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Diaitally sianed
<br />C .. DATE
<br />CERTIFICATE OF LIABILIT E by AtngieO/082021
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS IGHTS UPON ,'Fl= FOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND ALTER THE COVE P iE HHE1 POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CO T I2.
<br />dt
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. LVLL`t.
<br />W�°
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the olic Ies must have ADDITIONAL INSU� 22r yy��'�� r� ''�� ed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,) certain policies may .equire ante' ,,rl�rite�t!A tt'afe on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER LIC #OC36861 1-415-403-1491
<br />CONTACT Kimberly Leikam
<br />Alliant Insurance Services, Inc.
<br />� CNNo Ext: 415-403-1491 A/C, No: 415-874-4818
<br />E-MAIL kleikam@alliant.com
<br />ADDRESS:
<br />100 Pine Street, llth Floor
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA:VALLEY FORGE INS CO
<br />20508
<br />San Francisco, CA 94111
<br />INSURED
<br />INSURER B: TRANSPORTATION INS CO
<br />20494
<br />Layne Christensen Company
<br />INSURER CSTEADFAST INS CO
<br />26387
<br />INSURER D:
<br />585 West Beach Street
<br />INSURER E :
<br />INSURERF:
<br />Watsonville, CA 95076
<br />COVERAGES CERTIFICATE NUMBER: 63472988 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 />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />X
<br />X
<br />GL2074978689
<br />10/01/20
<br />10/01/23
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE � OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 2,000,000
<br />X
<br />MED EXP (Any one person)
<br />$ Nil
<br />XCU
<br />X
<br />Contractual Liability
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GEN'LAGGREGATE
<br />LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$ 10, 000, 000
<br />POLICY � JECT PRO X❑ LOC
<br />PRODUCTS - COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />BUA2074978692
<br />10/01/20
<br />10/01/23
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 2,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />BODILY INJURY (Per accident)
<br />$
<br />AUTOS ONLY AUTOS
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />UMBRELLALIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />X
<br />WC274978630 (CA)
<br />10/01/21
<br />10/01/22
<br />OT
<br />X STATUTE EERPER H
<br />AND EMPLOYERS' LIABILITY
<br />B
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE �
<br />X
<br />WC274978658 (NY)
<br />10/01/21
<br />10/01/22
<br />E.L. EACH ACCIDENT
<br />$ 2,000,000
<br />A
<br />OFFICER/MEMBEREXCLUDED?
<br />(Mandatory in NH)
<br />N/A
<br />X
<br />WC274978644 (AOS/StopGap)10/O1/21
<br />10/Ol/22
<br />E.L. DISEASE -EA EMPLOYEE
<br />$ 2,000,000
<br />B
<br />If ESCRIPTIONOFO
<br />DESCRIPTION OF OPERATIONS below
<br />X
<br />WC274978661 (MT,WI,HI)
<br />10/01/21
<br />10/01/22
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 2,000,000
<br />C
<br />Professional Liability
<br />E00508792217
<br />10/01/21
<br />10/01/22
<br />Ea Claim/Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Re: On -Call Water Well, Pump, and Motor Rehabilitation and Repair Services
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as Additional
<br />Insured as required by written and executed agreement per the attached endorsements. Coverage is primary &
<br />non-contributory and waivers of subrogation apply.
<br />30 Days Written Notice of Cancellation for Non -Renewal and 10 Days Notice of Cancellation for Non -Payment of Premiums
<br />GL Per ISO Form CG0001 10/01; AL Per ISO Form CA0001 10/13
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 97201
<br />ACORD 25 (2016103)
<br />ttaganap
<br />63472988
<br />USA
<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 />© 1988-2015 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />Risk kluaganadDIMsian
<br />REVIEWED & APPROVED BY.-
<br />z
<br />�_r- Risk Management Specialist
<br />
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