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Francine R. Digitally signed by Francine R. <br />Villareal <br />Villareal Date: 21121.04.07 11ANI <br />-0700' <br />All ORO® CERTIFICATE OF LIABILITY INSURANCE <br />la.� <br />DATE IMWDD/YYYYI <br />1 03/18/2021 <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 />PaooucER <br />ISU Insurance Services Cormarc Tasman <br />25220 Hancock Ave, Suite 230 <br />Murrieta, CA 92562 <br />CONTACT <br />NAME: Kelvin Waniwan <br />PHONE (951)290-5040 FAX Ne: (951)278-0664 <br />E-MAIL ADDRESS: kelvin@isucormarc.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIC4 <br />License #: OE63467 <br />INSURERA: Evanston Insurance Company <br />35378 <br />INSURED <br />INSURER B: United Financal Casualty Co. <br />11770 <br />ALL CITIES ENGINEERING,INC <br />INSURER C: State Compensation Insurance Fund <br />35076 <br />PO BOX 51405 <br />INSURER IS: Ohio Security Insurance Co <br />24082 <br />BILLINGS, MT 59105 <br />INSURE: <br />ER <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 00000975-3200135 REVISION NUMBER: 83 <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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 />LTR <br />TYPE OF INSURANCE <br />ADDLSUBR <br />POLICYNUMBER <br />PODGY EFF <br />MMIDD <br />POLICY UP <br />MwDDIYYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE %( OCCUR <br />y <br />MKLV5PBC002885 <br />02/1212021 <br />02/12/2022 <br />EACH OCCURRENCE <br />$ 1 000000 <br />DA AGE REN D <br />PREMISES t —NITE noe <br />$ 300,000 <br />MED UP (AM one person) <br />$ 10,000 <br />PERSONAL$ AM INJURY <br />$ 11000.000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY JELOC <br />T <br />GENERAL AGGREGATE <br />$ 2000000 <br />2,000,000 <br />$ <br />OTHER: <br />B <br />06656482-2 <br />03/2712021 <br />03/27/2022 <br />EOaeBBINEDSINGLELIMIT <br />$1000000 <br />BODILY INJURY(Par person) <br />$ <br />ANYAUTO <br />PONIOBILELIABIUTY <br />OV.NED SCHEDULEDAUTOS ONLY X AUTOSBODILY <br />INJURY(Per loc�Jtlen[) <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY X AUTOSONLV <br />PROPERTY DAMAGE$ <br />Per actldent <br />A <br />UMBRELLALIAB <br />X <br />OCCUR <br />MKLVSEUL103060 <br />07J1212021 <br />0211212022 <br />EACHOCCURRENCE <br />$ 3,000,000 <br />AGGREGATE <br />$ 3,000,000 <br />X <br />EXCESS LAB <br />CLAIM'MADE <br />OEO I I REIENTON$ <br />$ <br />C <br />MWERSCOMPENSATON <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTME YIN <br />OFFICERIMEMBER EXCLUDES? <br />(Maud-ii'm NH) <br />NIA <br />9284998.20 <br />10/03/2020 <br />10/0312021 <br />TH- <br />it ISTATUTE ER <br />E.L EACH ACCIDENT <br />$ 1,000,000 <br />E.L DISEASE -EA EMPLOYEE <br />S 1,000,000 <br />DESCRIPTION OF OPERATIONS balmy <br />El- DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />D <br />Contractors Equipment <br />BM069653304 <br />08/08/2020 <br />0810812021 <br />Leased a Rented <br />75,000 <br />Deductible <br />1,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) <br />RE: 15.6446; Saint Gertrude and Grand Ave Water Main <br />City of Santa Ana, its Officers, employees, agents and representatives are named a additional insured with respects to general <br />liability per CG20100704/CG20370704. Insurance is Primary and Non -Contributory per CG20010413. "Except 10 day notice for <br />non-payment of premium/30 days for all other reason. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana CITY20C THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Risk Managment Division 4th Floor ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE <br />©1988-2015 ACORD Co .g�""""`t,.M°n°BO1M"tB1OR <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD e9: a REVIEWFDSAPPRovED BY: <br />Printed by K% Flail is., VWA44d <br />Risk Management Analyst <br />