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.4c R5-1 CERTIFICATE OF LIABILITY INSURANCE 11/16/21 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 NUGEN & ASSOCIATES INSURANCE SERVICE INC 10722 Arrow Route #116[Affle. CONT CI PHONE FAX 909-941-0167 AICNaLic.#OC17304 ADDRESS: Rancho Cucamonga, CA 91730 INSURERIS) AFFORDING COVERAGE NAICN # OC173O4 INSURERA:INTEGON NATIONAL INSURANCE COMPANY 29742 INSURED J & G INDUSTRIES, INC. JAMES K CAIN 7511 SUZI LANE INSURER B: THE OHIO CASULA Y INSURANCE COMPANY 24074 INSURERC: I INSURERD: WESTMINSTER, CA 92683 714 903-2002 INSURER E: INSURER F: COVERAGES CERTIFICATF NIIMRFR- oclnn,r.0 s 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. LTN TYPE OF INSURANCE ADDLISU INED R VIVO POLICY NUMBER MM%OD/YYYY MWDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE '— $ �I u OCCUR -UAPAGCLAIMS-MADE PREMISES fET EO aEoccurrDence $ MED E_XP ?Any one person) $ PERSONAL& ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO- LOC PRODUCTS - COMPIOP AGG $ JECT $ OTHER: AUTOMOBILE LIABILITY Ee acddanl $1, OOOr000. 00 ][ AN'AUTO NY SCHEDULED 2010543587 11/01/2111/01/22 BODILY INJURY (per person) —$ — A AUTOS ONLYNXAUTOS Y Y BODILY INJURY (Per accident) $ X ED NON -OWNED A Per accident $ AUTOS ONLY AUTOS ONLY UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DIED I I RETENTION$ a WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN STATUTE I I ER E.L. EACH ACCIDENT $ ANY PROPRIETOMPARTNERIEXECUTIVE OFFICERINEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYE S (Mandetery In NHI If es,descdbe under E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS below B EQUIPMENT FLOATER BMO(22)62157329 11/01/21 11/01/22 SCHEDULED $2,022,000. DEDUCTIBLE 2% LEASED/RENTED $ 750,000. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space Is required) A-2017-036,J&G AGMT AND A-2014-183 J&G AMU, CITY OF SANTA ANA HAS BEEN REQUESTED TO BE NAMED AS ADDITIONAL INSURED AND WAIVER OF SUBROGATION IN RESPECT TO THE AUTO LIABILITY HOLDERS NATURE OF INTEREST: �� CITY OF SANTA ANA SHOULD ANY OFT DATE E ABI RISK MANTHE EXPIRATI MANAGEMENT DIVISION ACOORDANC ITr 1 20 CIVIC CENTER PLAZA PO BOX 1988 AUTHORIZED R RES NTATIVE SANTA ANA CA 92702 1988-20id ACORD25(2016103) The ACORD name and logo are registered marks of ACORD DESCRIBED POUCIL$ BE CANCELLED IEREOF, NOTICE WILL BE DELIVE I'iY'' IiRt!R ice, , t' rn vut j