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Francine R. Dlgltallysigned by <br />Francine R. Villareal <br />Date: 2022.02.01 <br />Villareal <br />16:47:56-08'00' <br />CERTIFICATE OF LIABILITY INSURANCE I 0 (MMDDIYYYI.---.Y) <br />THIS CERTIFICATE IS ISSUEDPS 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: It the cartVicate holder Is an ADDITIONAL INSURED, the pollcy(lea) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, 'subject to the terms and conditions of the policy, cartaln policies may require an endorsement. A statement on <br />PRODUCER Wright, Finnegan <br />23001 La Palma A <br />Yorba Linda, CA S <br />License #: Dk9361 <br />Carter Insurance Associates <br />I. Ste 100 <br />INSURED INSURERS: Travelers Pro ert Casualty Co 2 674 <br />Stephen Doreck Equipment Rentals, Inc. g--K h <br />DBA Doreck Construction INSURERC: <br />9075 Telegraph Rod INSURER 01 <br />Pico Rivera, CA 90�60 INSURERS: <br />r.nVPRAr r.q I rIFRTIFICATF NI IMRFR. nOM1Anfl.s9rumnA RFVIRNIN NIINIRFR. 49, <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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS 4F SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />SR <br />TYPE OP INSURANCE <br />ADDI. <br />POLICY NUMBER <br />P0� ICY FF <br />0 Llf) EXP <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABIIITY <br />CLAIMS -MADE © OCQUR <br />Y <br />Y <br />CO-720OP638-TCT-21 <br />0310112021 <br />03/01/2022 <br />EACHOCCURRENCE <br />$ 1 600 660 <br />P E 16 S E u <br />$ 90O OOO <br />MED EXP Any one arson <br />$ 6,000 <br />Contractual Liab 1 <br />Pollution Liab I <br />PERSONAL & ADV INJURY <br />$ 1000000 <br />GEN'L AGGREGATE LIM IT APPLIES PER: <br />POLICY ®JECT ❑ LOC <br />GENERAL AGGREGATE <br />a 2000000 <br />PRODUCTS •COMPlOP AGG <br />$ 2 OOO OOO <br />Pollution <br />$ 2,000,000 <br />OTHER, <br />B <br />AUTOMOa11,E1JAOILITY <br />810-8L58787A-21-26-G <br />0310112021 <br />03101/2022 <br />e e ESN uMl <br />s <br />$ 1,000,00() <br />BODILY INJURY (Par pemen) <br />$ <br />X <br />ANYAUTO <br />OWNED 80HECOLED <br />AUTOS ONLY AUTOS: <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />BODILY INJURY ( Peracaldent 1 <br />$ <br />PROPS GE <br />er c tlant <br />$ <br />$ <br />Phy Damage <br />B <br />UMBRELLA UAB <br />X <br />OCCUR <br />CUP-2J30069A-21-26 <br />0310112021 <br />03/0112022 <br />EACH OCCURRENCE <br />$ 5000000 <br />AGGREGATE <br />$ 6000,000 <br />X <br />EXCESS LIAR <br />CIA" -MADE <br />D DERB RETENTIOTIONN$ WOO <br />B <br />ANDEMPLOY RSEUABLOY- <br />ANY PROPRIRTORIPARTNERIIXECUTI <br />(Mandatary In NH)IXCLUDF�Y <br />ea describe antl er r8� IPTION OFO R TIONS below <br />E YI <br />Y Y <br />NIA <br />Y <br />UB-OK312896.21-26-G <br />0310112021 <br />03101/2022 <br />X E ITT E H <br />E.L. EACH ACCIDENT <br />$ 1 OOO 000 <br />E.L. DISEASE -FA EMPLOYE <br />$ 1000000 <br />E,L. DISEASE -POLICY LIMIT <br />$ 1 000 000 <br />B <br />Install Floater <br />QT-660-213410826-TIL-21 <br />081`1812021 <br />06118P2022 <br />bed 1,000 <br />360,000 <br />B <br />Equip Rented From <br />I <br />QT-660-2G410826-TIL-21 <br />68H812021 <br />08/18/2022 <br />ACV <br />130,000 <br />DESCRIPTION OF OPERATIONS I LOOAnOf S/VEHICLES (ADDED 101, Additional Remarks Sohadulo, may be ataohad Breen, space Is required) <br />Pollution Policy Westchester; Surplus Lines Ina NAIC # 10172 Policy #G27153136008 Eff Date 03/0112021 through 03/01/2022 <br />$2,000,000,00. NEW RESIDENTIAL EXCLUSION FOR GENERAL LIABILITY POLICY. <br />JOB: PROJECT# 21.6466-GI20VEMONT STREET WATER MAIN IMPROVEMENTS, SDER JOB#2021-09. CRY OF SANTA <br />ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE ADDITIONAL INSURED AND <br />PRIMARY WORDING APPLI"' PER THE BLANKET ADDITONAL INSURED ENDORSEMENT ATTACHED TO THE POLICY -AS <br />continued c ACORD 101 A dltlonal Remarks Schedule <br />i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />CITY OF SANTAIANA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 CIVIC CENTER PLAZA <br />Santa Ana, CA k701 AUTHORIZED REPRES�B <br />RIAManagement Diwlmt <br />REVIEWED 6 Ama rED BY: <br />01988.201(1 ACORD COR F ,' . R v l <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Printed b )@ ', Risk Management Analyst <br />