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ACORD0 CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDD/YYYY)
<br />`"
<br />12/27/2017
<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 />3475 E. Foothill Blvd., Suite 100
<br />Pasadena, CA 91107
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />626 799-7000 FVC No: 626 583-2117
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />;GEC3001234
<br />INSURERA: Greenwich Insurance Company 22322
<br />www.boltonco.com 0008309
<br />INSURED
<br />United Pumping 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 />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />�/ COMMERCIALGENERALLIABILITY
<br />✓
<br />;GEC3001234
<br />12/31/2017
<br />12/31/2018
<br />EACH OCCURRENCE $1,000,000
<br />CLAIMS -MADE OCCUR
<br />✓
<br />DAMAGE O RENTED
<br />PREMISES Ea occurrence $ 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 ✓� PRO-
<br />JECT M LOC
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />AECO048938
<br />12/31/2017
<br />12/31/2018
<br />EOaaBINEDiSINGLELIMIT $1000,000
<br />✓
<br />ANY AUTO
<br />AECO048939
<br />12/31/2017
<br />12/31/2018
<br />BODILY INJURY (Per person) $
<br />I✓
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident) $
<br />HIRED NON -OWNED
<br />AUTOS ONLY ✓ AUTOS ONLY
<br />PROPERTY DAMAGE $
<br />Per accident
<br />Ded Comp & Collision $1,000
<br />C
<br />UMBRELLALIAB
<br />✓
<br />OCCUR
<br />UECO04894
<br />12/31/2017
<br />12/31/2018
<br />EACH OCCURRENCE $15,000,000
<br />✓
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $ 15,000,000
<br />DED I ✓ I RETENTION$ 10,000
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVEN
<br />OFFICER/MEMBEREXCLUDED7 ❑N
<br />/ A
<br />WEC3001235
<br />12/31/2017
<br />12/31/2018�/
<br />STATUTE ETH
<br />E.L. 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 />I
<br />E.L. DISEASE - POLICY LIMIT $1,000,000
<br />D
<br />Pollution Liability
<br />PECO048963
<br />12/31/2017
<br />12/31/2018
<br />15,000,000 Each Claim 1$25,000 (Ded)
<br />D
<br />Professional Liab - Claims Made
<br />PECO048963
<br />12/31/2017
<br />12/31/2018
<br />15,000,000 Each Claim 1$25,000 (Ded)
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be 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. Excess Policy follows form.
<br />Re: Project #15-6844 / Agreement #A-2015-089-02, 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 />REVIEWED BY: EUNICE HEREDIA (PG I OF<)
<br />u r-mI Irik mI a rIVLUCR
<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 REPRESENTATIVEl6xGi-
<br />Cassandra Rosales
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />39558143 1 UNITPUM-01 1 17-18 GL, Auto, Umb, WC, POLL, Prof Liab I Matthew Nobriga 1 12/27/2017 4:11:35 PM (PST) I Page 1 of 5
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