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Client#: 1376991 <br />3050CPUM <br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDrrm) <br />02101 /2013 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATY��'Nii PATIVELY AMENAE� EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INS CE DOES(hO t;ON$TITUTE 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 be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy; Certain policies may require; an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endoktbment(s). <br />PRODUCER <br />BB&TInsurance Services <br />o range County <br />680 Langsdorf Drive Suite 100 <br />E:CTKimberly Elfring <br />PHONE --- AX— <br />aC No, EKt : 714 578-7022 ac 877-297-9247 <br />E-MAIL ADDRESS -—— kelfring@bbandt.com <br />- - <br />—-------- <br />Fullerton, CA 92831 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER A: Admiral Insurance Company <br />24856 <br />INSURED <br />Orange County Pump Corporation <br />1627 South Boyd Street <br />Santa Ana, CA 92705 <br />INSURER B Everest National Insurance Co <br />10120 <br />INSURER c : Golden Eagle Insurance Corporat <br />10836 <br />INSURER 0, <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMRER- <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 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 />LTR <br />TYPE OF INSURANCE AD <br />+INS <br />tLD SUBR�� <br />*VD'; POLICY NUMBER <br />POLICY EFF <br />MMIOD <br />POLICY EXP <br />MM/DDNYYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />I CA00001372305 <br />1211912012 <br />12/19/2013 <br />EACH OCCURRENCE _ <br />$1 t <br />X COMMERCIAL GENERAL LIABILITY X <br />CLAIMS -MADE Ex OCCUR <br />— <br />! <br />j <br />pAMA�ET O RENTED <br />PREMISES Ea occurrensgi <br />$ 50 OOO <br />MED EXP (Any one person) <br />sEXCLUDED <br />_..._...._.____ <br />' <br />PERSONAL & ADV INJURY <br />$1 ,000,000 <br />GENERAL AGGREGATE <br />s2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: I <br />PRODUCTS - COMP/OP AGG <br />$2 000,000 <br />I <br />CT LOCPOLICY X; PO <br />$ <br />C <br />AUTOMOBILE <br />_ <br />X <br />- <br />X <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS_ AUTOS <br />NON -OWNED <br />HIRED AUTOS X AUTOS <br />I <br />j BA8827101 <br />I <br />12/19/2012 <br />12/19/201 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />1,000,000 <br />I BODILY INJURY (Per person) <br />S <br />BODILY INJURY Per accident <br />( ) <br />S <br />PROPERTY DAMAGE <br />Per accident <br />S <br />_ <br />UMBRELLA LIAB <br />OCCUR <br />I <br />EACH OCCURRENCE <br />$ <br />EXCESS LIAB !..CLAIMS -MADE; <br />j <br />AGGREGATE <br />_ <br />S <br />$ <br />DED RETENTION $ <br />I <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORMARTNER/EXECUTIVE Y f N <br />OFFICERIMEMBER EXCLUDED? !NIA <br />7600008312121 <br />I <br />2/19J2012 <br />12/1912013 <br />X 1 WC STATU- OTH- <br />E.L. EACH ACCIDENT <br />_ <br />S1 00O 000 <br />— <br />E.L. DISEASE - EA EMPLOYEE <br />..,t.—--_—__— <br />51,000,000 <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />-- <br />S1,000,000 <br />I <br />I <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <br />********x#«**«***«*««**«***** SUPERSEDES ANY CERTIFICATE PREVIOUSLY ISSUED «*«******#*******#**«******«**# <br />RE: Job #07-033 & 6th Street and Flower <br />Certificate Holders name is amende to read: City of Santa Ana, its officers, employees, agents, volunteers <br />and representatives and Bill O'Connor. <br />Certificate Holder is/are named as Additional Insured with respect to the General Liability, per form <br />(See Attached Descriptions) APPROVED <br />City of Santa Ana / <br />PWA Water Resources <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />S[it[ PIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AS - S aDt C i t V A Ilofi,jf <br />AUTHORIZED REPRESENTATIVE <br />AJc /4"-' <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010105) 1 of 2 <br />#S9904090/M9904087 <br />The ACORD name and logo are registered marks of ACORD <br />KSELF <br />OQD� <br />