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AC oo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYY r)
<br /> a/16/2025
<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 policies may require an endorsement, A statement on
<br /> this certificate does not confer rights to the certificate holder In Ileu of such endorsements.
<br /> PRODUCER Phone: (7 0 7119 9 6-29 1 2 CONTACT Jerilee Carpenter
<br /> Fax: (707)996-7912 NAME:
<br /> Apollo General insurance Agency,Inc,(I) PHONE FAX
<br /> P.O,Box 1508 EDualEss: jeritcec@apgcn.com
<br /> Sonoma,California 95476 INSURER 9 AFFOROINGCOVERAGE NAIC1
<br /> INSURERA: Nautilus Insurance Company 17370
<br /> INSURED INSURER B: Key Risk Insurance Company 10885
<br /> I&G Industries,Inc. INSURER C: State Compensation Insurance Fund Of Califomia 35076
<br /> 18627 Brookhur3t Street INSURER o: Tokio Marine America Insurance Co 10945.
<br /> PMB 302
<br /> Fountain Valley,CA 92708 INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1493 REVISION NUMBER:
<br /> THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD j
<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 /> ILTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
<br /> POLICYNUMBER MMIDONYYY) (MMIDOfYYYYI LIMITS
<br /> ✓ COMMERCIAL GENERAL LIABILITY HCP203890&12 1]/1/2024 11/1/2025 EACH OCCURRENCE 3 1,000,000 !
<br /> A CLAIMS-MADE Q OCCUR DAMAGE
<br /> E6t 9E3 EaEI mue S 00,000
<br /> ✓ Professional$1,000,000 ✓ y MED EXP(ArLy one parsan) s
<br /> PERSONAL SAOVINJURY S 1,000,000
<br /> GENt AGGREGATE LIMIT APPLIES PER: LGENERAL AGGREGATE 3 2,000,000 I
<br /> POLICY JEST IOC PRODUCTS-COMPIOPAGO 3 2,000,000
<br /> OTHER: Pollution S I,000,000 i
<br /> AUTOMOBILELIAH(LITY RAP2041776-11 11/l/2024 11/1/2025 (CE(,' ul,INdEeDISINOLELIMIT
<br /> B $ 1,000,000
<br /> ANY AUTO e0011Y INJURY(Per person) 3
<br /> OWNED aI SCHEDULED e00RY INJURY(Par scddenl)
<br /> AUTOS ONLY AUTOS ✓ Y
<br /> ✓ HIRED e/ NON-OWNED PROPERTY DAMAGE 3
<br /> AUTOS ONLY AUTOS ONLY Par tl nt
<br /> 3
<br /> �RE.LIAR ✓ OCCUR FFX2038907-12 11/1/2024 11/1/2025 EACH OCCURRENCE 3 5,000,000
<br /> A ✓ CLAIMS-MADE AGGREGATE 3 5,000,000RETENTION ✓ y 3
<br /> WORKER3 COMPENSATION 9346758-24 10/1/2024 10/1/2025 ✓ PER OTH
<br /> C AND EMPLOYERS'LIABILITY YIN
<br /> ANYFROPR � ER
<br /> CUTNE IETORrPARTNER E.L.EACH ACCIDENT S I,000,000
<br /> OFFICERAAEMSEREXCLUDED? NIA y
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000
<br /> If yes descAbeunder I,000,000
<br /> DESCRIPTION OF OPERATIONS beraw E.L.DISEASE-POLICY LIMIT S
<br /> D Inland Marine(Commercial) CPP6412447.00 11/1/2024 11/1/2025 ReslydlL d:Perlrem 750,000
<br /> Rvucd1cascd Pa Occurrence 750,000 '
<br /> DESCRIPTION OF OPERATIONS ILOCATION3 IVEH(CLES WORD 141,Adchlonal Remarks Schedule,may be attached If more apace Is required)
<br /> Re: RFP 25-027 Citywide on-Call Demolition Services for Abatement. City of Santa Ana, its City Council, officers,
<br /> officials, employees, and volunteers are hereby named as Additional Insured, if required by written contract, per I
<br /> endorsement hereto. Waiver of Subrogation is provided, as required by written contract with the insured as respects
<br /> coverage evidenced herein. Coverage evidenced herein is primary and non-contributory. Excess is follow form to the I
<br /> underlying General Liability, Pollution, Professional, Commercial Auto and Workers Compensation Coverage listed. A j
<br /> 30-day written notice shall be mailed to the certificate holder at the address provided herein, should a described
<br /> policy(s) be cancelled before the expiration date thereof! 10-day notice for non-payment of premium
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Holder's Nature of fnlerest:Additional Insured
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Planning and Building Agency
<br /> 20 Civic Center Plaza AUTHORIZED REPRESENTf1�
<br /> Santa Ana,CA 92701 W411YAll
<br /> 01988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br /> Tu Tran D.gitAyugnedby APPROVED
<br /> Tu Tran Nguyen
<br /> Date.7075.04.73 By Tu Tran Nguyen at 11:53 am,Apr 23,2025
<br /> Nguyen lI5417-0T00'
<br />
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