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DIIIWII,lpd byF andne R. <br />Francine R. Villareal Wlareel <br />Date:2D21 0I.I51 o:13A3-00'( <br />A'ca'R& CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDIVYYV) <br />`-'� <br />1/91/2021 <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 INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Bolton &Com an <br />3475 E. Foothill Blvd., Suite 100 <br />Pasadena, CA 91107 <br />CONTACT <br />NAME: <br />AHC"N E,,. 626799-7000 ac No: 626 583-2117 <br />EMAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURERA: Greenwich Insurance Company <br />22322 <br />www.boltonco.com 0008309 <br />INSURED <br />United Storm Water, Inc' <br />14000 East ValleywsuRERc: <br />Blvd. <br />INSURER B: XL Insurance America Inc. <br />24554 <br />Indian Harbor Insurance Company <br />36940 <br />INSURER D: <br />City of Industry A 91746 <br />INSURER E: <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 59652633 REVISION NUMBER: <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 />ILTR <br />LTR <br />OF INSURANCE <br />ADDLTYPE <br />I=SUp <br />POLICYNUMBER <br />MMIDDY� <br />MO/U�YEXP <br />YYY <br />LIMITS <br />I <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE MOCCUR <br />✓ <br />GEC3001234 <br />12/31/2020 <br />12131/2021 <br />EACH OCCURRENCE <br />$1000000 <br />PAMAGE TO RENTED <br />REMISES Ea occurrence <br />$ 100 000 <br />MED EXP (Any one person) <br />$ 5 000 <br />PERSONAL & ADV INJURY <br />$ 1 000 000 <br />AGGREGATE LIMIT APPLIES PER: <br />GENERALAGGREGATE <br />$2,000,000 <br />GEN'L <br />POLICY EjEp7 0LOC <br />PRODUCTS-COMPIOPAGG <br />$2000000 <br />$ <br />OTHER: <br />B <br />AUTOMOBILE <br />LIABILITY <br />AECO048938 I AECO048939 <br />12/31/2020 <br />12/31/2021 <br />OMBINEDISINGLE LIMIT <br />31000000 <br />BODILY INJURY (Par person) <br />$ <br />ANYAUTO <br />1�/ <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY(Peraccident) <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY ✓ AUTOS ONLY <br />PROPERTYDAMAGE <br />Per accident <br />$ <br />C <br />UMBRELLA LIAB <br />OCCUR <br />UECO048940 <br />12131/2020 <br />12/31/2021 <br />EACH OCCURRENCE <br />$15 000 000 <br />H <br />AGGREGATE <br />$15 000 000 <br />✓ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED ✓ RETENTION 10,000 <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />OFFICERIMEMB REXCLUDED9ECUTIVE � <br />NIA <br />WEC3001235 <br />12l31/2020 <br />12/31/2021 <br />,/ STATUTE ER <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$j 00 <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />I $1000000 <br />C <br />Pollution Liability <br />PECO048963 <br />12/31/2020 <br />12/31/2021 <br />$16,000,000 Occ/Aggregate ! $25,000 Ded. <br />C <br />Professional Liab - Claims Made <br />PECO048963 <br />12/31/2020 <br />12/31/2021 <br />$15,000,000 Each Claim/Agg ! $25,000 Ded. <br />DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />Re: Agreement #A-2017-157, A-2020-079 (1st Amendment), A-2020-158-06 (2nd Amendment), and A-2020-158-29 (3rd Amendment) In City of Santa Ana. <br />GL Additional Insured applies per CG20101219 & CG20371219 attached, only If required by written contract/agreement. <br />GL Primaryy & Non -Contributory Wording applies per XIL4240606 attached. Excess Policy follows form. <br />Additional Insured(s): City of Santa Ana, its officers, agents, volunteers and employees. <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <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 />Cassandra Rosales <br />©1988-2015 ACORD C <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />.� PlekMannipenent DMa[rnt <br />REVIEWED & APPROVm BY: <br />t F4Awt4.e P,, V4,-44aP <br />Risk Mnnagemcnt PoSBlyn <br />59652633 1 UNITPUM-01 1 20-21 All Linea I Cory Hoepedalea 1 1/11/2021 3:53:53 PM (PST) I Page 1 of 5 <br />