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Burns & <br />Wilcox <br />101 California Street, Suite 975, San Francisco, CA 94111 <br />Phone: (415) 421-4244 OR (800) 759-4855 Fax: (415) 421-0620 <br />DATE: 4/7/2021 INSURANCE BINDER Page 4 of 4 <br />---.....- --._.----..__._.... -— -- ---..._. __ _ <br />OCCURRED."] <br />"CG2010 -ADDITIONAL INSURED OWNER, LESSEES OR CONTRACTOR. <br />ENTITY NAMES AS A/I: "" ALL ARTISTS PAINTING ELECTCIAL / UTILITY BOXES FOR CITY OF SANTA ANA """ <br />CG2033 - BLANKET ADDITIONAL INSURED - WHEN REQUIRED BY AGREEMENT- DO NOT USE WITH CG2139. <br />CG2404 - BLANKET WAIVER OF SUBROGATION (ADD THE FOLLOWING WORDING TO FORM) "ANY PERSON OR <br />ORGANIZATION WITH WHOM THE INSURED HAS AGREED TO WAIVE RIGHTS OF RECOVERY, PROVIDED SUCH <br />AGREEMENT IS MADE IN WRITING AND PRIOR TO THE LOSS "). <br />CONDITIONS: <br />QUOTE BASED ON ONE MULTI BOX PROJECT AT A FLAT RATE OF $600.00 - MINIMUM PREMIUM APPLIES. <br />1 A/I INCLUDED FOR THE CONTRACTORS. <br />PLEASE REVIEW THIS BINDER CAREFULLY AS IT MAY DIFFER FROM COVERAGES AND LIMITS REQUESTED. <br />THIS COMPANY BINDS THE KIND(S) OF INSURANCE STIPULATED HEREIN. THE ABOVE COVERAGES ARE THE ONLY COVERAGES BOUND. <br />ANY COVERAGE REQUESTED IN THE APPLICATION THAT DIFFERS FROM THE ABOVE IS NOT INCLUDED. THE INSURANCE IS SUBJECT TO <br />THE TERMS, CONDITIONS, LIMITATIONS, AND FORMS OF THE POLICY(S) IN CURRENT USE BY THE COMPANY. THIS BINDER IS <br />CANCELLED SIXTY (60) DAYS FROM THE EFFECTIVE DATE OR WHEN REPLACED BYA POLICY, WHICHEVER COMES FIRST. <br />THE AGENT MUST READ THIS CERTIFICATEAND IF NOT CORRECT RETURN IT IMMEDIATELY TO BURNS & WILCOX, LTD. <br />BY: Harvey Goldenberg, Authorized Representative (CA INS LIC # 0828615) <br />s RiekMunagzmuxtUMeion <br />t ' k <br />n REv EMED & APPROVED BY: <br />__- -- - Risk Management Analyst <br />