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ACORO® CERTIFICATE OF LIABILITY INSURANCE <br />`� <br />DATE(AVAVYYYD <br />1 1 /312020 <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(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WANED, 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 Bolton 8 Company <br />3475 E. Foothill Blvd., Suite 100 <br />Pasadena, CA 91107 <br />www.boltonco.com 0008309 <br />CONTACT <br />NAME: <br />PHONE 626 799-7000 1FAx Ne: 62 583-2117 <br />i1AIL <br />ADDRESS, <br />INSUREINS) AFFORDING COVERAGE <br />NAIC0 <br />INSURERA: Greenwich Insurance Company <br />22322 <br />INSURED <br />United Storm Water, Inc. <br />14000 East Valley Blvd. <br />City of Industry CA 91746 <br />INSURERS: XL Insurance America Inc. <br />24554 <br />INSURERC: XLSpecialty Insurance Company <br />37885 <br />INSURERD: Indian Harbor Insurance Company <br />36M <br />INSURERE: <br />INSURERF: <br />COVERAGES CERTIFICATE NUMBER: 53408109 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 WHCH 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 />INSR <br />Lra <br />TYPEOFINSURANC6 <br />POLICYNUMBEq <br />POLIC-_ <br />M"DrYYYYYY <br />UP <br />MWDOr <br />LIMITS <br />A <br />c """r""--uAeIL" <br />✓ <br />GEC3001234 <br />12/31/2019 <br />12/31/2020 <br />EACHOCCURRENCE <br />S1000000 <br />CLAIMS -MADE F/I OCCUR <br />PREMISES IES m <br />$100 000 <br />MED EMP (A, ore ) <br />$5000 <br />PERSONAL S ADV INJURY <br />$1.000.01)(1) <br />AGGREGATE LIMIT APPLIES PER <br />POLICY E'CT 1_J LOC <br />GENERALAGGREGATE <br />52,000,000 <br />GEML <br />PRODUCTS -COMPMP AGG <br />S2000WO <br />S <br />OTHER: <br />B <br />D <br />"-MOSILELIABILITY <br />ANY AlnO <br />AECO048938/ AECO048939 <br />12/312019 <br />12131/2020 <br />COMBINED SINGLE LIMIT <br />S1000 W0 <br />BODILY INJURY (Par �) <br />S <br />DIVINE ONLY �SCH�ULEpAURCIS <br />BODILY INJURY (Per ecaantl <br />S --- <br />HIRED NON O MED <br />AUTOS ONLY ✓ AUTOS ONLY <br />PROPERTY DAMAGE <br />1 <br />S <br />S <br />C <br />"'tlL1aRELUA Luc <br />accuR <br />UECO048940 <br />12/3112019 <br />12/31/2020 <br />EACHMCURRENCE <br />S15000000 <br />✓ <br />EXCESS LIA6_ <br />C":NADE <br />AGGREGATE <br />515000000 <br />OED <br />✓.I RETENTIONS 10,000 <br />S <br />C'" <br />DEMPLOYE EMPLOYERS'LIABILITY <br />AxbexpwvERs•Luwurr r)x <br />OF CEOPRIETERE%CLER ECUTNE � <br />N)A <br />WEC3001235 <br />12/31/2019 <br />12/31/2020 <br />✓ PS.ETA� &H- <br />E.L EACH ACCIDENT <br />$100D000 <br />EL DISEASE -EA EMPLOYEE <br />S <br />fMendatmy In NH) <br />If yes, descnt,e urWw <br />DESCRIPTION OF OPERATIONS WI. <br />E.L. DISEASE -POLICY LIMIT <br />$1000000 <br />D <br />Pollution Liability <br />PECO048963 <br />121312019 <br />12131/2020 <br />$15,D0o,000 Each Claim I $25,000 Dad. <br />D <br />Professional Liao -Claims Made <br />PECO048963 <br />I <br />12131/2019 <br />121312020 <br />$15,000,000 Each Claim 1$25,000 Dad. <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AGGRO 101, A611dwe1 Remarks Schedule, may M etuNed B mane Space H nequ"d) <br />GL Additional Insured applies per CG20100413 8 CG20370413 attached, only if required by written contract/agreement. <br />GL Primary 8 Non -Contributory Wording applies par XIL4240605 attached. <br />Re: Agreement #A-2017-157 in City of Santa Ana. Excess Policy follows form. <br />Additional Insured(s): City of Santa Ana, its officers, agents, volunteers and employees. <br />CERTIFICATE HOLDER CANCELLATION <br />Re: Agreement #A-2017-157 <br />Santa Ana <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Risk Management Division <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />REVIEWED <br />& APPROVED <br />By Ri <br />MANAGEMENT DIVISION <br />AUTHOR DREPRESEMATIVE <br />Cassandra Rosales <br />n Ub CUCU IH 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2018/03) ACORD name a{nd� tnoT' o are registered marks of ACORD <br />53409/09 1 UNITPIgI-Oi ( 19-20 All Li. G•d' T.HAI 3�.-A rji"{ -TI (PM I Page : cf S _ _ , <br />