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,ate RbP CERTIFICATE OF LIABILITY INSURANCE
<br />DATE/21/2017wi
<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 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 />3475 E. Foothill Blvd., Suite 100
<br />Pasadena, CA 91107
<br />CAMEACT
<br />PHONED a 826 799-7000 Al No)' 626 583 -2117_ -
<br />L--- G (—L --
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC9
<br />,/
<br />INSURER A; Greenwich Insurance Company 22322
<br />www.boltonco.com 0008309
<br />_ _
<br />INSURED
<br />United Pumpingg Service, Inc.
<br />B: XL Insurance America , Inc.24554
<br />_INSURER
<br />NSURERC_ec:i0ty Insurance Company 37885
<br />United Storm Water, Inc.
<br />INSURER D: Indian Harbor Insurance Company
<br />36940
<br />4 Lease, Inc,
<br />14000 East Valley Blvd,
<br />City of Industry CA 91746
<br />INSURER E:
<br />—
<br />INSURER F:
<br />—
<br />COVERAGES CERTIFICATE NUMBER' gd7AgdIA RFVISION NUMRFR-
<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 />ILTR
<br />TYPE OF INSURANCE
<br />A
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY XP
<br />MMMDM'tE,,.n�l
<br />LIMITS
<br />A/
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑✓ OCCUR
<br />,/
<br />GEC3001234
<br />12/31/2016
<br />12/31/2017RENCE
<br />$ 1,000,000
<br />occurren S 50,000
<br />one paracn) $ 5,000
<br />PrOpertV Damag2 Dad $25000
<br />DV INJURY S 1,000,000
<br />✓'Bodily lniUNDed $25000
<br />GEN'L AGGREGATE LIMIT' APPLIES PER:
<br />POLICY Z JECT El LOC
<br />REGATE $ 2,000,000
<br />OMP/OP AGO S 2,000,000
<br />$
<br />''. OTHER:
<br />B
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />AECO048938
<br />AECO048939
<br />12/31/2016
<br />12/31/2016
<br />12/31/2017
<br />12/31/2017
<br />COMBINEDetSING ELIMIT $ 1 000000
<br />BODILY INJURY (Par parson) $
<br />". AUTOS ONLY AUTOS SCHEDULED
<br />'AUTOS
<br />✓ AUTOS ONLY ✓ AU OSONLHIRED CY
<br />BODILY INJURY ( Pekeccldent $
<br />)
<br />Pte.ccdmmnPERTY �GE $
<br />Dad Comp &Collision $ 1,000
<br />C
<br />UMBRELLALIAS
<br />/
<br />OCCUR
<br />UE00048940
<br />12/31/2016
<br />12/31/2017
<br />_EACH OCCURRENCE $ 15,000000
<br />✓ EXCESS LIAB
<br />CI -MMS -MADE
<br />_
<br />AGGREGATE $ 15,000,000
<br />OED ✓ RETENTION$O
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANWROPRIETOWPARTNEWEXECUTIVE YIN
<br />OFFICENMEMBEREXCLUOED9
<br />(MandomrylnNH)
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />WEC3001235
<br />12/31/2016
<br />12/31/2017
<br />,/ gTATUTE 'ERT"-
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />----------------
<br />E.L. DISEASE - EA EMPLOYEE $If 1.000,000
<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 load)
<br />D
<br />Professional Liab - Claims Made
<br />PECO048963
<br />12/31/2016
<br />12/31/2017
<br />15,000,000 Each Claim 1$25,000 (Ded)
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks ScheNule, maybe attechod If mora space Is required)
<br />GL Additional Insured applies per OG20100413 & CG20370413 attached, only If required by written contract/agreement.
<br />GL Primary & Non -Contributory Wording applies per XIL4240605 attached. Excess Policy follows form.
<br />Re: Project #15-6844 / Agreement #A-2015-089-01, installation of Connector Piper Screen (CPS) for Residential Catch Basins Located
<br />In City of Santa Ana. Additional Insured(s): City of Santa Ana, its officers, agents, volunteers and employees.
<br />__..��._ �.-__._
<br />REVIEWED BY: EI1NIr^b HEREOIFl(PG] OF)...
<br />OFRTffICATF HOI. nFR rANCFI I ATInM
<br />Project415-6844
<br />CeltYy of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />PUBIC Works Oe
<br />Department
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza ent
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />— —
<br />AUTHORIZED REPRESENTATIVE
<br />4_I�
<br />Cassandra Rosales
<br />©1988.2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />is elsnre urn T,, :reJ le -n ,1. �e�, .tee, eo>.1. 7.1 . Iee tech e„ -a• 1
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