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� CERTIFICATE OF LIABILITY INSURANCE <br />°A WYYYYI <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 WANED, subject to the terns 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 81 Company <br />CONTACT <br />3475 E. Foothill Blvd., Suite 100 <br />Pasadena, CA 91107 <br />PHONE 626 7997000 FAX <br />xe: 828 5832117 <br />EMA L <br />ADD E s: <br />INSURE S AFFORDINGCOVERAGE <br />"Co <br />www.boltonco.com 0008309 <br />INSURERA: Greenwich Insurance Company <br />22322 <br />INSURED <br />United Storm Water, Inc. <br />14000 East Val <br />Wit Blvd. <br />INSURest a: XL Insurance America Inc. <br />24554 <br />NSURERC: XI -Specialty, Insurance Company <br />37885 <br />INSURER a: Indian Harbor Insurance Company <br />36M <br />City of Industry CA 91746 <br />INsuaEaE: <br />NSURER:: <br />COVERAGES CERTIFICATE NUMBER: 53411111ing 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 />LTR <br />TYPE OF INSURANCE <br />INfin <br />B <br />VU <br />POLICY NUMBER <br />POLICY EFF <br />POLICY UP <br />UMRe <br />A <br />COMMERCIALGENEMILIABILITY <br />GEC3001234 <br />12/31/2019 <br />12131/2020 <br />EACH OCCURRENCE <br />51000000 <br />PREMISES Ea <br />$100000 <br />CWMS-MADE a OCCUR <br />MED UP( eM pm$gn) <br />$5000 <br />PERSONAL 4 ADV INJURY <br />$1 000 000 <br />APPLIESPER <br />POLICY a JECT F-1LOC <br />GENERAL AGGREGATE <br />52,000,000 <br />GENYAGGREGATEUMR <br />PRODUCTS-COMPATP AGO_ <br />s2000000 <br />5 <br />OTHER <br />B <br />D <br />AUW <br />MOBILE UAeIUTY <br />ANY AUTO <br />AECO048938I AECDO48939 <br />IV312019 <br />12/31/2020 <br />g=SINGLE LIMIT <br />s1000000 <br />BODILY INJURY (Per pemgn) <br />S <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />SODILYINJURY(Pxeco t 1 <br />S <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERWOAMAGE <br />I <br />f <br />S <br />C <br />UMBRELLALIAS <br />V <br />OCCUR <br />UECO048940 <br />12(31I2019 <br />121312020 <br />EACH OCCURRENCE <br />S15000000 <br />.� <br />EXCESS UAW <br />CIAIMSMAOE <br />AGGREGATE <br />51$000000 <br />DED <br />RETENrONf10,000 <br />5 <br />C <br />WORKERSCOMPENSATION <br />AND EMPLOYERS' W1BILITY YIN <br />°FMFCEOPRIST EREX�CLUOED ECUTIVE I <br />NIA <br />WEC3001235 <br />12/3112019 <br />12131/2020 <br />sETAR= t TM <br />E.L EACH ACCIDENT <br />$1000000 <br />El DISEASE -EA EMPLOYEE <br />f <br />(MenfttM In NH) <br />If yb. d.wM .w- <br />E.L DISEASE -POLICY LIMIT <br />$1000000 <br />DESCRIPTIONOFOPERATIONS Wlae <br />D <br />Pollution Liability <br />PECO048963 <br />121312019 <br />121312020 <br />$15,000,000 Each Claim / $25,000 Ded. <br />D <br />Professional Liab - Claims Made <br />PECOD48963 <br />121312019 <br />121312020 <br />$15,000,000 Each Claim / $25,000 Ded. <br />DESCRIPTIONOFOPERATIONSILOCATIONSIVEHICLES(ACOROfe1,Aaft1 R$marmscAa .m$yf IKaeh$aNmo $peaismquimd) <br />GL Additional Insured applies per CG20100413 & CG20370413 attached, only if required by written contractlagreement. <br />GL Primary S Non -Contributory Wording applies per XIL4240605 attached. <br />Re: Agreement #A-2017-157 in City of Sante 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 />City Santa Ana <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />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 />REVI <br />ED & APPROVED <br />BY Ri <br />MANAGEMENT DIVISION <br />AUTHORREDREPRESENTATIVE <br />Cassandra Rosales <br />N U0 LULU ®1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (21316/03) k I ACORD name and logo are registered marks of ACORD <br />53408105 1 aNITPUN-01 1 19-20 All Linea YSAN#AMA <br />R./ 3hWBEEiRTPP. <br />