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A� o® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE
<br />E /7/2015wY)
<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(les) 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 endorsement(s).
<br />PRODUCER Bolton & Company
<br />ON A CT
<br />3475 E. Foothill Blvd., Suite 100
<br />Pasadena, CA 91107
<br />PHONE FAX
<br />,;till (626)799 -700o AI&d41: (626) 583 -2117
<br />EMAIL
<br />ADDRESS,
<br />INSURERIS) AFFORDING COVERAGE
<br />NAIC R
<br />INSURER A: Steadfast Insurance Company
<br />26387
<br />www.boltonco.com 0008309
<br />INSURED
<br />United Pumping Service, Inc.
<br />United Storm Water, Inc.
<br />INSURER B: Zurich American Insurance Company
<br />16535
<br />INSURER C:
<br />$ 50,000
<br />INSURER D:
<br />MED EXP (Any one person)
<br />4 Lease Inc.
<br />14000 East Valley Blvd.
<br />City of Industry CA 91746
<br />NsuaeR E:
<br />_
<br />NSURER F:
<br />COVERAGES CFRTIFICATFNINVIFI 0,1=91`17 RFVICIONI NIIMRCR-
<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 />INSM
<br />SUBR
<br />mr,
<br />POLICY NUMBER ------
<br />POLICY EFF
<br />(MMIDDNYYYI
<br />POLICY EXP
<br />IMNVODfYYYY)
<br />LIMITS
<br />A
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS MADE 121 OCCUR
<br />✓
<br />GPLOO8626700
<br />1213112014
<br />12131/2015
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DREM SIB Ea occ. RENTED
<br />men e)
<br />$ 50,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />_
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY [7] JEOT F—] LOG
<br />GENERALAGGREGATE
<br />$ 4,000,000
<br />GEN'L
<br />PRODUCTS COMP /OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />BAP008625100
<br />12/3112014
<br />12/31/2015
<br />EOMBINEDtSINGLE LIMIT
<br />$ 1000000
<br />BODILY INJURY (Per person)
<br />$
<br />✓
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Par accltlenl)
<br />$
<br />✓
<br />NON�OWNED
<br />HIRED AUTOS ✓ AUTOS
<br />PROPERTY DAMAGE
<br />(Par erdara
<br />$
<br />Dad Comp &Collision
<br />$ 1,000
<br />A
<br />UMBRELLA UAB
<br />,/
<br />OCCUR
<br />8X5008626800
<br />12/31/2014
<br />12/31/2015
<br />EACH OCCURRENCE
<br />$ 11000000
<br />AGGREGATE
<br />$ 11,000,000
<br />✓
<br />EXCESS LIAS
<br />CLAIM &MADE
<br />DED
<br />I ✓ I RETENTION$0
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory, in NH)
<br />NIA
<br />WC008625000
<br />12/31/2014
<br />12/31/2015
<br />,/ STATUTE OTH-
<br />BL EACH ACCIDENT
<br />$ 1,000,000
<br />E, L. DISEASE - EA EMPLOYEd
<br />$ 1,000,000
<br />DESCRIPTIONOFOPERATION3below
<br />E.L. DISEASE POLICY LIMIT
<br />1 $ 1,000,000
<br />•
<br />Pollution Liability
<br />GPLOO8626700
<br />12/31/2014
<br />12131/2015
<br />1,000,000 Each Claim
<br />•
<br />Professional Llab - Claims Made
<br />GPL008626700
<br />12/31/2014
<br />1213112015
<br />1,000,000 Each Claim
<br />DESCRIPTION OF OPERATIONS /LOCATIONS (VEHICLES (ACORD IOf, Additional Remarks Schedule, may be attached If more space Is required)
<br />GL Additional Insured and Primary & Non - Contributory wording applies per STFESP101 ECW0910 attached as required by wirlten contract.
<br />Job: Project #15 -6488, Installation of Connector Piper Screen (CPS) for Residential Catch Basins Located in City of Santa Ana.
<br />Additional Insured(s): City of Santa Ana, its officers, agents, volunteers and employees.
<br />UNITED STORM WATER AGR IT TBD PROJECT 15 -6488 REVIEWED BY:_ EUNICE HEREDIA (PG 1 OF 4)
<br />r.�e- alllyrw.rll�Eri��m: .s..ar ..
<br />Project #15 -6488
<br />Cltyy of Santa Ana
<br />Pu b lic Works De a tment
<br />20 Civic Center Plaza ent
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />Cassandra Rosales
<br />91988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />24995137 I UNTTPUM -01 1 14 -15 GL, Akita, Bit, WC, POLL, Prof List I Holton Certificate Processing 1 611/2015 10:03:13 PM IPOTI I Page 1 of 4
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