
<br />War
<br />P.O. Box 1318
<br />INSURER e : Westchester Surplus Lines Insurance Co.
<br />10172
<br />INSURERC: Alaska National Insurance Company
<br />38733
<br />INSURERD: Evanston Insurance Company
<br />35378
<br />Santa Ana CA 92702 /
<br />1�1
<br />INSURERS:
<br />INSURER Fi
<br />COVERAGES GCK I ]PICA It NUMBIEK: tiNHR1nr.96 GPIRCInhi MIIn.10Eo.
<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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />ILTD
<br />TYPE OF INSURANCE
<br />ADDL
<br />U
<br />POLICY NUMBER
<br />MOIDD EPF YYYI
<br />MMIOOYEXP
<br />LIMITS_
<br />A
<br />X
<br />COMMERGIAL GENERAL LIABILITY
<br />CLAIMS -MADE II OCCUR
<br />STOOD PD Bed,
<br />Y
<br />GEC3000730-04
<br />228/2019
<br />2/26/2020
<br />EACH OCCURRENCE
<br />If1,000000
<br />TED
<br />A PREMISES
<br />RE urre
<br />$100,000
<br />$5EDD
<br />X
<br />e c.
<br />MED ENE (Any one person)
<br />Per Owunence
<br />PERSONAL B ADV INJURY
<br />_
<br />$1,000,000
<br />AGGREGATE UMITAPPLIES PER:
<br />POLICYI jE� El LOG
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GEN'L
<br />PRODUCTS - COMPIOP AGO
<br />$2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />X`
<br />LIABILITY
<br />ANYAUTO
<br />AE00046386M
<br />212812019
<br />2128/2020
<br />COMBINED SINGLE LIMIT
<br />E cider
<br />$ 0000
<br />BODILY INJURY (Per person)
<br />—
<br />3
<br />_
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY( Per arddenQ
<br />$
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />ereccid_enI),
<br />$
<br />BUPD Dedustlble
<br />$10,400
<br />B
<br />X
<br />UMBRELLA LIAD
<br />EXCESS DAG
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />G46863306002
<br />2)28/2019
<br />2/28/2020
<br />EACH OCCURRENCE
<br />a 10,000,000
<br />AGGREGATE
<br />$10,OOo 000
<br />DFD RETENTIONS
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YIN
<br />OFFICERMEMBER IPAEXOIUDEDp ECUTIVF.
<br />NIA
<br />1BH WS 05450
<br />81112018
<br />8/1I2010
<br />X I PER OTH-
<br />STATUTE ER
<br />_
<br />E.L. EACH ACCIDENT
<br />$$1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$$1000,000
<br />(Mandatory In NH)
<br />If yea, downbe under
<br />E.L.DISEASE'- POLICY LIterr
<br />_
<br />8$1,0OQo00 -
<br />DESOUPTICALOF OPERATIONS Le"v
<br />D
<br />Envlmnmonlai lmpalment
<br />LIa0111ty/LPL
<br />FT17CPLOWE00598
<br />2281201]
<br />2I282020
<br />Eech Loee 1000,000
<br />A88ra9zto IDU0,000
<br />Deduodam 10,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACOaD 101, Addlpenal Remarks Srhedule, maybe acaCbed it more space Is required)
<br />(General Liability Per Project Aggregate applles perwfhten contract) ,
<br />RE: Work performed by the insured for certificate holder per written contract
<br />Additional Insured: City of Santa Ana: its officers, employees, agents, Volunteers and representative
<br />Forms: CG201 D 0413, OG2037 0413, IXI405 0910, XIL431 0605 L ur 1 a &F� l�S -t`i� f it V t✓ V 4
<br />CITY OF SANTA ANA PUBLIC WORKS AGENCY
<br />PO BOX 1988 M-21
<br />SANTA ANA CA 92701
<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 />AUTHORIZED REPRESENTATIVE
<br />©1
<br />All rinhic rasansbd
<br />ACORD 25 (2014101)
<br />The ACORD name and logo are registered marks of ACORD
<br />
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