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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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,�cv�® CERTIFICATE 4F LIABILITY INSURANCE DATE(MMIDDIYYYY} <br /> 6/25/2025 <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 /> NAME: Man6 e oint LLC <br /> Accretive Global Risk Advisors, LLC PHONE FAX <br /> dba Libertate Insurance Services AIC i <br /> E-MAIL <br /> 20 N.Orange Avenue, Suite 500 ADDRESS: qqb.teguesta.certs@alq.com <br /> Orlando, FL 32801 INSURERS AFFORDING COVERAGE NAIC# <br /> www.libertatEilrs.com INSURER A: Key Risk Insurance Company 10885 <br /> INSURED ENSURER B: <br /> Manarpoint, LLC <br /> 9119 Otis Avenue INSURERG: <br /> Indianapolis IN 46216 INSURERD: <br /> INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 85922418 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 /> INTR ADDTYPE OF INSURANCE INSD SUBRWVD POLICY NUMBER MMID�mYY MMlDD1Y� LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> 171 DAMAGE TO RENTED <br /> CLAIMS-MADE OCCUR PREMISES Ea oocurrerce $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJU RY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ <br /> POLICY❑PRO- <br /> JECT ❑ LOG PRODUCTS-COMP/OPAGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Par person) $ <br /> OWNED SCHEDULED (Per aocidenl <br /> AUTOS ONLY BODILY INJURY P AUTOS ( ) $ <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per a.do.tj <br /> UMBRELLALIAB H OCCUR EACH OCCURRENCE $ <br /> EXCESS L1AD CLAIMS-MADE AGGREGATE $ <br /> Dii I I RETENTION$ $ <br /> A WORKERS COMPENSATION KEYPE000003501 12/1/2024 12/1/2025 s7aTurE DTH <br /> AND EMPLOYERS'LIABILITY YIN <br /> ER <br /> ANYPROPRIETORlPARTNERIEXECUTIVE E,L.EACHACCIDENT $1,000,000 <br /> OFFICERlMEMBEREXCLUOED7 � N 1 A <br /> (Mandatory In NH} E.L.DISEASE-EA EMPLOYEE $1.000,00 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000 000 - <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> THIS CERTIFICATE CONFERS NO ADDITIONAL INSURED RIGHTS UPON THE CERTIFICATE HOLDER. <br /> Coverage provided in all states(except in monopolistic states)for all leased employees but not subcontractors of: <br /> PEO Client:120Water,Inc. Effective 12/01/2020 <br /> Waiver of Subrogation in favor of City of Santa Ana <br /> ffAPPROVED <br /> Tu Tran Nguyen at 7 2T am,Jun 26,2025 <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Water Services Quality Coordinator ACCORDANCE WITH THE POLICY PROVISIONS, <br /> 215 S Center St <br /> Santa Ana CA 92703 AUTHORIZED REPRESENTATIVE <br /> Paul R.Hughes <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(20161031 The ACORD name and logo are registered marks of ACORD <br /> e5922419 I Master NITA RW08 I pam Summers L 6/25/2025 20:52:e1 AM (EDT) I Page 1 of 1 <br /> This certificate cancels and uuperse es ALL previously issued certificates. <br />
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