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ASDATE
<br />R" CERTIFICATE OF LIABILITY INSURANCE
<br />(MM/DD/YYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />3/21/2017
<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(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER Bolton & Company
<br />CONTACT
<br />NAME:
<br />3475 E. Foothill Blvd., Suite 100
<br />Pasadena, CA 91107
<br />PHONE IFAX
<br />A/C No Ext): 626 799-7000 A/C No): (626) 583-2117
<br />E-MAIL
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />12/31/2016
<br />INSURER A: Greenwich Insurance Company 22322
<br />www.boltonco.com 0008309
<br />INSURED
<br />United Pumpinq Service, Inc.
<br />INSURER B: XL Insurance America, Inc. 24554
<br />INSURER C: XLSpecialty Insurance Company 37885
<br />United Storm Water, Inc.
<br />INSURER D: Indian Harbor Insurance Company_____ 36940
<br />4 Lease, Inc.
<br />14000 East Valley Blvd.
<br />City of Industry CA 91746
<br />INSURER E:
<br />--
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER! 3d7dFd99 RFVISION NIJMRFR-
<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 />ADSL
<br />SUER
<br />NUMBER
<br />POLICPOLICY
<br />MMIDDYEFF
<br />MM/DDN YY
<br />LIMITS
<br />A
<br />/ '', COMMERCIAL GENERAL LIABILITY
<br />✓
<br />GEC3001234
<br />12/31/2016
<br />12/31/2017
<br />EACH OCCURRENCE $ 1,000,000
<br />CLAIMS -MADE 1V OCCUR
<br />DAMAGE TO
<br />PREM SES Ea occur ence $ 50,000
<br />MED EXP (Any one person) $ 5,000
<br />✓ Property Damage Ded $25,000
<br />✓ Bodily Injury Ded $25,000
<br />PERSONAL &_ADV INJURY $ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 2,000,000
<br />'.. POLICY PECTRO ❑ LOC
<br />J
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />$
<br />!. OTHER:
<br />B
<br />AUTOMOBILE LIABILITY _
<br />!, ANY AUTO r ``
<br />AECO048938
<br />AE00048939
<br />12/31/2016
<br />12/31/2016
<br />12/31/2017
<br />12/31/2017
<br />COMBINEDtSINGLELIMIT $ 11000000
<br />(Ea✓ ciden
<br />BODILY INJURY (Per person) $
<br />'.. OWNED SCHEDULED
<br />AUTOS ONLY AUTOSHIRED
<br />BODILY INJURY (Per accident) $
<br />✓ AUTOS ONLY ✓ AUTOS ONLDY
<br />Peri accldenDAMAGE $
<br />Ded Comp & Collision $ 1,000
<br />C
<br />'.. UMBRELLA LIAB
<br />✓
<br />OCCUR
<br />UECO048940
<br />12/31/2016
<br />12/31/2017
<br />EACH OCCURRENCE $ 15,000,000
<br />AGGREGATE $ 15,000,000
<br />✓ EXCESS LIAB
<br />CLAIMS -MADE
<br />':- DED I ✓ RETENTION$0
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE YIN
<br />OFFICER/MEMBEREXCLUDED?
<br />N/A
<br />WEC3001235
<br />12/31/2016
<br />12/31/2017
<br />�/ STATUTE ORH
<br />_ER
<br />EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />D
<br />Pollution Liability
<br />PECO048963
<br />12/31/2016
<br />12/31/2017
<br />15,000,000 Each Claim / $25,000 (Ded)
<br />D
<br />Professional Liab - Claims Made
<br />PECO048963
<br />12/31/2016
<br />12/31/2017
<br />15,000,000 Each Claim / $25,000 (Ded)
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />GL Additional Insured applies per CG20100413 & CG20370413 attached, only if required by written contract/agreement.
<br />GL Primary & Non -Contributory Wording applies per XIL4240605 attached.
<br />Re: Agreement #A-2013-114-03 in City of Santa Ana. Excess Policy follows form.
<br />Additional Insured(s): City of Santa Ana, its officers, agents, volunteers and employees.
<br />[ft -V{FVtiIE BY: 11iFDIA QPcCF :T1
<br />CERTIFICATE HOLDER CANCELLATION
<br />Cit of Santa Ana
<br />Public Works A enc M 22
<br />Construction E geneering
<br />20 Civic Center Plaza
<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 />Santa Ana, CA 92702
<br />Cassandra Rosales
<br />Q 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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