|
DATE(MM/DD/YYYY)
<br /> A` �� CERTIFICATE OF LIABILITY INSURANCE 7/3/2024
<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 CONTACT
<br /> Emily W21SS
<br /> Alliant Insurance Services, Inc. PHONE FAX
<br /> 32 Old Slip A/C No Ext: 'C'No):
<br /> New York NY 10005 ADDRESS: Emi'y,W0i,5seaUient.11m
<br /> I I G #
<br /> INSURERA: Iron Thor S ecialt In rance 25445
<br /> INSURED Anqie WATEQUA-01 INSURER B: LIO'GAS t
<br /> PSI Water Technologies, Inc.
<br /> 550 Sycamore Drive, INSURER C: C mtin an y
<br /> Milpitas, CA 95035 INSURER D: imer;. L,�_ t t 4
<br /> p Acevedo INSURED F , y
<br /> INSL'_RF:<F:
<br /> COVERAGES CERTIFICATE NUMBER:1282080817 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR I POLICY NUMBER MM/DD/YYYY MM/DDIYYYY
<br /> A X COMMERCIAL GENERAL LIABILITY Y IEPICACKBOE003 7/3/2024 7/3/2025 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED
<br /> PREMISES Ea occurrence $500,000
<br /> MED EXP(Any one person) $25,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> PRO-
<br /> POLICY� ECT1:1 LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: $
<br /> C AUTOMOBILE LIABILITY Y 7092528432 7/3/2024 7/3/2025 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> A X UMBRELLALIAB X OCCUR IEELCASKBZ1003 7/3/2024 7/3/2025 EACH OCCURRENCE $10,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000
<br /> DED X RETENTION$n $
<br /> C WORKERS COMPENSATION 7092528446 7/3/2024 7/3/2025 X PER OTH-
<br /> D AND EMPLOYERS'LIABILITY YIN 7092528463 7/3/2024 7/3/2025 STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? NIA
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> A Contractors Pollution Liability IEPICACKBOE003 7/3/2024 7/3/2025 Limit $1,000,000
<br /> B Professional Liability HPL24-0281 7/3/2024 7/3/2025 Limit $2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> WC:7092528446-AOS
<br /> WC:7092528463-CA
<br /> City of Santa Ana,its officers,employees,agents,volunteers,and representatives are Additional Insureds with respect to General Liability and Auto Liability as
<br /> required by written contract.Insurance is Primary and Non-Contributory when required by written contract.
<br /> 30 days'prior written notice of cancellation applies
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF. NOTICF WILL FIF DELIVERED IN
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PRC
<br /> Risk Management Division a„.° "F RUManaganentDtwsicrn
<br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE REVIEWED&APPROVmBY.
<br /> Santa Ana CA 92702 4g;eAecv44
<br /> ® Risk Management Specialist
<br /> ©1988-2015 ACORD
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|