Item 16 - Agreements for On -Call Environmental Services

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DocuSign Envelope 10: FC7E9346-8A22-4923-BD05-AA3CA0439841 DATE (MMIDDf] ,d►co►2o CERTIFICATE OF LIABILITY INSURANCE 8/28/2023 8/17/2022YYYY THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER Lockton Companies NAMECT 444 W. 47th Street, Suite 900 PHGHE FAX Kansas City MO 641 12-1906 E-MAIL Ext : A!C No (816)960-9000 ADDRESS: kcasu@lockton.com INSURERS AFFORDING COVERAGE NAIC 0 INSURER A: Zurich American Insurance Comr)anv 16535 INSURED DUDEK 1475107 605 THIRD STREET ENCINITAS CA 92024 INSURER B : American Guarantee and Liab. Ins. Co. 26247 INSURER C :Continental Casual man 20443 INSURER D : INSURER E COVERAGES CERTIFICATE NUMBER: 1676574S REVISION NUMBER: xxxxxxx THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDWYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE NIOCCUR Y Y GLO0146311 8/28/2022 8/28/2023 EACH OCCURRENCE $ 1000 000 DA AGE To PREMISES EaEoccurrence $ 100,000 _7RNTED AHED EXP (Arty one person) $ 10,000 PERSONAL d ADV INJURY $ 1,000,000 GENT AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- � LOC PRODUCTS - COMWOP AGG : 2,000,000 S OTHER A AUTOMOBILE LIABILITY y y BAP0146329 9/28/2022 8/28/2023 Ea BCGdeD151N LE LIMIT $ 1,000,000 x BODILY INJURY (Per person) S xxxxxxx ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per aooldent] S xxxxxxx PROPERTY DAMAGE Per acadent $ xxxxxxx HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $xxxxxxx B x UMBRELLA LIAB X OCCUR N Y AUC0146407 8/28/2022 8/28/2023 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ xxxxxxx AAND WORKERS COMPENSATION EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFF ICERIMEMBER EXCLUDED? F (Mandatory in NH) NIA Y WC0146330 $12$12022 $12812023 PER OTH. STA TE ER $ 1,000,000 $ 1,000,000 E.L.EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE If es, describe under DESCRIPTION OF OPERATIONS below $ l 000 000 E.L. DISEASE - POLICY LIMIT C PROFESSIONAL N N EEH591932835 INCL POLL 8/28/2022 8/28/2023 PER CLAIM $1,000,000 LIABILITY AGGREGATE $2,000,000 INCLUDES POLLUTION DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CITY OF SANTA ANA, OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE ADDITIONAL INSURED ON GENERAL AND AUTO LIABILITY COVERAGE ON A PRIMARY, NON-CONTRIBUTORY BASIS, AS REQUIRED BY WRITTEN CONRACT WAIVER OF SUBROGATION IN FAVOR OF THE ADDITIONAL INSURED APPLIES ON WORK COMP, GENERAL, AUTO AND UMBRELLA LIABILITY COVERAGE, AS REQUIRED BY WRITTEN CONTRACT AND WHERE ALLOWED BY LAW. COVERAGE IS SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. rF:PTIFIrATF Wni nl=P rAM9'_1=1 I OTIn1d Caa Aftnrhmantc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 16765248 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF SANTA ANA RISK MANAGEMENT DIVISION AUTHORIZED REPRESENTATIV 20 CIVIC CENTER PLAZA SANTA ANA CA 92702 L 1 1 _� M _& a I @ 1988L-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD