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<br /> R CERTIFICATE OF LIABILITY INSURANCE DATE10/2/20"YYY'
<br /> 0/2/2025
<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. I
<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 rl hts 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) PHONEC Not:
<br /> P.O.Box 1508 ADDRESS: lerileecQapgen.com
<br /> Sonoma,California 95476 INSURERS AFFORDING COVERAGE NAIC N
<br /> INSURER A; Nautilus Insurance Company 17370
<br /> INSURED INSURER a; Key Risk Insurance Company 10885
<br /> J&G Industries,Inc. INSURER c; State Compensation Insurance Fund Of California 35076
<br /> 18627 Brookhurst Street INSURER D; Tokio Marine America Insurance Co 10945.
<br /> PMB 302 INSURER E;
<br /> Fountain Valley,CA 9270$
<br /> INSURER F;
<br /> COVERAGES CERTIFICATE NUMBER:1561 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 /> INS R TYPE OF INSURANCE AODL UBR POLICY EFF POLICY EXP j
<br /> LR POLICY NUMBER LIMITS
<br /> ✓ COMMERCIAL GENERAL LIABILITY ECP2038906-12 11/1/2024 11/1/2025 MGOCCURRENCE S 1,000,000
<br /> A CLAIMS-MADE a OCCUR PREME Eevocu SES $
<br /> iO0,000
<br /> ✓ Professional$1,000,000 ✓ y MEDEXP(An one rsen $
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000
<br /> POLICY a JECT El LOG PRODUCTS.COMPEOP AGG S 2,000,400
<br /> OTHER: S
<br /> AUTOMOWLELIASILITY BAP2041776-II 11/1/2024 II/l/2025 COMBRJEDSINGLELIMIT S 1,000,000
<br /> B
<br /> ANY AUTO BODILY INJURY(Per person) S
<br /> OWNED
<br /> AUTOS ONLY ✓ AID EDULED ✓ Y BODILY INJURY(Per accident) S
<br /> HIRED NON-OWNED PROPERTY DAMAGE S
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> $
<br /> UMBRELLAUAB ✓ OCCUR FFX2038907-12 11/1/2024 11/l/2025 EACHOCCURRENCE $ 5,000,000
<br /> A ✓ EXCESS UABCLAIMS-MADE AGGREGATE S 5,000,000
<br /> I
<br /> Del) RETENTIONS ✓ Y $
<br /> C WORKERS COMPENSATION 9346758-25 10/1/2025 10/1/2026 '� STATUTE 0ERH
<br /> AND EMPLOYERS'LIABILITY YIN P
<br /> ANYPROPRIETORIPARTNER!£XECUTIVE I I E.L.EACH ACCIDENT $ 1,000+000
<br /> OFFICER(MEMBEREXCLUDE07 N/A Y
<br /> (Mandatory In NH) E.L DISEASE-EAEMPLOYEE $ 1,000,000
<br /> Udesrfibe under 1,000,000
<br /> D004OQ
<br /> RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S e +
<br /> D Inland Marine(Commercial) CPP6412447-00 11/1/2024 11/l/2025 Rentedn.eM&Per hem 750,000
<br /> RenteKmssee&PerOccursence 750,00 {
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORO 101,Additional Remarks Schedule,may be attached N more space 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 _
<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
<br /> underlying General Liability, Pollution, Professional, Commercial Auto and Workers Compensation Coverage listed. A
<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 Interest: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 REPRESEN TT E
<br /> Santa Ana,CA 92701 /,,&&
<br /> APPROVED Q 1986-2015 ACORD CORPORATION. All rights reserved. !
<br /> AC name and logo are registered marks of ACORD
<br /> By Tu Tran Nguyen at 2:37 pm, Oct 15, 2025 Tu Tran Digitally signed by
<br /> Tu Tran Nguyen
<br /> Nguyen i14380620700'S
<br />
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