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NAIC # <br />www.boltonco.com 0008309 _ INSURER A Steadfast Insurance Company <br />INSURED INSURER B : Zurich American Insurance Company�_ <br />United Pumping Service, Inc. <br />United Storm Water, Inc. INSURER c <br />4 Lease, Inc. INSURER D: <br />14000 East Valley Blvd. INSURER E: <br />City of Industry CA 91746 <br />COVERAGES CERTIFICATE Nl1MRFR- 9,ina~3arn RFVIfiION NIIMRFR- <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 />TYPE OF INSURANCE <br />ADDL <br />SUER <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MMD/YYYY <br />/D <br />LIMITS <br />A <br />✓ <br />COMMERCIAL GENERAL LIABILITY <br />✓ <br />GPLOO8626700 <br />12/31/2014 <br />12/31/2015 <br />EACHOCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE OCCUR <br />✓ <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence)__ <br />$ SO,000 <br />MED EXP (Any one person) <br />�- <br />$ 5,000 <br />PERSONAL_& ADV INJURY <br />$ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />AGGREGATE <br />$ 4,000,000 <br />POLICY EJ JECT LOG <br />_GENERAL <br />PRODUCTS - COMP /OP AGG <br />$ 2,000,000 <br />I <br />_ <br />$ <br />OTHER: <br />B <br />AUTOMOBILE <br />LIABILITY <br />BAP008625100 <br />12/31/2014 <br />12/31/2015 <br />EO aBINEDtSINGLE LIMIT <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />✓ <br />ANY AUTO <br />1✓ <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />NON -OWNED <br />HIRED AUTOS V/ AUTOS <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />A <br />UMBRELLA LIAB <br />�/ <br />OCCUR <br />SXS008626800 <br />12/31/2014 <br />12/31/2015 <br />EACH OCCURRENCE <br />$ 9,000,000 <br />AGGREGATE <br />_ <br />$ 9,000,000 <br />✓ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I ✓ I RETENTION $0 <br />f <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY �. / N ANY PROPRIETOR /PARTNER/EXECUTIVE <br />WC008625000 <br />12/31/2014 <br />12/31/2015 <br />�/ STATUTE ORH <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />OFFICER /MEMBER EXCLUDED? F-] <br />(Mandatory in NH) <br />N / A <br />E.L. DISEASE - EA EMPLOYE <br />$ 1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />1 $ 1,000,000 <br />A <br />Pollution Liability <br />GPL008626700 <br />12/31/2014 <br />12/31/2015 <br />1,000,000 Each Claim <br />A <br />Professional Liab - Claims Made <br />GPL008626700 <br />12/31/2014 <br />12/31/2015 <br />1,000,000 Each Claim <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />GL Additional Insured and Primary & Non - Contributory wording applies per the STFESP101 ECW0910 attached as required by wirtten contract. <br />Re: Operations of the Named Insured. Additional Insured(s): City of Santa Ana, its, officers, agents, volunteers and employees. <br />UNITED STORM WATER A -2 (..)13- °I'14-0'1 REVIEWED BY. z??"?' � � Z.—I &mtlNICE FiPPEDIA (PG '1 of 4) <br />City of Santa Ana <br />Public Works Department <br />20 Civic Center Plaza M -36 <br />Santa Ana CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />Cassandra Rosales <br />071988 -2014 ACORD CORPORATION, All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />CEAT NO.: 230936S5 CLIENT CODE: UNITPUM 01 N'- icy Cadwallader 1/16/2015 3:;37.97. NM (P9'1) Pace 1. uf 4 <br />