|
304363
<br />ACORL7a CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM /DD /YYYY)
<br />7/5/2016
<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(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 endorsement(s).
<br />PRODUCER
<br />Commercial Lines - (818) 464-9300
<br />Wells Fargo Insurance Services, Inc. - CA Lic #: OD08408
<br />15303 Ventura Boulevard, 7th Floor
<br />NAME: Jonathan Rodriguez
<br />P HONE 818-464-9328 FAX 866 475 -9866
<br />AIC No Ex1: A/C No
<br />E -MAIL onathan.rodri uez4 @wellsfar o.com
<br />ADDRESS: I 9 9
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC k
<br />Sherman Oaks, CA 91403 -3197
<br />INSURERA: Nautilus Insurance Company
<br />17370
<br />INSURED
<br />Ocean Blue Environmental Services., Inc.
<br />INSURER 13: Great Divide Insurance Company
<br />25224
<br />INSURER C:
<br />GEN'L AGGREGATE LIMIT AP PLIES PER
<br />925 West Esther Street
<br />INSURER D:
<br />PRO-
<br />E
<br />--
<br />Long Beach, CA 90813
<br />.INSURER
<br />INSURER F;
<br />PRODUCTS - COMPIOP AGG
<br />COVERAGES CERTIFICATE NUMBER: 10669041 REVISION NUMBER: See below
<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 ?ADDL�SUBR- -- __ -_._ - ..- ._..._ -. - -- - 06CICY EFF POLICY EXP T -- - _....... __- __...... -_.._ _
<br />LTR TYPE OF INSURANCE D POLICY NUMBER i MM /DD/YYYY MM /DD /YYYY LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY X ECP2018650 -10 '07/01/2016
<br />i
<br />07/01/2017 EACH OCCURRENCE ___
<br />li $ 1,000,000
<br />I
<br />CLAIMS -MADE II X OCCUR ( j
<br />DAMAGE TO RENTED
<br />PREMISES_LEa occurrence/..
<br />L_S_ _— .100000
<br />____ _ (
<br />�MEDEXP An one person)
<br />S 5 000
<br />(
<br />PERSONAL 8 ADV INJURY
<br />I
<br />i $ 1,000,000
<br />+ -- -- _
<br />GEN'L AGGREGATE LIMIT AP PLIES PER
<br />GENERAL AGGREGATE
<br />S 2,000,000
<br />PRO-
<br />--
<br />POLICY X LOC
<br />JECT l
<br />PRODUCTS - COMPIOP AGG
<br />I S 2 000 000
<br />X SIR: $20,000
<br />OTHER: t f
<br />�
<br />— —
<br />1$
<br />B
<br />AUTOMOBILE
<br />LIABILITY BAP2018652 -10 07/01/2016
<br />COMBINED SINGLE LIMIT
<br />07/01/2017 Eaaccident
<br />$ 1,000,000
<br />X
<br />ANY AUTO i!
<br />BODILY INJURY (Per person)
<br />ALL OWNED SCHEDULED
<br />AUTOS _. i,
<br />AUTOS
<br />BODILY INJURY (Per accident)
<br />�$
<br />$
<br />X
<br />X ' NON -OWNED
<br />-._ .. -.-
<br />` PROPERTY DAMAGE
<br />.... --
<br />$
<br />HIRED AUTOS
<br />.Leraccident1_. --
<br />- - - -. --
<br />- - -_,., ., _ - -- - - -
<br />x
<br />MCS -90
<br />$
<br />A
<br />UMBRELLA LIAB X OCCUR
<br />--
<br />FFX2018651 -10 07/01/2016
<br />O7JO1/2017 EACH OCCURRENCE
<br />$ 9,000,000
<br />X
<br />AB i
<br />EXCESS LI CLAIMS -MADE
<br />- - 1
<br />AGGREGATE
<br />- -. .._._._. - -_
<br />$ 9,000,000
<br />_- ---
<br />DED RETENTIONS
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />WCA2O1 $653-1 O 07/01/2016
<br />X PER X OTH-
<br />07/01 /2017' STATUTE ER
<br />USL &H
<br />AND EMPLOYERS' LIABILITY Y / N
<br />-- - - --
<br />-,. _
<br />S 1,000 000
<br />ANY PROPRIETOR /PARTNER /EXECUTIVE
<br />OFFICER /MEMBER EXCLUDED> [—Y—]; !N/Al,
<br />E L. EACH ACCIDENT
<br />- - -- - --
<br />- ---- ---_
<br />(Mandatory m NH)
<br />!
<br />! E. L- DISEASE - EA EMPLOYEE
<br />S 1,000,000
<br />If yes, describe under I,,
<br />DESCRIPTION OF OPERATIONS below I'�,
<br />E.L. DISEASE - POLICY LIMIT
<br />.. -
<br />.....................-
<br />S 1,000,000
<br />A
<br />Pollution Liability
<br />07/01!2016
<br />07/01/2017 '', Limits: $1,000,000 Each Occurrence
<br />1
<br />751-10
<br />Ded:$20,000; Occurence Form
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Certificate Holder, its officers, agents, and employees are named as Additional Insured as respects General Liability per policy forms.
<br />This Insurance is primary and non- contribuatory with any other insurance carried by or for the benefit of the additional insured
<br />d
<br />/
<br />(REJkEWEf.? BY: ")NICE I--fEREDIA (PG OF 6,
<br />,.rR I Ir i,_m 1 C riVLUCR I.HIVLCLLA I IU N
<br />City of Santa Ana
<br />Attn: Purchasing Department
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701 -0000
<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 />The ACORD name and logo are registered marks of ACORD ©1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01)
<br />
|