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HomeMy WebLinkAboutDIVERSIFIED WATERSCAPE, INC. (2) INSURANCE NOT ON FILE A-2023-024-01 WORK MAY NOT PROCEED MAYOR CITY CLERK CITY MANAGER Valerie Amezcua +�� ,,x Alvaro Nunez MAYOR PRO TEM DATE: LIAR 2 5 2026 at ' CITY ATTORNEY David Penaloza Sonia R.Carvalho COUNCILMEMI3ERS ? CITY CLERK Phil Bacerra . Jennifer L.Hall Johnathan Ryan Hernandez Jessie Lopez Thai Viet Phan Benjamin Vazquez CITY OF SANTA ANA v*'PWACz) PUBLIC WORKS AGENCY J'O(5 t;Acp ved o j 20 Civic Center Plaza I PO Box 1988 Es 2ndidu f2e25 (pz) Santa Ana,California 92702 www.santa-ana.ora January 23, 2026 Diversified Waterscapes,Inc. Attn: Patrick Simmsgeiger, President 27324 Camino Capistrano, Ste. 213 Laguna Niguel, CA 92766 Re: Extension of Agreement No.A-2023-024 to_provide-lake,stream, and pond maintenance services Pursuant to Section 3 ("Term") of the above-referenced Agreement, entered into by Diversified Waterscapes,Inc. and the City of Santa Ana,dated February 21,2023,the parties hereby exercise their First one-year extension to the term of the Agreement through February 20, 2027. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely, o Ros Acting Executive Director, Public Works Agency CITY OF ANTA ANA ATTEST Alvaro Nunez AP City Manager APPROVED AS TO FORM DIVERSIFIED WAf RSCAPES, INC. Iye Nellesen By: F,�M fCx, .SrnnrAs G VGC—R Assistant City Attorney Title: i- SANTA ANA CITY COUNCIL Vaterie Amezcua Ravd Pensioza Thai Viet Phan Benjamin Vazquez Jascie 1-wez Phil Bacerra Johnathan Ryan Hernandez Mayor Mayor Pm Yam-Ward S Ward! ward 2 ward 3 Watd a Wartl 5 vamezcuactsanta�M.av lir naloza.,MNnlaana.o (Phan sanaa�_..9M 6Yazeuez�9an Ana.[#a iessielaaez�Ssnla-aaa.ora pba--�lsghta-ana.00 wanhemandez�isanta-an-a.o DIVEWAT-01 VA5 UEZI '4 R� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDYYYY) 717120 25 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(iss)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER License#OE67768 DONTACT [sabel Vasquez IOA Insurance Services PHONE FAX 3009 Douglas Blvd. (A1C,No,Ezt):(916)692-7022 (AIC,No): Suite 110 E-MAIEss:IsabeLVasquex@ioausa.com Roseville,CA 95661 INSURER 5 AFFORDING COVERAGE NAIC# INSURERA:AXIS Surplus insurance Company 26620 INSURED INSURER B Diversified Waterscapes Inc INSURER c: 27324 Camino Capistrano#213 INSURER D: Laguna Niguel,CA 92677 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLTYPE OF INSURANCE 1N9Q WVDSUR POLICY NUMBER POLICY EFF POLICY EXP LTRN D WVD MM DOYM) (MMODMOM LIMITS A X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000 CLAIMS MADE 0 a-CUR X X EMP1900099807 5/15/2025 5115/2026 pREMISES EaoNTF ence 140,400 VIED EXP(Any one arson 10,000 PERSONAL&ADV INJURy 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE 2,000,000 X POLICY JECT LOG PRODUCTS-COMPIOPAGG 2,000,000 OTHER: POLLUTION PROFE 2,000,000 COMBINED SINGLE LIMIT AllTOM DBILE LIABILITY Ea accid n ANY AUTO BODILY INJURY Per arson OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accldent AUTOS ONLY AON-OWNED ROPER eo.,d DAMAGE A UMBRELLA LAB OCCUR l EACH OCCURRENCE $ 2,000,000 X EXCESS LIAR CLAIMS-MADE EMX1900023407 5/1512025 5115l2026 AGGREGATE $ 2,000,000 ➢ED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY .Y/N A LITE rp ANY PRO OFFICERIMEMBERPRIETORIEXCLUDEID?ECUTIVE ❑ NIA F .EACH ACCIDENT $ (Mandatory In NH) F,L.DISEASE-EA EMPLOYEE $ f yes,describe under DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT $ A Pollution Liability I X EMP1900099807 5/15/2025 5/15/2026 Aggregate 2,000,000 A Pollution Liability EMP1900099807 5/1512025 5/15/2026 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additlonal Remarks Schedule,may W attached It more space is requlred} PO Number 6785-1 The City of Santa Ana,it's officers,employees,agents,and representative are named as Additional Insured with respect to General Liability and Pollution when required by written contract perform#CG2010 0704 and PGI EL 018 0210 Certificate Holder is Additional Insured with respect to General Liability and is Primary and Non,Contributory,when required by written contract perform#PGI EL 020 0210 Each insurance policy required above shall provide that coverage shall not be canceled,except with notice to the Entity.City will be mailed 30 days written notice of policy cancellation. CERTIFICATE HOLDER CANCELLATION APPROVED By 7'a Tran Nguyen.at9,34 am,Arrg 64,20 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana AUTHORIZED REPRESENTATIVE Risk Management Division 20 Civic Center Plaza,4th floor TU 7 °1g1a1y5gned ✓� t rant byTUT­ ISanta Ana,CA 92702N9uyen ACORD 25(2016I03) Nguyen 99:3450-0700'S ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATE PAMlI?WMYl " CERTIFICATE OF LIABILITY INSURANCE 0711712025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTEr . THE COVERAGE AFFORDED BY THE POLICIES SELOW. THIS �CERTIFICA►T.E OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE7WEErN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT, If the cerlificate.holder is an ADDITIONAL INSIJRWL the pollcy(les)m.ust be endorsed. If SUBROGAMON IS WAIVED,subject to the torms and cckWitions alf the policy, certairl policies may require an endorsement. A statement on this cartifirate does net confer rights to the certificate holder in lieu of such endorsemerrt(s), P"ERSTATE FARM INSURANCE r GARY BL CKBURIY__ ..,�..,........�.,. GARI'BI ACIURN,ANT LIC,#049052 JtI�; �xRl.. 581 17EI00 —-- wQ . 2 t381 1A A> RlGPeNT ; STIW 5�6 ADD Lss:t3ARY.BLfiCK8URN.B"Z§TATEFASRM.COI!A "• rh13T�fRIS1AFFORRE3Uf pOifEIF 5 .-.. NIIiC Li MISSION VIEJO,GA21 wrprnoll !rur_ _s .r _ b1VERSIFIED WATERSCAPES,CAPI S, INC 27324 CfAMINO CAPISTRANO STE_213 aasunetrc: LAGUNA NIGUEL,CA 92677 nlsnff�a= SURER F- COVERAGES CERTINGATE NUMBER: REVISION NUMBER. THIS 45 To CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN IS$IJED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATYM. NOTYATIIVANDING ANY REQUIREMENT, TE fti OR CONDMOR OF ANY CONTRACT OR OTHER DOCUMENT 4 ATH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFQRDM BY THE POLICIES DESGRIIRF,-D HEREIN I$SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO C_ONWHiNs Ol=SUCH POLICIES.LIMIT$SH"MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR f!i7LrCY P� n''I e10FM5IIRMCE imme tuvn PMACYNuMlIM4 Llram GPNR�NlAL LAFi�k1`11t -- EAG'H OC.CIJRRENCE -$ CX,WAERGt#..05NMA#.LlA81LIIY GdAiIN 3 YlAC11 y I C UR MW EKE}(Arw one W.sm) C AIFR AL 11 1RE{IAF eE'N'L A.GGRE�C^ATE.r�1M[r AP(P�I.wS PER; PROI)Qr T5-00MN.QP A01a €!�G'I.EGY` 1..�3RL'13".. 1 ...I..LQt A rlil'P4M 04+43 i Ia11JTY Y Y. —_ nLNY AUTO 332#2If7-E#? -78U �SKl l t12 1 k1e?5i tt BgoiL IxJti fear va eon) s 1,ue t, Dq ALLVY'4NEE2 9cH5a IL r I AUTO$ 11.1709 13r]L71I Y£xJIfE�Y(Per scr�etu) � l AItER tlQ[I 6213 3gpz 1ER1176fi3 I3 ai�i17A5 t1tI1tI7S iOrly s - 1 tkl4.#74q 3K �s=rtt:E3nkl � 'Al1"r� � Et �r•' Il:.�.-......_....-. ry UMBRELLA LAB i 1F l tlIT- FA CH 0CfA)RRFNf'F 1 .. inMCI=5SuA" I�L�k1"rErti!� �N=REOATF _ f - 1.75C7- RL:T�NTIC:F)$„•...... .,, $- - I�F4RKER5 C[114ip£iu13A,raD� -- - - srarll � - ANQ0WL0YXRV1AAAILM YI...N. - ,. .-................ ANV PROPRIETIJIPimii•wEn ExEcUnVE -^ F-L,EACH AC=ENT 8 i?F�IGFJhSEkAl3 JECI:UCEEa3 NIA — flaandatory rn Ilo-lk. E4,IEEE•EA EMPLOYE I It Yen,ae'wibaunder• C4S P«aE•t?D€.Ai�t'IJNIAT APPROVED pE' !�#'X10N14F©r+ERRelt.t9fl,.fk'nA'I(7N$1.VRHIGI.V!-(If 11Acth01,AddMuna3-AsatarksSchvdwu,WMM space IsrNWIM41 THE CITY OF SA,NTA.A+N;A1,ITS OFFK;ER$,EMPLOYEES,AGENTS AND REPRESENTATIVES ARE ADUI'fi IONA n INSUREDS. 628 117 09.TES IS AN ENOL POLICY 332 12OT-U&T61J IS A.2006 TOYGT,AA TUNDRA CERTIFICATE OF INSURANCE PROVIDE,THIRTY(30)DAY PRj0R'VVRiTN NOTICE OF CANCELLATION CERTIFICATE FOLDER CANCELLATION CITY OFAI TA.AN 1 814OULD APW OF THE ABOVz-DESCRIBED POLICIES BE CAKE€I ED BEFORE TK EXPIRATION DATE 7HERVOF, NOTICE VAIILL BE DELIVERED IN DISK MA.NA6EMENT ACCORDANCE ARTH THE POLICY PROVISIONS, 20 CIVIC CENTER PLAZA,4TH FLOOR AUTHORIZED REP ATIitB SANTA ANA,CA 92711 0 19"2POACIRDCORPORATi+CIN. All rights reserved. ACOPtCI 25(20405) The 4COREi►tall►fls and fogs are re ia`tt*r ti marks o(AqORE) 1001466 132 49,8 11-15-2010 Policy#:EMP19000998-07 PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT This endorsement changes the Policy. Please read it carefully. SCHEDULE Name of Person or Organization: Any person(s) or organization(s)whom the Named Insured agrees, in a written contract,to provide Primary and/or Non-contributory status of this insurance. However,this status exists only for the project specified in that contract. In consideration of the premium charged, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third parties in respect to work performed by you under any written contractual agreement with such third party. It is further agreed that any other insurance which the person(s) or organization(s) named in the schedule may have is excess and non-contributory to this insurance. PG1 EL 020 0210 Page 1 of 1 Policy Number: EMP1900099807 COMMERCIALGENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization s : Locations Of Covered Operations Any person(s) or organization(s)whom the Named Insured agrees, in a written contract, to name as an Additional insured. However,this status exists only for the project specified in that contract. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section li—Who Is An Insured is amended to include as an additional insured the person(s)or organization(s) shown in the Schedule, but only with respect to liability for"bodily injury","property damage"or"personal and advertising injury'caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s)at the location(s) designated above. B.With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: This insurance does not apply to"bodily injury"or"property damage"occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work,on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed; or 2. That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 POLICY NUMBER: EMP1900099807 COMMERCIAL GENERAL LIABILITY CG 24 04 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person(s) or organization(s)whom the Named Insured agrees, in a written contract, to provide a waiver of subrogation, However, this status exists only for the project specified in that contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement). The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV—COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or"your work"done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Insurance Services Office, Inc.; 1992 POLICY NUMBER: EMP1900099807 ADDITIONAL INSURED ENDORSEMENT This endorsement changes the Policy. Please read it carefully. This endorsement modifies insurance provided under the following: CONTRACTORS POLLUTION LIABILITY COVERAGE Name of Person or Organization: Any person(s) or organization(s)whom the Named Insured agrees, in a written contract,to name as an additional insured. However,this status exists only for the project specified in that contracts The person or organization shown in this Schedule is included as an insured,but only with respect to that person's or organization's liability arising out of COVERED OPERATIONS performed for that insured. PGI EL 018 0210 Page 1 of 1 ;c) State Farm Mutual Automobile Insurance Company 96788-4-A MATCH 01000 MUTL VOL PO Box 2368 Bloomington IL 6f 702-2368 DECLARATIONS PAGE PAGE 1OF2 NAMED INSURED 0101D0 75-8127-4 A A POLICY NUMBER &M 3607-E09 75USIM MAR IA POLICY PERIOD JUL 17 2025 to NOV 09 2025 AND DIVERSIFIED MD WA & PATRICK 12:01 A,M Standard Time AND DIVERSIFIED WATERSCAPES, INC STE 213 STATE FARM PAYMENT PLAN NUMBER 27324 CAMIND CAPISTRANO 1346356623 LAGUNA NIGUFL CA 92677-1118 AGENT — GARY BLACKBURN 23881 VIA FABRICANTE STE 506 MISSION VIEJO,CA 92691.3139 PHONE:(949)661.0800 DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. IF AN AMOUNT IS DUE,THEN A SEPARATE STATEMENT IS ENCLOSED- ----- _ YOUR CAR YEAR MAKE AWDEL I _ CLAW yUM� NONOWNED AUTO 670A[)PG002 SYMBOLS. COVERAGE'&UMITS PREMIUMS_ A Liability ooverage':<. Bodily Injury Limits Each Person, Each A660erti $1,000,000 $1,000,000 Property Damage Limd Each Accident S1,Dbb.bDD Li Limnsured Motor Vehicle Coverage 6.84 Bodily Injury Limits Each Person, Each Acc dent Totslpremiu n for JULL17 2025 to NOV 09 2025. $141.99 INS as not a bill. IMPORTANT MESSAGES IMPORTANT NOTICE For your protection California law requires the fallowing to appear with this policy: Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. Replaced policy number 6283607-75T. Notice of insurance information collection practices-personal,family,or household insurance transactions: We may ooilect customer information from persons other than the individual or individuals applying for coverage Such customer information as well as other personal or privileged information subsequently collected may,in certain circumstances,be disclosed to third parties without your authorization as permitted by law. You have the right to submit a written request to access,correct,amend,or delete your personal information and the right to receive a response within 30 days of submitting your request. If we deny yyour request,you have the right to file a statement with us containing the information you feel is accurate and fair along with tko reasons you disagree with our denial.Instructions on how to file such request and our full privacy notice can be found www statefarn_comlcustomer.carelprivacy-securitylprivacy or contact your State Farm Agent. Your total renewal premium for MAY 09 2025 to NOV 09 2025 is$228.28. Location used to determine rate charged-29641 VIA CEBOt L a LAGUNA NIGUEL CA 92677. CONTINUED 087W07456 See Reverse Side tss-ara cAz 0&,VW a ra} nsxn» Sat�eS This fict icy is Igsued by State Farm Mutual Automobile Insurance Company- MUMAL CONDITIONS 1. Membership.While this policy is In farce,the lust Insured shown on the Declarations Page is entitled ta}:vote at all meetiNs of.membom and to receive d€v€derWs the Board of Directors in its discretion may declare In accordance with reasonable classifications and group€ngs of policyholders established by such Board. , No contingent i.labifity. This policy is ron-assessable. 3. Annual Moeltim The annual meOng cif the members of the company shall ba held at Its horns office at Bloomington, Ninols,on the second tulonday at June at the boat of 1 O:00 A.hR., untess the Board cof Directors shall olec't to change the lime and place of such meeting, In which case, blrt not othem€se, due notice shall be maRed each mernber at the address disclosed in this policy at least 10 days prior thereto, In. Witnesa Whereof, the State Farm Mutual Automobile Insurance Company Ims caused this ppl€cy to be slgood by its President and Secretary at Bloomington,lll€nofs. - �^erisFn:y F�snsR#�,eN Important Cd�fornla taw tequkras us to provide you with intarmatlen for filing txmrpwrits with. Stale Inbeuance Vepertw. errt regarding the coverage anditetylee provided under this poky. Complaints she(Ad he Wd onfy afler you and stmiff Farm or your agent or other company it pree�reiaE;+re have failed to rah a salis ad;lary a errtent on a problerm. ploaaa forward such comptainic.tm Californian Department of Insurance CQ"*=et Se VICQ*E tvision 300 South spring Street LosAn9eks,CA 9013 Or(file s complaint lhrmigh the Deparimenl of Ins uramie's lrrlernet Web site(win wJnsuran oca gov) . Or Call evil fry q-S00,4L7-HELP(4357). Nance nce yk are required la furnL0 you with the fgilowing kffomulion: 1. Aar autratnobilu liablllfy iPsu mnca company may cancel a policy balors t end of the current policy om s�rts ctesd lo, reavribsd in the provision titled Canc$tlaflon which is focafed in General erns section of your policy (rater to the Contents in this Wgirrning of your:poky for the page rrirmisz�}, Z An.atuerrtubfe riafity Insuraace aorn.pany may inomase the pie€ruiim car raferse to ra#tsow the poesy for ariy of the tollvwtrV reagons: :a_ Accident iriaoivemant by an hisured_and whether an insured it at fault in the a=ident. b Aiftrtoe In,ordere li of,corn Insured Wilde. e, A: I ►r sin,or WdNon of,an insured under the poliay. d. A charigo In the,location of garaighla of tin Ensured uehic16. w. A cfr tga in the use of drta Insurodvahirla f. Gamracticaris.farviatatfrty 4my provision of the V90169 Coda or the Periat Glide relatatg to the Qpergk en of a rnobr iiehide. U-1ha.peyrnerAma by raft lnsawdua to a tl�int filed by an in sicced ara.drird party-, An autorrtnbila ilabinly insuranaa of pany may incisaaa the preit>ium ar ruse to renew the pc&y for masoris that are not f1sted Above but which are hwdul and real unfaidy dlw iirrin atory. sx� SdbFam State Farm Mutual Automobile Insurance Company 96788-4-A MATCH 01000 MUTL VOL B ngton IL 6 1 702-236 8 DECLARATIONS PAGE 01000 PAGE 2 OF 2 NAMED INSURED 75-8127-4 A A POLICY NUMBER 629 3607-EO9-75U awe POLICY PERIOD JUL 17 2025 to NOV 09 2026 AND DIVERSI, ED WA B PATRICK 12.01 A.M.Standard Time AND DIVERSIFIED WATERSCAPES, INC STE 213 STATE FARM PAYMENT PLAN NUMBER 27324 CAMINO CAPISTRANO 1346356523 LAGUNA NIGUEL CA 92677-1118 EXCEPTIONS,POLICY 80O€CLET 6 ENDORSEMENTS(See policy booklet&Individual endorsements for coverage delal1 YOUR POLICY CONSISTS OF THIS DECLARATIONS PAGE THE POLICY BOOKLET FORM 9805B�IBAND ANYENT ENDORSEMENTS EN�ALMENT THAT APPLY, INCLUDING THOSE ISSUED TO YOU 01 6028BU ADDITIONAL INSURED-CITY OF SAN MARCOS, SUCCESSOR AGENCY TO THE SAN MARCDS REDEVELOPMENT AGENCY, 1 CIVIC CENTER OR, SAN MARCOS CA 92069-2918. 02 60288U ADDITIONAL INSURED-KEYSTONE PROPERTY MANAGEMENT, LLC, 240 COMMERCE STE 200 IRVINE CA 92602-5005. 03 6028BU AUDITINAL INSURED-LAKES AT MENIFEE, 30416 LAGUNA VISTA OR, MENIFEE CA 2584--9999. vv 04 6028BU ADDITIONAL INSURE CA EDAVALON MANAGEMENT GROUP INC, 31608 RAILROAD 05 60283U ADDITIONAL INSURED-VILLAGE SAN JUAN HOMEOWNERS ASSOC AND PROGRESSIVE ASSOC MGMT 1290 N HANCOCK ST STE 103 ANAHEIM CA 92B07-1925, 06 6028BU ADDITIONAL INSURED-COUNTY OF LOS ANGELES DEPARTMENT OF PARKS gg, 07C6628B NADDDITIONAL DINSURED-CITYOOFSLARQ TtN4TA,�V7W5HCABLRLE TAMPICO, LAA23. pUINTA CA 92253-2839. 08 6028BU ADDITIONAL INSURED-CITY OF SANTA ANA RISK MANAGEMENT DIVISION, 20 09V6028OU TAR DITIONAL4 MUREDTEASTLAKE 927 OA-&FALTERS MANAGEMENT, 9665 CHESAPEAKE OR STE 300 SAN DIEGO CA 92123-1364. 10 6028BU ADDITIONAL INSURED-FIRST SERVICE RESIDENTIAL CALIFORNIA LLC, 6190 TAYLOR DR STE B FLINT MI 48507-4691. 11 6028BU ADDITIONAL INSURED-POWERSTONE PROPERTY MGMT INC ATTN- RISK MANAGER 9060 IRVINE CENTER ppDR STEII3yy0��00I IR�jINE CA 9C2C618-U4645. ISADA28550ANDEWPORTACENTERRFDR,NEWPORTNeEACHPCAY92660F7030NE MANAGEMENT CO., 13 6Q'28BU ADDITIONAL INSURED-30 DAYS-CITY OF TEMECULA C /0 EXIGIS INSURANCE COM144 66g0pp288zBUEAa(O}OITI©NA� INNSBREDACIP OFWESCCONDIDO, 201 N6BRROADWAY, ESCONDIDO 15 6028BU2AIIDITIONAL INSURED-THE CITY OF HUNTINGTON BEACH, 2000 MAIN ST, HUNTINGTN BCH CA 92648-2763. 16 6028BU ADDITIONAL INSURED-COACHELLA VALLEY WATER DISTRICT, PO BOX 1088, COACHELLA CA 92236-1088. ��rr vv RANCHO MISSIIONTVIIEJO LNCUR10805VHOLDERESTL05TEE23QLLCYPRESSMCAN9D6$30- 146. 18 6028BU ADDITIONAL INSPIRED-LOS ANGELES UNIFIED SCHOOL DISTRICT THE BOARD OF EDUCATION OF THE CITY OF LA, 333 5 SEAUDRY AVE FL 28, LOS ANGELES CA 90017-5157. 603OGF BUSINESS NAMED INSURED. 6125A AMENDATORY ENDORSEMENT. 6126MD EXCESS COVERAGE FOR PERSONAL VEHICLE SHARING. 62 4�}P HIRE}AC RYL NB_ ECOVERAGE- 6165CS EMPLOYES NON I NED CAR LIABTLITY COVERAGE. 6196AA - WAIVER OF SUBROGATION UNDER THE LIABILITY COVERAGE FOR ONNI FLO�I ER HOLDINGS LLC- OMNI CONTRACTING CALIFORNIA INC- THE IRVINE CO- 1IRVTNE MGMT CO- CITE! OF ECONDIDO THE CITYT OF HUNTIIGTON BEACH; CObCHELLA RANCHO M1SSION�VItJASSES LLCM MT REA�TYMTNCA3DMBVSANCJUAN INVESTMENTDNORTNC' LLC AND RMV SAN JUAN WATNSH D LLC; THE CITY OF SANTA ANA RISK MGMT. Agent: GARY BLACKBURN Telephone: (949)581-0800 08765107456 Prepared AUG 04 2025 8127-A64 i543fi6 CA2 C62002 J01.025k) (o10115k) ,3SX0 folnr&"