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A - I DATE IMMIDD/YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE F11/112024
<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(les)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policlas 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 Phone: (707)996-2912 CONTACT Jerilee Carpenter
<br /> Fax: (707)996-7912 NAME:
<br /> Apollo General Insurance Agency,Inc,(1) PHONE A1C Nc
<br /> E-MAIL jerileec@apgen.com
<br /> apgen.com
<br /> P.O,Box 1508 ADDRESS:
<br /> Sonoma,California 95476 INSURER(S)AFFORDING COVERAGE NAIC9
<br /> INSURER A: Nautilus Insurance Company 17370
<br /> INSURED INSURERS: Key Risk Insurance Company 10895
<br /> J&G Industries,Inc. INSURERC: Slate Compensation Insurance Fund OfCa[sfornia 35076
<br /> 18627 Brookliurst Street INSURER D: Tokio Marine America Insurance Co 10945.
<br /> PMB 302
<br /> Fountain Valley,CA 92708 INSURERE:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1493 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 /> i POL
<br /> LTR TYPE OF INSURANCE ADDLSUER POLICYNUMBER AM0IbYfYYYY MMlOECIYEXP LIMITS
<br /> ✓ COMMERCIAL GENERAL LIABILITY ECP2038906-12 Il/I/2024 II/1/2025 EACHOCCURRENCE $ 1,000,000
<br /> A CLAIMS-MADE a OCCUR 100,000
<br /> PREMISES Eaaceurrenee $
<br /> ✓ Professional$1,000,000 y Y MEDEXP Anyoneperson)
<br /> PERSONAL&ADV INJURY S 1,000,000
<br /> GI AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY 2]PRO Lf3C PRODUCTS•COMPIOPAGG $ 2,000,000
<br /> OTHER: Pollution $ 1,000,000
<br /> AUTOMCBILE LIABILITY BAP2041776-11 11/1/2024 11/1/2025 COMBINEDI SINGLE LIMIT $ 1,000,000
<br /> a 2cr
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> AO OS ONLY WNED SCHEDULED BODILY INJURY(Per accident) $
<br /> HIRED j/ NON-OWNED PROPERTYDAMAGE S
<br /> AUTOS ONLY AUTOS ONLY Par acddenl
<br /> VMBRELLALIAB OCCUR FFX2038907-12 11/1/2624 11/1/2025 EACH OCCURRENCE $ 5,000,000
<br /> A EXCESS LIAR
<br /> CLAIMS-MADE AGGREGATE $ 5,000,000-
<br /> OE D RETENTION S Y $
<br /> WORKERS COMPENSATION 9346758-24 10/1/2024 1011/2025 ERH
<br /> C AND EMPLOYERS'LtABILITY
<br /> ANYPROPRIETORIPARTNERIEXE:CUTIVfE YIN
<br /> N E.L.EACH ACCIDENT S 1,000,000
<br /> OFROERIM EMBER EXCLUDED? O NIA Y I,000,000
<br /> (Mandatory In NH) E.L.DISEASE-FA EMPLOYEE $
<br /> If yes,describe under 1 000 000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S ,
<br /> D Inland Marine(Commercial) ✓ Y CPP6412447-00 11/1/2024 11/1/2025 RcwcD`Laau&,Pet Item 750
<br /> Renlednaased:Perbccorr"ce 75
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES IACORD 101,Addlllonal Remarka Schedule,may be attached I!mare space is required)Continued on Attached Supplement.
<br /> Re: "Demolition Services on an On-Call basis Agreement: A-2022-065-01". Operations of the Named Insured, City of
<br /> Santa Ana, its officers, officials, employees, and volunteers are hereby named as Additional Insured, if required by
<br /> written contract, per endorsement hereto. Waiver of Subrogation is provided, as required by written contract with the
<br /> insured as respects coverage evidenced herein. Coverage evidenced herein is primary and non-contributory. Excess
<br /> (schedule of controlling underlying insurance attached) is follow form to the underlying General Liability,
<br /> Commercial Auto and Workers Compensation Coverage, A 30-day written notice shall be mailed to the certificate holder
<br /> at the address provided herein, should a described policy(s) be cancelled before the expiration date thereof; 10-day
<br /> CERTIFICATE HOLDER CANCELLATION APPROVED
<br /> Holder's Nature of interest:Additional Insured Sy Cynthia Mora at 8:52 am,,tan 16,2t?25
<br /> SHOULD ANY OF THE:ASO
<br /> City of Santa Ana THE (EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza M-30
<br /> Santa Ana,CA 92702 AUTHORIZED REPRESZ1.
<br /> nVE
<br /> �� 9
<br /> C119811-2015 ACORD CORPORATION, All rights reserved,
<br /> ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD
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