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120 WATER, INC.
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120 WATER, INC.
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Last modified
7/1/2025 1:15:16 PM
Creation date
7/1/2025 1:14:22 PM
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Contracts
Company Name
120 WATER, INC.
Contract #
N-2025-175
Agency
Public Works
Expiration Date
4/6/2027
Insurance Exp Date
6/7/2025
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AC"Rl:> CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) <br /> 111`1� 1 411812025 <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 /> Alliant Insurance Services, Inc. PHONE Paulina Lipinski FAX <br /> 125 High St. Ste. 2205 AIc No): <br /> Boston MA 02110 -ADDRESS: Pauli na.Ll inski alliant,com <br /> INSURERS AFFORDING COVERAGE NAiC# <br /> License#:OC36661 INSURER A:Homeland Insurance Company of 34452 <br /> INSURED INSURER B <br /> 120 Water, Inc. <br /> P.O. Box 604 INSURER C: <br /> Zionsville IN 46077-0604 INSURERD: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:695074136 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 SUBA POLICY EFF POLICY EXP <br /> LTR POLICY NUMBER MMIDDNYYY MMIDDIYYYY LIMITS _ <br /> A X COMMERCIAL GENERAL LIABILITY Y Y 793-01-34-30-0000 7/712024 6/7/2025 EACH OCCURRENCE $1,000,OOD <br /> DA A E TO RENTED <br /> CLAIMS-MADE X OCCUR PREMISES Ea occurrence $100,000 <br /> MED EXP(Any one person) $10,000 <br /> PERSONAL BADVINJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> POLICY JJECOT- 1.00 PRODUCTS-COMPIOP AGO $2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> 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 accldent $ <br /> UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY YIN STATUTE I ER <br /> ANYFROPRIETORIPARTNERIEXECUTIVE <br /> OFFICERIMEMBEREXCLUDED7 NIA E.L.EACH ACCIDENT $ <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) <br /> RE:END-TO-END LEAD AND COPPER COMPLIANCE PROGRAM SOLUTION RENEWAL SERVICES <br /> See the attached endorsements/policy forms for applicable requirements.Refer to page 30-31 for Separation of Insureds provision on the General Liability <br /> �IgRalfy n19n d <br /> 7u Tran ' Tra <br /> r APPROVED <br /> Jg�yen <br /> Nguye n Mr.!N25 ua.z5 <br /> 07:2e16-07100' By Tu Tran Nguyen at 7.27 am,Jun 26,2025 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Attention: (Heidi Chou,Water Resources Division) <br /> 220 S. Daisy Avenue M-85 AUTHORIZED REPRESENTATIVE <br /> Santa Ana CA 92703 <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />
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