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n® CERTIFICATE OF LIABILITY INSURANCE
<br />F DATE YY)
<br />1 /16/2015
<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 pollcy(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 endors humor( s).
<br />PRODUCER Bolton & Company
<br />3475 E. Foothill Blvd., Suite 100
<br />Pasadena, CA 91107
<br />CON AC
<br />_
<br />PHONE "— FAX
<br />(626) 799- 7000- A C No): (626) 583„ -2117
<br />E-MAIL _..__.- - „ -__,
<br />ADDRESS,
<br />INSURERS AFFORDING COVERAGE
<br />NAIC p
<br />✓
<br />INSURERA: Steadfast Insurance Company
<br />GPLOO8626700
<br />www,boltonco.com 0008309
<br />INSURED
<br />United PumpiN Service, Inc.
<br />United Storm VV ater, Inc.
<br />INSURER B: Zurich American Insurance Company
<br />$ 1,000,000
<br />---- ----- — —�
<br />INSURER C:
<br />CLAIMS -MADE OCCUR
<br />INSURER D:
<br />4 Lease Inc.
<br />14000 ffast Valley Blvd.
<br />City of Industry CA 91746
<br />INSURER E:
<br />INSURER F
<br />TO -RENTD
<br />PREMISES E. ocr.ence
<br />COVERAGES CERTIFICATE NUMBER: 23093655 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 />INSR
<br />R
<br />TYPE OF INSURANCE
<br />INSD ADDLSUBR
<br />MIT
<br />POLICY NUMBER
<br />MMIDDY�
<br />MMDDY�
<br />LIMITS
<br />COMMERCIAL GENERALUABILITY
<br />✓
<br />GPLOO8626700
<br />12/31/2014
<br />12/3112015
<br />EACHOCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE OCCUR
<br />TO -RENTD
<br />PREMISES E. ocr.ence
<br />$ 50,000
<br />MED EXP (Any one person )
<br />$ 5,000
<br />PERSONAL& ADS INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />POLICY Z PRO-
<br />JECT E LOG
<br />PRODUCTS- COMP /OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />BAP008625100
<br />12131/2014
<br />12/31/2015
<br />EOMBINEDS INGLE LIMIT
<br />$ 1.000.000
<br />BODILY INJURY (Per person)
<br />$
<br />✓
<br />ANYAUTO
<br />ALLOWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />✓
<br />NON-OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />Peraccident
<br />$
<br />A
<br />UMBRELLA LIAB
<br />OCCUR
<br />SXS008626800
<br />12/31/2014
<br />12/31/2015
<br />EACH OCCURRENCE
<br />$ 9000000
<br />AGGREGATE
<br />$ 9,000,000
<br />,/
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED
<br />✓
<br />RETENTION$0
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />WC008625000
<br />12/31/2014
<br />12/31/2015
<br />PER UT 'EA”-
<br />E.L. EACH ACCIDENT
<br />$ 1,090,009
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory, in NH)
<br />EL .DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Pollution Liability
<br />GPLODS626700
<br />12/31/2014
<br />12131/2015
<br />1,000,000 Each Claim
<br />A
<br />Professional Liab - Claims Made
<br />GPLOO8626700
<br />12131/2014
<br />12131/2015
<br />1,000,000 Each Claim
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is reed !red)
<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,/a, its officers, agents, volunteers and employees.
<br />UNITED STORM WATER A- 2013 - 114 -01 REVIEWED BY:zq> , (� EUNICE HEREDIA (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 />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 />AUTHORIZED REPRESENTATIVE
<br />I
<br />reserved.
<br />ACORD 25 (2014/01)
<br />The ACORD name and logo are registered marks of ACORD
<br />CERT NO.: 23093655 CLIENT COU£: UN17PUM -01 Naacy Cadwallader 1/16/2015 3:3'1:41 PM (PST) Page 1 of I
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