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DIVEWAT-01 <br />VASQUEZI <br />,d►coRO CERTIFICATE OF LIABILITY INSURANCE <br />#% <br />DATE(MM/ 0YYYY) <br />5/16/2024 <br />THIS CERTIFICATE IS ISSUED AS 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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER License # OE67768 <br />IOA Insurance Servi <br />3009 Douglas Blvd. <br />Suite 110 mngie <br />Roseville, CA 956 <br />N <br />Ar•T lsab <br />I Va <br />UeZ • <br />Prft <br />( <br />ON <br />2 <br />A <br />A/ <br />): <br />E-MAIL abel.Vas ez^loa a.com <br />ADDRESS: �i CG <br />• <br />UR S NP JftVO4Cr%NAIC <br /># <br />IN u <br />1 <br />r lu c <br />26620 <br />INSURED <br />I. C RER B : <br />I JU. <br />jn• <br />Diversift Waterscapes Inc <br />Lag U4 ino CA o <br />g <br />. eve d <br />INSURER D <br />' <br />' ' <br />WFIV,• <br />• <br />I <br />COVERAGES CERTIFICATE NUMBER: 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/YYYY <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE X OCCUR <br />X <br />X <br />EMP1900099806 <br />5/15/2024 <br />5/15/2025 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />100,000 <br />$ <br />MED EXP (Any oneperson) <br />$ 10,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GENT <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />X <br />POLICY PRO LOC <br />PRODUCTS - COMP/OP AGG <br />$ 2,000,000 <br />POLLUTION PROFE <br />$ 2,000,000 <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY Perperson)$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY Per accident <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />A <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ 2,000,000 <br />X <br />EXCESS LIAB <br />CLAIMS -MADE <br />EMX1900023406 <br />5/15/2024 <br />5/15/2025 <br />AGGREGATE <br />$ 2,000,000 <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />PER OTH- <br />STATUTE ER <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ <br />OFFICER/MEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />N / A <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />A <br />Pollution Liability <br />X <br />EMP1900099806 <br />5/15/2024 <br />5/15/2025 <br />Aggregate <br />2,000,000 <br />A <br />Professional Liabili <br />EMP1900099806 <br />5/15/2024 <br />5/15/2025 <br />Aggregate <br />2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />PO Number 6785-1 <br />The City of Santa Ana, it's officers, employees, agents, and representative are named as Additional Insured with respect to General Liability and Pollution <br />when required by written contract per form# CG2010 0704 and PGI EL 018 0210 <br />Certificate Holder is Additional Insured with respect to General Liability and is Primary and Non -Contributory, when required by written contract per form# PGI <br />EL 020 0210 <br />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 <br />notice of policy cancellation. <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza, 4th floor <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREO <br />ACCORDANCE WITH THE POLICY PRG RA Mougmumt DMsIan <br />z, REVIEWED& APPROVED BY: <br />AUTHORIZED REPRESENTATIVE <br />�/q <br />r"I Aavdo <br />—mm,� Risk Management Specialist <br />ACORD 25 (2016/03) <br />© 1988-2015 ACORD <br />The ACORD name and logo are registered marks of ACORD <br />