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DIVEWAT-01
<br />VASQUEZI
<br />r
<br />ACOROW CERTIFICATE OF LIABILITY INSURANCE
<br />FWDATE (MMIDDIYYYY)
<br />7/7/2025
<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 License # OE67768
<br />CONTACT Isabel Vasquez
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (916) 692-7022 (A/C, No):
<br />IOA Insurance Services
<br />3009 Douglas Blvd.
<br />Suite 110
<br />E-MAIL-ADDRESS: Isabel.Vasquez@ioausa.com
<br />Roseville, CA 95661
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA:AXIS Surplus Insurance Company
<br />26620
<br />INSURED
<br />INSURER B :
<br />INSURER C7
<br />Diversified Waterscapes Inc
<br />INSURERD:
<br />27324 Camino Capistrano #213
<br />Laguna Niguel, CA 92677
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />rl
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />EMP1900099807
<br />5/15/2025
<br />5/15/2026
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />100,000
<br />$
<br />MED EXP (Any oneperson)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />X
<br />POLICY PRO LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />POLLUTION PROFE
<br />$ 2,000,000
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY DAMAGE
<br />ccident
<br />Per accident)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />EMX1900023407
<br />5/15/2025
<br />5/15/2026
<br />AGGREGATE
<br />$ 2,000,000
<br />DED RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />PER OTH-
<br />STATUTE ER
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />E.L. EACH ACCIDENT
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />A
<br />Pollution Liability
<br />X
<br />EMP1900099807
<br />5/15/2025
<br />5/15/2026
<br />Aggregate
<br />2,000,000
<br />A
<br />Pollution Liability
<br />EMP1900099807
<br />5/15/2025
<br />5/15/2026
<br />Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />PO Number 6785-1
<br />The City of Santa Ana, it's officers, employees, agents, and representative are named as Additional Insured with respect to General Liability and Pollution
<br />when required by written contract per form# CG2010 0704 and PGI EL 018 0210
<br />Certificate Holder is Additional Insured with respect to General Liability and is Primary and Non -Contributory, when required by written contract per form# PGI
<br />EL 020 0210
<br />Each insurance policy required above shall provide that coverage shall not be canceled, except with notice to the Entity. City will be mailed 30 days written
<br />notice of policy cancellation.
<br />APPROVED
<br />By Tu Tran Nguyen at 9:34 am, Aug 05, 2025 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 />City of Santa Ana AUTHORIZED REPRESENTATIVE
<br />Risk Management Division
<br />Digitally signed
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<br />The ACORD name and logo are registered marks of ACORD
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