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<br />250152
<br />AC40 O' CERTIFICATE OF LIABILITY INSURANCE
<br />DAT2 /28/2013YY)
<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 a -endo ed. 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 endorsement(s).
<br />PRODUCER
<br />Wells Fargo Insurance Services USA, Inc.
<br />CA DOI Lic. #OD08408 (916) 589 -8000
<br />10940 White Rock Road, 2nd floor
<br />Rancho Cordova, CA 95670 -6076
<br />NAME CT Tracy Dolan
<br />PHONE 916 589 -8 53 FAX 877 611 -1971 No.
<br />A/C No
<br />E-MAIL
<br />ADDRESS: tracy.dolan @wellsfargo.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Zurich American Insurance Co
<br />16535
<br />INSURED
<br />Zim Industries, Inc. DBA:Bakersfeld Well &Pump Company
<br />4545 E. Lincoln
<br />INSURER B: Fireman's Fund Insurance Company
<br />21873
<br />INSURER C: Aspen American Insurance Company
<br />43460
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 100,000
<br />MED EXP (Any one person)
<br />INSURER D:
<br />PERSONAL & ADV INJURY
<br />INSURER E
<br />Fresno, CA 93725
<br />INSURER F:
<br />.�cc ucww
<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
<br />LTR
<br />I TYPE OF INSURANCE
<br />ADDLSUBR
<br />POLICY NUMBER
<br />MMIDDY/YYYY
<br />MM /DD/YYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE IJ OCCUR
<br />GL0831166209
<br />3 -1 -13
<br />3 -1 -14
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 100,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,000
<br />POLICY X PRO LOC
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />BAP831166309
<br />3 -1 -13
<br />3 -1 -14
<br />EO MBIINdEeDi SING LE LIMIT
<br />$ 1,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />B
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />SSE 00015019979
<br />3 -1 -13
<br />3 -1 -14
<br />EACH OCCURRENCE
<br />$ 9,000,000
<br />AGGREGATE
<br />$ 9.000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y/N
<br />ANY PROPRIETORIPARTNER/EXECUTIVE
<br />OFFICER /MEMBER EXCLUDED? ❑
<br />N/A
<br />WC831166109
<br />3 -1 -13
<br />3 -1 -14
<br />X WC STATU- OTH-
<br />T T
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT 1
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />C
<br />C
<br />C
<br />Installation /Builders Risk
<br />Rented /Leased Equipment
<br />Scheduled Equipment
<br />IMAC95131513
<br />IMAC95D513
<br />IMAC95D513
<br />3 -1 -13
<br />3 -1 -13
<br />3 -1 -13
<br />3 -1 -14
<br />3 -1 -14
<br />3 -1 -14
<br />$1,000,000
<br />$100,000
<br />$14,006,100
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as Additional Insured on the General Liability policy per the
<br />form attached, Primary and non - contributory wording applies.
<br />APPROVED AS TO t
<br />- '-- '-- ' - - - -'- I IVIY
<br />City f Santa Ana Laur SLM Shcedy
<br />y ?AS51SLd[lt City AIIOrne}' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />PWA, Water Resources y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />220 S. Daisy Avenue (M -85) ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92703 AUTHORIZED REPRESENTATIVE
<br />— 11011- 041u IUYU dle leyisereu marKS or Al,,UNU v 1aus -ZU1U ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05)
<br />
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