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A400RO CERTIFICATE OF LIABILITY INSURANCE
<br />11..
<br />DATE IMMIDDIYYYY)
<br />1/21/2016
<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(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 />3475 E. Foothill Blvd., Suite 100
<br />Pasadena, CA 91107
<br />CONTACT
<br />PHONE FAX
<br />A N 626 799-7000 AIC No: 626 583-2117
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />www.boltonco.com 0008309
<br />INSURERA: Steadfast Insurance Company
<br />26387
<br />INSURED
<br />United Pumping Service, Inc.
<br />United Storm Water, Inc.
<br />INSURER B: Zurich American Insurance Com an
<br />16535
<br />INSURER C :
<br />4 Lease, Inc.
<br />14000 East Valley Blvd.
<br />City of Industry CA 91746
<br />INSURER D;
<br />INSURER E:
<br />INSURER F
<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 />Lm
<br />TYPE OF INSURANCE
<br />ADDLISUBRI
<br />So
<br />Me
<br />POLICY NUMBER
<br />MMIDD�V
<br />MMI[DY�
<br />LIMITS
<br />A
<br />,/ COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE F✓ OCCUR
<br />✓
<br />GPL008626701
<br />12/31/2015
<br />12/31/2016
<br />EACH OCCURRENCE $ 1,000,000
<br />DAMAGES Ea occur ante $ 50,000
<br />MEDEXP(Any on parson) $ 5,000
<br />PERSONAL A ADV INJURY $ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />CPOLICY ✓� JEOT 1-1LOOPRODUCTS-COMP/OP
<br />GENERAL AGGREGATE $ 4,000,000
<br />AGG_ $ 2,000,000—
<br />$
<br />HER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />BAP008625101
<br />12/31/2015
<br />12/31/2016
<br />EeeaaldentSINGLE LIMIT $ 1,000000
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />ALLOWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY Peratedenl $
<br />( )
<br />✓
<br />NON -OWNED
<br />HIRED AUTOS ✓ AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />Ded Cam & Collision $ 1,000
<br />A
<br />UMBRELLA LIAB
<br />[Zj
<br />OCCUR
<br />SXS008626801
<br />12/31/2015
<br />12/31/2016
<br />EACH OCCURRENCE $_110100,000
<br />EXCESS LIAa
<br />I
<br />CLAIMS -MAGE
<br />AGGREGATE $ 11,000,000
<br />DEO ✓ I RETENTION 0
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY VIN
<br />ANY CERIMEETORI EXCLUDED?
<br />OFFICERIMEM BER EXCLUDED4
<br />NIA
<br />WC008625001
<br />12131/2015
<br />12131/2016P
<br />ER OTH-
<br />✓ STATUTE ER
<br />_
<br />E.L. EACH ACCIDENT $ 1,060,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />NH)and
<br />If yas, describe
<br />tys,
<br />E. L. DISEASE -POLICY LIMIT $ 1,000,000
<br />IPTI Nunder
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />Pollution Liability
<br />GPLOO8626701
<br />12/31/2015
<br />12/31/2016
<br />1A00,000 Each Claim
<br />A
<br />Professional Liab - Claims Made
<br />GPLOO8626701
<br />12/31/2015
<br />12/31/2016
<br />1,000,000 Each Claim
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more spar. Ie regclrad)
<br />Re: Pro act #15-6844 / Agreement #A-2015-089, Installation of Connector Piper Screen (CPS) for Residential Catch Basins Located in City of Santa Ana.
<br />GL Additional Insured and Primary & Non -Contributory wording applies per STFESP101 ECW0910 attached as required by wirtten contract.
<br />Additional Insured(s): City of Santa Ana, Its officers, agents, volunteers and employees.
<br />l REVIEWED BY:W EUNICE HEREDIA (PG I OF f'" )
<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 />O
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />20223732 1 ONITPON-01 1 15-16 GL, Auto, Vmb, VIC, POLL, Prof Liab I ASisa Lopez 1 1/21/2016 4: Se!23 PM (PST) I Page 1 u2 4
<br />All rights
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