BACKFLOW APPARATUS & VALVE COMPANY (2)

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F7DATE1MM:1DD/YYYY) ®CERTIFICATE OF LIABILITY INSURANCE 9/219 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). PRODUCERONTACT United A encies Inc.inCNAME; United Agencies Inc. 750 The Ety Drive South. Ste 450 PHONE FAx Orange, CA 9286$ aN 626-214-7902 NOY ADnREss kdumatol unfteda encies.com OG23764 INSURED Backflow Apparatus & Valve Company DBA BAVCO 20435 S. Susana Road Long Beach CA 90810 INSURERS AFFORDING COVERAGE NAIC INSURER A: Travelers Property Casualty Cc of America 25674 INSURER B INSURER C . INSURER D INSURER E. INSURERF: CC1VFRAnFS CFRTIFICATF NIIMRFR- rignannn REVISION NUMRFR! 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 11&A TYPE OF INSURANCE DL S R POLICY NUMBER POLICY EFF EXP POLIDNMI CY LIMITS f COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F_v,1 OCCUR ✓ 630-8J664090 10/31/2018 10/31/2019 EACH OCCURRENCE $1000000 PREMISES tFa accurrerrx $ 100 000 MED EXP (Any one person) $ 5 000 PERSONAL & ADV INJURY $ 1 000 000 GEN'LAGGREGATE LIMIT APPLIES PER: PRCO-- 0LOC POLICY ✓� JE OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG s21000000 $ A AUTOMOBILE LIABILITY OWNED SCHEDULED .11 ANY AUTO AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BA-8J664090 10/31/2018 10/31/2019 COMOMd Dent SINGLEU IT $1 000000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PR51ERTY DAMAGE Per acGdenI $ A UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE CUP-9J209005 10/31/2018 10/31/2019 EACH OCCURRENCE $5000000 ✓ H AGGREGATE $ 5,000,000 DED ✓ t RETENTION 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNERlEXECUTIVE YIN OFFICEMMEMBEREXCLUDED7 ❑Y (Mandatory In NH) If es, dascrlhe under IDfPWdIPTION u) OPE AT IONS below N/A UBOL941578 8/27/2019 8/27/2020 1/ STA7UTE OTH- E.L. EACH ACCIDENT $ 1,000 000 E.L. DISEASE - EA EMPLOYEE $ E,L. DISEASE - POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be 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 only per the attached form. REVIEWED & APPROVED Ci#y of Santa Ana a T 0 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza 4th FL , A Santa Ana CA 92702 FRANCINE R. VILLARE, AUTHORi2EDREPRESENTATIVE % Gary Chem lin ©1988-2015 ACORD CORPORATION. All rights reserved, ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 51383140 1 18-19 GL, Auto, Umb, 19-20 WC I Brigitte Leber 1 9/26/2019 7:51:27 AM (PDT) I Page 1 of 13