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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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AR©, CERTIFICATE OF LIABILITY INSURANCE rATE <br /> (MMID fY Y) <br /> 11`.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 1NSURER(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. NAME: Aimee Smith <br /> PHONE FAX <br /> 32 Old Slip 29th FI c Arc No <br /> New York NY 10005 E-MAIL Aimee.Smith@aIlianl.com <br /> INSURER S.AFFORDING COVERAGE NAIC# <br /> Licenser€:OC36861 INSURER A:Houston Casualty Company 42374 <br /> INSURED 120WATE-01 INSURER B: <br /> 120 Water, Inc. <br /> 250 S Elm Street INSURER C: <br /> Zionsville IN 46077 INSURERD: <br /> INSURER E <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER:1179352150 REVISION NUMBER: <br /> THIS 15 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 /> INSit TYPE OF INSURANCE ADOL SUBR POLICY EFF POLICY EXP <br /> LTR POLICY NUMBER MMJDDfYYYY) (MMIDDfYYYYL LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED <br /> PREMISES Ea occurrence $ <br /> MED EXP(Any une person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY JECTPRO- <br /> LOG PRODUCTS-COMPlOP AGG $ <br /> OTHER: 3 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) S <br /> OWNED SCHEDULED BODILY INJURY Per accident $ <br /> AUTOS ONLY AUTOS ( 1 <br /> HIRED NON-OWNED PROPERTYDAMAGE <br /> AUTOS ONLY AUTOS ONLY Per accident $ <br /> UMBRELLA LIAe OCCUR EACH OCCURRENCE- <br /> EXCESS LAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTIONS $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER <br /> ANYPROPRIETOR/PARTNERIEXECUTIVE <br /> OFFICERlMEMBEREXCLLIDED? ❑ N f A E.L.EACH ACCIDENT 5 <br /> [Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below EL,DISEASE-POLICY LIMIT <br /> A Cyher Liability Y Y H24TG34885-00 6/7/2024 6f7l2025 Each ClaimlAggregate $2,000.000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> City of Santa Ana,its City Council, its officers,officials,employees,agents,and volunteers are included as Additional Insured with regards to the Cyber Liability <br /> as required by written contract subject to the policy terms and conditions.Coverage is Primary and Non-Contributory with regards to the Cyber Liability as <br /> required by written contract subject to the policy terms and conditions.Waiver of Subrogation applies with regards to the Cyber Liability as required by written <br /> contract subject to the policy terms and conditions.30 days notice of Cancellation applies,except non payment of premium which is 10 days,in accordance with <br /> the terms and conditions of the policy. <br /> APPROVED <br /> CERTIFICATE HOLDER CANCELLATION ByTu Tran Nguyen at 7:27 am,.fury 26,2025 <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 /> O 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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