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304363
<br />A ®® CERTIFICATE OF LIABILITY INSURANCE
<br />DAT DIYYYY)
<br />6//27/227/2 018
<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
<br />Commercial Lines - 213-253-6700
<br />USI Insurance Services National, Inc, CA Lic#: OD08408
<br />777 South Fig ueora St, Ste 2100
<br />Los Angeles, CA 90017
<br />CONTACT Jonathan Allen
<br />NAME:
<br />PHONEFAX
<br />AI No ExtI: 213-337-6350 AIc No ; 610-537-2253
<br />-MAIL
<br />ADDRESS: Jonathan.allen@usl.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Nautilus Insurance Company
<br />17370
<br />INSURED
<br />Ocean Blue Environmental Services., Inc.
<br />925 West Esther Street
<br />INSURER B: Great Divide Insurance Company
<br />25224
<br />INSURER C:— ----- ---•-.-�..
<br />INSURER 0:
<br />----.......__ _- _.
<br />............................
<br />..
<br />CLAIMS -MADE I OCCUR100,000
<br />INSURER E
<br />_................-..............-.--..................................__...,.....,...,....._.........__......,,......,_._.._..
<br />Long Beach, CA 90813
<br />...............................- ..... _,.
<br />INSURER F:
<br />..,. _.
<br />COVERAGES CERTIFICATE NUMBER: 13233814 REVISION NUMBER: See below
<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 />........... ._.........__......._......._._..........__.._..._..........--_........_..... ...................-- I- ...._..._... _-.._........._..._-...............,..,...,......__......._....._.._.......__._......._...--
<br />INSR _ ....._..........._ AppL SUBR .._.._ .
<br />LTR TYPE OF INSURANCE t POLICY NUMBER MMI ID%YYYY MMIDDy1YiYYY LIMITS
<br />A
<br />X COMMERCIAL GENERA LLIABILITY
<br />X
<br />ECP2018650 12
<br />07/01/2018
<br />07/01/2019
<br />EACH OCCURRENCE $ 1,000,000
<br />X
<br />_ .................................................................................
<br />CLAIMS -MADE I OCCUR100,000
<br />PROMISES(E "cxgurrence)" $
<br />MED EXP (Any one person) $ 5,000
<br />_.........................
<br />PERSONAL&ADV INJURY $_ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />_
<br />GENERAL AGGREGATE $ 2,000.000
<br />� JE
<br />_
<br />POLICY LOC
<br />PRODUCTS :COMP/OP AGG $ 2,000,000
<br />............._..........-.-...,._...,......._...--,.,.._............
<br />X OTHER: SIR: $20,000
<br />$
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />BAP2018652-12
<br />07/01/2018
<br />07/01/2019
<br />COMBINED SINGLE LIMIT $
<br />Ea accident) 1,000,000
<br />BODILY INJURY (Per person) $
<br />X
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY _ AUTOS
<br />_x
<br />BODILY INJURY (Per aocidant) $
<br />X
<br />HIRED NON -OWNED
<br />PR6I5Ei2T7 DAMAGE $
<br />AUTOS ONLY AUTOS ONLY
<br />Per accident)
<br />$
<br />x
<br />MCS -90
<br />1
<br />1
<br />A
<br />UMBRELLALIAB
<br />X
<br />Y
<br />OCCUR
<br />FFX2018651-12
<br />07/01/2018
<br />07/01/2019
<br />EACHOCCURRENCE $ 9,000,000
<br />AGGREGATE $ 9,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I I RETENTION
<br />$ SIR - N/A
<br />B
<br />WORKERS COMPENSATION
<br />WCA2018653-12
<br />07/01/2018
<br />07/01/2019
<br />X PTATUT X ERH USL&H
<br />AND EMPLOYERS' LIABILITY YIN
<br />-- 1,000,000
<br />E.L. EACH ACCIDENT $
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBEREXCLUt C
<br />NIA
<br />— —
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />(Mandatory in NH)
<br />If yea, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />A
<br />Pollution Liability
<br />ECP2018650-12
<br />07/01/2018
<br />07/01/2019
<br />Limits: $1,000,000 Each Occurrence
<br />Ded:$20,000; Occurence Form
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required)
<br />RE:RFP# 16-144 Certificate Holder is named as additional insured as it relates to general liability in accordance with the terms and conditions of the policy.
<br />REVIEWED BY:EUNICE HER DIA (PG,¢ OF111Lo
<br />4CR I It•14A1 G n
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Attn: Public Works Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />p ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 CIVIC Center Plaza M-22
<br />Santa Ana, CA 92702-0000 AUTHORIZED REPRESENTATIVE an
<br />The Ali name and logo are registered marks of ACORD O 1988.2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03)
<br />
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