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/-- N OCEABLU-06
<br />IDAVIS2
<br />DATE(MM/ODIYYYY)
<br />5/6/2024
<br />.A4* 2 CERTIFICATE OF LIABILITY INSURANCE
<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 ADD Ti0JNA_\L�I/N.SaW ED, thI11]eme[Ppa�li,,��}'(�l.e,,a must ADDITIONAL INSURED provisions or be endorsed.
<br />AU GA IVED, subject to the G rin r fLcl�ldtjth9)t.�(i�'N phismay require an endorsement. A statement on
<br />1 n c nfer ri hts to the certi0� rite h�ioldB�Illn Ileu offsyss(GGG�ch�—en-d sement s . J
<br />Lie e 5 76 Y1
<br />Angle A
<br />colurncT I' Davis
<br />HUB Internet! i surance Services Inc.
<br />9855 Scranton Road
<br />Suite 100 Date.
<br />S iego, CA 92121
<br />FAx
<br />(A/C, No, Est: 825-2681 A/C. No :(951) 231-2572
<br />A I is@hubinternational.com
<br />R B AFFORDING COVERAGE
<br />NAIC N
<br />INsu - s Insurance Company
<br />17370
<br />_
<br />SL
<br />IN isk Insurance Company
<br />10885
<br />INSURER C -Great Divide Insurance Company
<br />25224
<br />Ocean Blue Environmental Services, Inc.
<br />INSURER 0
<br />925 West Esther Street
<br />Long Beach, CA 90813
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER' RFVIRIr7N N[IMRFR-
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVEBEEN ISSUEDTOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY UPAJIL
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FA] OCCUR
<br />X
<br />X
<br />GLP2040732.10
<br />711/2023
<br />71112024
<br />EACH OCCURRENCE
<br />1,000,000
<br />DAMAGETORENTED
<br />100,000
<br />MED EXP (Any oneperson)
<br />5,000
<br />PERSONAL B ADV INJURY
<br />1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY JE2T LOC
<br />GENERALAGGREGATE
<br />2,000,000
<br />GENT
<br />X
<br />PRODUCTS - COMP/OP AGG
<br />2,000,000
<br />X
<br />OTHER- DED: $50,000
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />$ 1,000,000
<br />X
<br />BODILY INJURY Per arson
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOSpS
<br />X
<br />X
<br />BAP204073510
<br />711/2023
<br />7/1/2024
<br />BODILY INJURY Per accident
<br />Por.OP.E.Eent AMAGE
<br />X
<br />AIIIRTOS ONLY AUTO ONLY
<br />MCS-90 Pollution
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />9,000,000
<br />AGGREGATE
<br />91000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />FFX2040737-10
<br />7/1/2023
<br />711/2024
<br />DED I I RETENTION$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE YIN
<br />OFFICEtory EMBERn NH) EXCLUDED? ❑N
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />X
<br />WCA2040736-10
<br />711/2023
<br />7/1/2024
<br />X PER OTH-
<br />E.L. EACH ACCIDENT(Manda
<br />1000000
<br />E.L. DISEASE - EA EMPLOYE
<br />1,,000,,000
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />A
<br />Pollution Liability
<br />X
<br />CPP2040739-10
<br />7/1/2023
<br />71112024
<br />Each Occ/Aggregate
<br />5,000,000
<br />A
<br />Professional Liabili
<br />CPP2040739.10
<br />7/1/2023
<br />71112024
<br />Aggregate
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />RE: Project Number: A-2021-198; First Amendment To Agreement To Provide Spill Response, Hazardous Waste Disposal, And Storm Drain Facility
<br />Maintenance Services
<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 CG2038 12/19 and CG2040 12119. Primary wording applies with regards to the General Liability policy when
<br />required by a written contract, per the attached endorsement form CG2001 12119. 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 BENVCA0619/17. Waiver of Subrogation applies with regards t0 the Auto Liability
<br />SEE ATTACHED ACORD 101
<br />SHOULD ANY OF THE ABOVE DESCF
<br />City of Santa Ana THE EXPIRATION DATE THEREr
<br />ACCORDANCE WITH THE POLICY PR
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702 AUTHORIZED
<br />REPRESENTATIVE
<br />7.r�rdL%&r-rdLL
<br />ACORD 25 (2016/03) @ 1988-2015 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />REVIEWED & APPROVED By:
<br />A-f , AuI
<br />Risk Management Spedalist
<br />
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