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<br />bCERTIFICATE OF LIABILITY INS1JRAE n
<br />THIS
<br />CERTIFICATEATE RCATE IS ISSUED AS A MATTER OF DOES NOT AFFIRMATIVELY OR NEGATVELIYTION AMEND, EXTEND OR ALTEfiONLY AND CONFER** PDXf:EACOM-hi1EMIITIM
<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 endorsementfs).
<br />PRODUCER ""euav m m au r v
<br />HUB International Insurance Services Inc.
<br />9855 Scranton Road
<br />Suite 100
<br />San Diego, CA 92121
<br />...... Allsna UaVls
<br />jacD,NNo, Ext): (877) 825-2681
<br />E- DRlEss: alisha.davis@hu
<br />_
<br />INSURED
<br />Ocean Blue Environmental Services, Inc.
<br />925 West Esther Street
<br />Long Beach, CA 90813
<br />COVERAGES CFRTIFICATF NIIMRFR• RPVISInM MI IMRRD•
<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 />TYPE OF INSURANCE
<br />ADDLSUBR INSD
<br />MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPJJJL
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />GEC300156802
<br />711/2022
<br />71112023
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />Ea occurr n
<br />100,000
<br />MED EXP (Any one Isarson
<br />$ 5,000
<br />PERSONAL B ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE
<br />POLICY
<br />OTHER:DED:$5,000
<br />LIMIT APPLIES PER
<br />jE�T LOC
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />GENL
<br />X
<br />PRODUCTS - COMPIOP AGG
<br />$ 2,00%000
<br />X
<br />B
<br />AUTOMOBILELIABILITY
<br />OMBIINE SINGLELIMIT
<br />Ed
<br />$ 1,000,000
<br />X
<br />BODILY INJURY Per arson
<br />$
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />X
<br />X
<br />AECO05699102
<br />711/2022
<br />71112023
<br />INJURY Per accident
<br />X
<br />BODILY
<br />Pa0F.E tlent AMAGE
<br />WN
<br />AUTOS ONLY AUUTOS ONLY
<br />MCSAO Pollution
<br />Hazardous Waste
<br />5,000,000
<br />C
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />OCCUR
<br />CLAIMS -MADE
<br />UECO05699202
<br />711/2022
<br />7/1/2023
<br />EACH OCCURRENCE
<br />$ 9,000,000
<br />X
<br />M
<br />AGGREGATE
<br />1 91000,000
<br />DED IXI RETENTION$ 10,000
<br />B
<br />WORKERSAND COMPENSATION
<br />OMP N LIABILITY RNY
<br />AANY PROPRIETOWPARTNEmEXECUTIVE YIN
<br />(Mandarory in NH) EXCLUDED?
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />X
<br />WEC300156702
<br />71112022
<br />7/1/2023
<br />X PER IJTE I
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />1,000,000
<br />E.L. DISEASE -POLICY LIMH
<br />1,000,000
<br />C
<br />Pollution I Environm
<br />X
<br />PECO05703302
<br />7/1/2022
<br />7/112023
<br />Each Occ/Aggregate
<br />5,000,000
<br />C
<br />Professional Liab
<br />PECO05703302
<br />7/112022
<br />71112023
<br />Each Occ/Aggregate
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
<br />RE: A-2021.097-01 and RFP #21-004
<br />City of Santa Ana, officers, agents, employees, and volunteers are Additional Insured's with regards to the General Liability policy when required by a written
<br />contract, per the attached endorsement forms CG201012119 and CG2037 12/19. Primary wording applies with regards to the General Liability policy when
<br />required by a written contract, per the attached endorsement form XIL424 06/05. Waiver of Subrogation applies with regards to the General Liability policy
<br />when required by a written contract, per the attached endorsement form CG2453 12119. Additional Insured applies with regards to the Auto Liability policy
<br />when required by a written contract, per the attached endorsement form XIC411 10113. Waiver of Subrogation applies with regards to the Auto Liability policy
<br />when required by a written contract, per the attached endorsement form CA04" 10113. Auto Pollution applies per the attached form CA994810113. Waiver of
<br />SEE ATTACHED ACORD 101
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />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 />AUTHORIZED REPRESENTATIVE
<br />bH6�At/,3L„
<br />ACORD 25 (2016103) 01988-2015 ACORD I
<br />The ACORD name and logo are registered marks of ACORD
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<br />REMEWED &APPRCNEDRY °..
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<br />Risk Mznzgemen[Specizlist
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