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Association of California Water Agencies / Joint Powers Insurance Authority <br />P.U. Box 619082, Roseville, CA 95661 -9 082 <br />CERTIFICATE OF COVERAGE <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN <br />THOSE PROVIDED IN THE COVERAGE DOCUMENT. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE <br />COVERAGE DOCUMENTS LISTED HEREIN. <br />MEMBER <br />Orange County Water District <br />15700 Warm Street <br />Fountain Valley, GA 92708 -6930 <br />t.\ wr ) S w. <br />/V­acok - <br />COVERAGE INFORMATION <br />This is to certify that coverage documents fisted herein have been issued to the Member Agency herein for the Coverage period indicated. Not withstanding any <br />requirement, term or condition of any contractor other document with respect to which the certificate may be issued or may pertain, the coverage afforded by the <br />coverage documents listed herein is subject to all the terms, conditions and exclusions of such coverage documents. <br />T e of coverage <br />Certificate # <br />Effective Date <br />Expiration Date <br />Limits <br />General Liability <br />MOLC- 100916 <br />1011/2016 <br />101112017 <br />Aggregate $1,000,000 <br />10 Commercial General Liability <br />Per Occurrence $1,000,000 <br />Q Contractual Liability <br />RI Products /Completed Operations <br />© Occurrence <br />Auto Liability <br />MOLC- 100116 <br />10/1/2016 <br />1011/2017 <br />Per Occurrence $1,000,000 <br />RI Owned Autos <br />0 Hired Autos <br />Z Non -Owned Autos <br />Auto Physical Damage <br />Scheduled Autos <br />Hired Autos <br />{ <br />Property <br />yt <br />Special Form <br />rw <br />° <br />Mobile Equipment <br />e <br />Boiler and Machinery <br />�tittip' t <br />r <br />Crime <br />Workers" Compensation <br />Coverage A - Workers' Comp. <br />Coverage B - Employer's Liability <br />DESCRIPTION <br />Regarding: License Agreement for monitoring well SCS -11 (Santiago Park). <br />Additional Covered Party(ies), as required by written contract: City of Santa Ana, its officers, employees, agents, volunteers and <br />representatives, per attached Addendum, <br />CERTIFICATE HOLDER <br />CANCELLATION <br />Should any of the coverage documents herein be <br />cancelled before the expiration date thereof, ACWA /JPIA <br />will c„.t.,^.,. *^ provide 30 days written notice to the <br />certificate holder named herein. <br />City of Santa Ana <br />Parks, Recreation & Community Services Agency <br />AUTHORIZED REPRESENTATIVE DATE <br />26 Civic Center Plaza <br />Santa Ana, CA 92701 <br />8/10/2016 <br />