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Burns <br />Wilcox <br />DATE: 4/7/2021 <br />101 California Street, Suite 975, San Francisco, CA 94111 <br />'415) 421.4244 OR (800) 759.4865 Fax: (415) 421-0620 <br />INSURANCE BINDER <br />Phone: <br />Page 4 of 4 <br />OCCU <br />—_..R...RED.---"]._.... ..-_-__,,,,--_.._- _.-._.... ..-..,._,_,... .___.- - <br />..,-_....-___ _.._.....----.-.- <br />"CG2010 -ADDITIONAL INSURED OWNER, LESSEES OR CONTRACTOR, <br />ENTITY NAMES AS AH: "" ALL ARTISTS PAINTING ELECTCIAL / UTILITY BOXES FOR CITY OF SANTA ANA """ <br />CO2033 -BLANKET ADDITIONAL INSURED -WHEN REQUIRED BY AGREEMENT -DO NOT USE WITH CG2139. <br />OG2404 - BLANKET WAIVER OF SUBROGATION (ADD THE FOLLOWING WORDING TO FORM) "ANY PERSON OR <br />ORGANIZATION WITH WHOM THE INSURED HAS AGREED TO WAIVE RIGHTS OF RECOVERY, PROVIDED SUCH <br />AGREEMENT IS MADE IN WRITING AND PRIOR TO THE LOSS"). <br />CONDITIONS: <br />QUOTE BASED ON ONE MULTI BOX PROJECT AT A FLAT RATE OF $600.00 - MINIMUM PREMIUM APPLIES. <br />1 All INCLUDED FOR THE CONTRACTORS. <br />PLEASE REVIEW THIS BINDER CAREFULLY AS IT MAY DIFFER FROM COVERAQES AND LIMITS REQUESTED, <br />THIS COMPANY BINDS THE KINO(S) OF INSURANCE STIPULATED HEREIN, THE ABOVE COVERAGES ARE THE ONLY COVERAGES BOUND. <br />ANY COVERAGE REQUESTED IN THE APPLICATION THAT DIFFERS FROM THE ABOVE IS NOT INCLUDED. THE INSURANCE IS SUBJECT TO <br />THE TERMS, CONDITIONS, LIMITATIONS, AND FORMS OF THE POLICY(S) IN CURRENT USE BY THE COMPANY. THIS BINDER IS <br />CANCELLED SIXTY (60) DAYS FROM THE EFFECTIVE DATE OR WHEN REPLACED BYAPOLICY, WHICHEVER COMES FIRST. <br />THE AGENT MUST READ THIS CERTIFICATE AND IF NOT CORRECT RETURN IT IMMEDIATELY TO BURNS & WILCOX, LTD. <br />BY: Harvey Goldenberg, Authorized Representative (CA INS LIC # 0626615) <br />aRWEWFD <br />RlekMan�+mnritlYrAafan <br />&AppltoVEDBr: Risk Management Anaiyct <br />