BACKFLOW APPARATUS & VALVE, CO. (3)

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ACORO® CERTIFICATE OF LIABILITY INSURANCE 111 DATE IMMIDDIYYYY) 1 11/21/2024 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 SIP Insurance Services -Orange 750 The City Drive South, 450 Orange CA 92868 CONTACT Heidi Farman! PHONE FA1c 951 365-3850 ac No626-564-6565 Eo "alEss: heldiflMsipbrokers.corn INSURERS AFFORDING COVERAGE NAIC# INSURER A: Travelers Property Casualty Company of America 25674 LicenseM 0 93299 INSURED BACXAPP-01 BackfloW Apparatus & Valve CO. 20435 S. Susana Road INSURER B: The Travelers Indemnity Company of Connecticut 25682 INSURERC: INSUO: Long Beach CA 90810 INSURRERER E INSURER F : COVERAGES CERTIFICATE NUMBER: 504427579 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 LTft TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF IMIDDIYYYY POLICY UP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY V Y 6308,1664090 10/31/2024 10/31/2025 EACH OCCURRENCE $1,000,000 CLAIMS -MADE I —XI OCCUR DAMA ETORENTED PREMISES RENT $300,000 MED UP (Any one erson) $ 5,000 PERSONAL B ADV INJURY $1,000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000.000 POLICY [fl JE� F-1 LOG PRODUCTS-COMP/OPAGG $2.000,000 $ OTHER: B Y Y BA7N173419 10/31/2024 10/31/2025 COMBINED SINGLE LIMIT Ea ascidenlANYAUTO $1.000,000 BODILY INJURY(Per person) $OWNED SCHEDU LEDAUTOS ONLY POMOBILELIABILITY BODILY INJURY (Per accitlentAUTOS ) $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Par accident $ A X UMBRELLA LIAR X OCCUR CUP9J209005 10/31/2024 10/31/2025 EACHOCCURRENCE $5,000,000 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ A WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY Y/N Y UB-3R155740 8/27/2024 8/27/2025 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 ANYPROPRIETORIPARTNERIEXECUTIVE ❑ OFFICER/MEMBEREXCLUDED] NIA E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory In NH) U yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 A Property 6308,1664090 10/31/2024 10/31/2025 Bus Personal Property Included DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, maybe attached it more space is required) Subject to all policy terms, exclusions and conditions. RE: COSA Agreement N-2020-153; City of Santa Ana and its officers, employees, agents, volunteers and representatives all for nonprofessional related exposures are an Additional Insured with respects to the General Liability and Auto Liability if required by written contract. General Liability Additional Insured, Primary and Non -Contributory and Waiver of Subrogation endorsements attached. Auto Liability Additional Insured and Waiver of Subrogation endorsement attached. Attached Workers Compensation Waiver of Subrogation endorsement applies if required by written contract.'PLEASE NOTE COPYRIGHT LAWS APPLY TO THE ACORD FORM PROHIBITING US FROM MODIFYING THE CANCELLATION CLAUSE. HOWEVER, PER S I P INSURANCE SERVICES PROCEDURES WILL NOTIFY YOU WITHIN 30 DAYS IF SAID POLICY CANCELS. Except 10 Days APPROVED CERTIFICATE HOLDER CANCELLATION By Cynthia Mora at 2.48 pm, Dec 04, 20 SHOULDANY OFT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Water Resources Division 215 S Center Street AUTHOB ZED REPRESENTATIVE Santa Ana CA 92703 ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD