OCEAN BLUE ENVIRONMENTAL SERVICES, INC. (3)

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Francine R. DigiWly,ig byF—cme R. W1a 1 Villareal N-11.11121-1211- OCEABLU-06 ADAVIS2 ,d►coRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/30/2021 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(ies) 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 endorsement(s). PRODUCER License # 0757776 CONTACT Alisha Davis NAME: PHONE FAX (A/C, No, Ext): (877) 825-2681 No):(951) 231-2572 HUB International Insurance Services Inc. 9855 Scranton Road Suite 100 E-MAIL-ADDRESS: alisha.davis@hubinternational.com San Diego, CA 92121 INSURERS AFFORDING COVERAGE NAIC # INSURERA:Greenwich Insurance Company 22322 INSURED INSURERB:XL Specialty Insurance Company 37885 INSURER C: Indian Harbor Insurance Company 36940 Ocean Blue Environmental Services, Inc. INSURER D 7 925 West Esther Street Long Beach, CA 90813 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR X X GEC300156801 7/1/2021 ]/1/2022 DAMAGE TO RENTED PREMISES Ea occurrence 100,000 $ MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JEC LOC PRODUCTS - COMP/OP AGG $ 2,000,000 X OTHER: DED: $5,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 $ X BODILY INJURY Perperson) $ ANY AUTO X X AECO05699101 7/1/2021 7/1/2022 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPERTY DAMAGE ccident Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X Hazardous Waste $ 5,000,000 MCS-90 Pollution C UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 9,000,000 X EXCESS LIAB CLAIMS -MADE UECO05699201 7/1/2021 7/1/2022 AGGREGATE $ 9,000,000 DED X RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A X WE C300156701 7/1/2021 7/1 /2022 X PER STATUTE ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ C Pollution / Environm X PECO05703301 7/1/2021 7/1/2022 Each Occ/Aggregate 5,000,000 C Professional Liab PECO05703301 7/1/2021 7/1/2022 Each Occ/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: A-2021-097-01 and RFP #21-004 City of Santa Ana, officers, agents, employees, and volunteers are Additional Insured's with regards to the General Liability policy when required by a written contract, per the attached endorsement forms CG201012/19 and CG203712119. Primary wording applies with regards to the General Liability policy when required by a written contract, per the attached endorsement form XIL424 06/05. Waiver of Subrogation applies with regards to the General Liability policy when required by a written contract, per the attached endorsement form CG240412/19. Additional Insured applies with regards to the Auto Liability policy when required by a written contract, per the attached endorsement form XIC411 10/13. Waiver of Subrogation applies with regards to the Auto Liability policy when required by a written contract, per the attached endorsement form CA044410/13. Auto Pollution applies per the attached form CA994810/13. Waiver of SEE ATTACHED ACORD 101 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE RisieMa& iaia � REVIEWED &APPROVED BY.- APPROPVE z a v� ACORD 25 (2016/03) © 1988-2015 ACORD C The ACORD name and logo are registered marks of ACORD Risk Management Analyst