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DIVEWAT-01 VA5 UEZI
<br /> '4 R� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDYYYY)
<br /> 717120 25
<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(iss)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 endorsements.
<br /> PRODUCER License#OE67768 DONTACT [sabel Vasquez
<br /> IOA Insurance Services PHONE FAX
<br /> 3009 Douglas Blvd. (A1C,No,Ezt):(916)692-7022 (AIC,No):
<br /> Suite 110 E-MAIEss:IsabeLVasquex@ioausa.com
<br /> Roseville,CA 95661 INSURER 5 AFFORDING COVERAGE NAIC#
<br /> INSURERA:AXIS Surplus insurance Company 26620
<br /> INSURED INSURER B
<br /> Diversified Waterscapes Inc INSURER c:
<br /> 27324 Camino Capistrano#213 INSURER D:
<br /> Laguna Niguel,CA 92677
<br /> INSURER E
<br /> INSURER F:
<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 ADDLTYPE OF INSURANCE 1N9Q WVDSUR POLICY NUMBER POLICY EFF POLICY EXP
<br /> LTRN D WVD MM DOYM) (MMODMOM LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS MADE 0 a-CUR X X EMP1900099807 5/15/2025 5115/2026 pREMISES EaoNTF ence 140,400
<br /> VIED EXP(Any one arson 10,000
<br /> PERSONAL&ADV INJURy 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE 2,000,000
<br /> X POLICY JECT LOG PRODUCTS-COMPIOPAGG 2,000,000
<br /> OTHER:
<br /> POLLUTION PROFE 2,000,000
<br /> COMBINED SINGLE LIMIT
<br /> AllTOM DBILE LIABILITY Ea accid n
<br /> ANY AUTO BODILY INJURY Per arson
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accldent
<br /> AUTOS ONLY AON-OWNED
<br /> ROPER
<br /> eo.,d DAMAGE
<br /> A UMBRELLA LAB OCCUR l EACH OCCURRENCE $ 2,000,000
<br /> X EXCESS LIAR CLAIMS-MADE EMX1900023407 5/1512025 5115l2026 AGGREGATE $ 2,000,000
<br /> ➢ED RETENTION$
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY .Y/N A LITE rp
<br /> ANY PRO OFFICERIMEMBERPRIETORIEXCLUDEID?ECUTIVE ❑ NIA F .EACH ACCIDENT $
<br /> (Mandatory In NH) F,L.DISEASE-EA EMPLOYEE $
<br /> f yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT $
<br /> A Pollution Liability I X EMP1900099807 5/15/2025 5/15/2026 Aggregate 2,000,000
<br /> A Pollution Liability EMP1900099807 5/1512025 5/15/2026 Aggregate 2,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additlonal Remarks Schedule,may W attached It more space is requlred}
<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 perform#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 perform#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 /> CERTIFICATE HOLDER CANCELLATION
<br /> APPROVED
<br /> By 7'a Tran Nguyen.at9,34 am,Arrg 64,20 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 /> City of Santa Ana AUTHORIZED REPRESENTATIVE
<br /> Risk Management Division
<br /> 20 Civic Center Plaza,4th floor
<br /> TU 7 °1g1a1y5gned ✓�
<br /> t rant byTUT
<br /> ISanta Ana,CA 92702N9uyen
<br /> ACORD 25(2016I03) Nguyen 99:3450-0700'S ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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