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304333
<br />A+C<?Rjff CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDIYVYY)
<br />TYPE OF INSURANCE
<br />6/29/2017
<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(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 a ch ondarsement s ..
<br />PRODUCER
<br />C ONTACT
<br />NAME: Jonathan Allen
<br />Commercial Lines - 213-253-6700
<br />PHONE 213-253-6711 FAXBfi6-475-9866
<br />.L Hw-ExtFINC NO)!
<br />Wells Fargo Insurance Services, Inc. - CA Lic#: 01)08408—
<br />EMAIL ona_than.n.allen_@wellsfar o.com
<br />AODRE.., ) g
<br />333 S. Grand
<br />_ _ __ ____
<br />_ ..---
<br />Los Angeles, CA 90071
<br />INSURERI6)AFFORDING COVERAGE
<br />INSURERA: Nautilus Insurance Company
<br />17370
<br />_
<br />INSURED
<br />_
<br />INSURER B: Great Divide Insurance Company
<br />252_24__
<br />Ocean Blue Environmental Services., Inc.
<br />925 West Esther Street.
<br />INSURERC:
<br />---
<br />GENERALAGGREGATE S 2,000,000
<br />----
<br />IN9URERD:
<br />INSURER E:
<br />-----_�--
<br />—'
<br />PRODUCTS-COMP/OP AGO_ $ 21000,000
<br />Long Beach, CA 90813
<br />INSURER P:
<br />COVERAGES CERTIFICATE NUMBER: 12027183 RPVISIflId MI IMRCC• Foo h.1—, - _--
<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 />ADO
<br />SUBe
<br />�
<br />POLICY NUMBER
<br />POLICY EFF
<br />MITI
<br />IM C EXP
<br />MMIDOIYYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERALLIABILnY
<br />�-j
<br />CLAIMS -MADE u OCCUR
<br />X
<br />ECP2018650.11
<br />07/01/2017
<br />07/01/2018
<br />EACH OCCURRENCE 5 1.000,000
<br />_
<br />�MiO RNY'E6 l-
<br />EREMISES JE1 cumlEnteI $ 100,000
<br />EXP (Anyone person) 5 5,000
<br />_
<br />_MED
<br />.PERSONAL dADVINJURY S 11000,000
<br />CEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY [y] PECT RO- ❑
<br />JLOC
<br />GENERALAGGREGATE S 2,000,000
<br />—'
<br />PRODUCTS-COMP/OP AGO_ $ 21000,000
<br />X OTHER: SIR: $201
<br />S
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />BAP2018652-11
<br />07/01/2017
<br />07/01/2018
<br />sOSI S 11000,000
<br />(c.p INEL LIMIT
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per parson) $
<br />OWNEDSCHEDULED
<br />AUTOS ONLYNXAUTOS
<br />BODILY INJURY i
<br />(Per accident $
<br />X
<br />HIRED NONAWNED
<br />ONLYAUTOS ONLY
<br />PROPERTYOAMAGE $AUTOS
<br />cci enl
<br />x
<br />MCS -90
<br />$
<br />A
<br />UMBRELLALIAB
<br />X
<br />OCCUR.
<br />FFX2018651-11
<br />07/01/2017
<br />07/01/2018
<br />EACH OCCURRENCE 5 9,000,000
<br />X
<br />EXCESS LIAa
<br />CLAIMS -MADE
<br />AGGREGATE s 91000,000.
<br />DED RETENT ION$
<br />$ SIR - NIA
<br />B
<br />WORKERS AND EMPLOYERSELIABILITY YIN NSATION
<br />OFFICER MEh1 ANYPROPRIETERE%OLUOEI07ECUTIVE
<br />NIA
<br />WCA2018653-11
<br />0710112017
<br />07!01/2018
<br />X 5lE'g7u7E X ER usLxH
<br />E.L. EACN ACCIDENT $ 1,000,000
<br />E.L. DISEASE -EA£MPLOYEE S 1,000,000
<br />(Mandatory In Ntq
<br />If yes, describe under
<br />E.L. DISEASE POLICY LIMIT 5 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />Pollution Liability
<br />ECP2018650-11
<br />.0710112017(17/01/2018
<br />Torts; $1,000.000 Each Occurrence
<br />Ded:$20,000; Occuoocs Form
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
<br />RE:RFP# 16-144 Certificate Holder is named as additional Insured as it relates to general liability In accordance wit the terms and conditions of the policy.
<br />REVIEWED BY: . 11, EUNICE HEREDIA
<br />City of Santa Ana
<br />Attn: Public Works Department
<br />20 Civic Center Plaza M-22
<br />Santa Ana, CA 92702-0000
<br />ACORD name and logo are
<br />ACURU 25 (2U11f103)
<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 />ge .4
<br />ACORD CORPORATION. All rights reserved.
<br />
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