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ACORO® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDIYYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />12/28/2018
<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 />A/c No Ext): 626 799-7000 A/C No): 626 583-2117
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />12/31/2018
<br />INSURERA: Greenwich Insurance Company
<br />22322
<br />www.boltonco.com 0008309
<br />INSURED
<br />United Storm Water, Inc.
<br />14000 East Valley Blvd.
<br />City of Industry CA 91746
<br />INSURER B: XL Insurance America, Inc.
<br />24554
<br />INSURERC: XL Specialty Insurance Company
<br />37885
<br />INSURER D: Indian Harbor Insurance Company
<br />36940
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 46278676 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 />SD
<br />SUBR
<br />WVD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDDIYYY
<br />LIMITS
<br />A
<br />�/ COMMERCIALGENERALLIABILITY
<br />✓
<br />GEC3001234
<br />12/31/2018
<br />12/31/2019
<br />EACH OCCURRENCE $1,000,000
<br />CLAIMS-MADE ✓ OCCUR
<br />DAMAGETO"-"'EL
<br />PREMISES Ea occurrence $ 100,000
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL & ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $2,000,000
<br />RO
<br />POLICY✓� ECT F7] LOC
<br />PRODUCTS - COMP/OP AGG $2000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />AECO048938 / AECO048939
<br />12/31/2018
<br />12/31/2019
<br />COMBINED SINGLE LIMIT $
<br />Ea accident 1,000,000
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />1✓
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident) $
<br />✓
<br />HIRED NON -OWNED
<br />AUTOS ONLY ✓ AUTOS ONLY
<br />(per AMAGE
<br />cidenD$
<br />$
<br />C
<br />UMBRELLALIAB
<br />f
<br />OCCUR
<br />UECO048940
<br />12/31/2018
<br />12/31/2019
<br />EACH OCCURRENCE $15,000,000
<br />AGGREGATE $ 15,000,000
<br />✓
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I ✓ I RETENTION $10,000
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN—
<br />I N
<br />WEC3001235PER
<br />12/31/2018
<br />12/31/2019
<br />�/ STATUTE OERH-
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBEREXCLUDED?
<br />N / A
<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 12/31/2018 12/31/2019 $15,000,000 Each Claim / $25,000 Ded.
<br />D
<br />Professional Liab - Claims Made
<br />PECO048963 12/31/2018 12/31/201,91$15,000,000 Each Claim / $25,000 Ded.
<br />REVIEWED BY: EUNICE HEREDIA (PG OF )
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I 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.
<br />Re: Agreement #A-2017-157 in City of Santa Ana. Excess Policy follows form.
<br />Additional Insured(s): City of Santa Ana, its officers, agents, volunteers and employees.
<br />&":I:A112LhG\I=1111:L41ill U=1 101"gIII W-111 ILei ►
<br />City of Santa Ana
<br />Public Works Agency M-22
<br />Construction Engineering
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<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 />Cassandra Rosales
<br />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 />46278676 I UNITPUM-01 1 18-19 A11 Lines I Mary Messinger 1 12/28/2018 4:39:52 P11 (PST) I Page 1 of 5
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