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A� V CERTIFICATE OF LIABILITY INSURANCE
<br />DAT 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 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 />PRODUCERp
<br />Bolton &Com an
<br />3475 E. Foothill Blvd., Suite 100
<br />Pasadena, CA 91107
<br />CONTACT
<br />NAME:
<br />PHO" o t. 626 799-7000 plc No: 626 583-2117
<br />EMAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAICN
<br />✓
<br />INSURERA: Steadfast Insurance Company 26387
<br />www.boltonco.com 0008309
<br />INSURED
<br />United Pumping Service, Inc.
<br />United Storm Water, Inc.
<br />INSURERS: Zurich American Insurance Company 16535
<br />INSURER C:
<br />INSURERD:
<br />4 Lease, Inc.
<br />14000 East Valley Blvd.
<br />City of Industry CA 91746
<br />INSURERS:
<br />INSURERF:
<br />COVFRAc:FR CFRTIFICATIP NI INl 1n11z11n RFa/ISInM NI IMRCR•
<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 />INSD
<br />SUBR
<br />MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDNYYV
<br />POLICY EXP
<br />MMIDDNYVY
<br />LIMITS
<br />A
<br />�/ COMMERCIAL GENERAL LIABILITY
<br />✓
<br />GPLOO8626701
<br />12/31/2015
<br />12/31/2016
<br />EACH OCCURRENCE $ 1,000,000
<br />CLAIMS -MADE EVIOCCUR
<br />DX �AD
<br />PREMISES Ea occurrence) $ 50,000
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 4,000,000
<br />POLICY0 PRO-
<br />JECT [:] LOC
<br />PRODUCTS - COMP/OP AGO $ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />BAP008625101
<br />12/31/2015
<br />12/31/2016
<br />EOeBINdEDtSINGLE LIMIT $ 1000,000
<br />BODILY INJURY (Per person) $
<br />✓
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident) $
<br />✓
<br />NON -OWNED
<br />HIRED AUTOS ✓ AUTOS
<br />PROPERTY DAMAGE $
<br />Per accident
<br />Ded Con -D& Collision $ 1,000
<br />A
<br />UMBRELLA LIAR
<br />V
<br />OCCUR
<br />SXS008626801
<br />12/31/2015
<br />12/31/2016
<br />EACH OCCURRENCE $ 11,000,000
<br />✓
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />AGGREGATE $ 11,000,000
<br />DED I ✓ I RETENTION $0
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y I N
<br />ANY PROPRIETORIPARTNERIEXECDTIVEE.
<br />OFFICERIMEMBER EXCLUDED? EN
<br />NIA
<br />WC008625001
<br />12/31/2015
<br />12/31/2016,/
<br />STATUTE ORH
<br />L. EACH ACCIDENT $ 1,006,900
<br />E, L. DISEASE - EA EMPLOYEE S 1,000,000
<br />(Mandatory In NH)
<br />Has describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E. L. DISEASE -POLICY LIMIT $ 1,000,000
<br />A
<br />Pollution Liability
<br />GPL008626701
<br />12/31/2015
<br />12/31/2016
<br />1,000,000 Each Claim
<br />A
<br />Professional Uab - Claims Made
<br />GPLOO8626701
<br />12/31/2015
<br />12/31/2016
<br />1,000,000 Each Claim
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: Agreement #A-2013-114-02
<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 />REVIEWED BY: EUNICE HEREDIA (PG ,I OF N )
<br />CFRTIFII Kral npR rANlrPI I Anna
<br />Agreement #A-2013-114-02
<br />City of Santa Ana
<br />Public Works De artment
<br />20 Civic Center laza M-36
<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 />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />28233910 I UNITPUM-01 1 15-36 GL, Auto, Umb, MC, PCLL, Prof Iii.ab I Alisa Lopez 11/21/2016 4:56:02 PM (PST) I Page 1 of 4
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