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<br /> CERTIFICATE OF LIABILITY INSURANCE DATE(
<br /> .A►coRo 11/6/2GfY2sYYY)
<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 pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain pollcies 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: (707)996-2912 CONTACT )erilee Carpenter
<br /> Fan: (707)996-7912 NAME:PHONE FAX
<br /> Apollo General Insurance Agency,Inc.(1) AIC No
<br /> P.O.Box 1508 ADDRESS: jerileec@apgen.com j
<br /> Sonoma,California 95476 INSURERS AFFORDING COVERAGE NAIC s
<br /> INSURER A: Nautilus Insurance Company 17370
<br /> INSURED INSURER B: Key Risk Insurance Company 10885 i
<br /> 3&G Industries,Inc. INSURER e: State Compensation Insurance Fund Of California 35076
<br /> 18627 Brookhurst Street INSURER D: TOk10 Marine America Insurance Co 10945.
<br /> PMB 302
<br /> Fountain Valley,CA 92708 INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1568 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 /> INSR AOOL SUER POLICY EFF POLICY EXP
<br /> LTA TYPE OF INSURANCE POLICY NUMBER MMIt1D LIMITS
<br /> ✓ COMMERCIAL GENERAL LIABILITY ECP2038906-13 11/1/2025 II/l/2026 EACH OCCURRENCE $ 1,000,000
<br /> A eNTECF-
<br /> CLAIMS-MADE ✓❑OCCUR PREM sEs TO
<br /> a occurrence s 100,000
<br /> ✓ Professional$1,000,000 ✓ y MEDEXP(Any one Person) S
<br /> ✓ Transportation PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY ✓�JEST LOC PRODUCTS-COMPIOPAGG s 2,000,000
<br /> ✓ OTHER. Non-Owned Disposal Site Pollution $ 1,00b,ObD
<br /> AUTOMOBILE LIABILITY BAP2041776-12 11/l/2025 11/1/2026 EeaoddenlSINGLEUMIr $ 1,000,000
<br /> B
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED ✓ SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS ✓ Y
<br /> HIRED �/ NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Para and
<br /> S
<br /> UMBRELLALIAS ✓ OCCUR FFX2038907-13 11/l/2025 11/1/2026 EACH OCCURRENCE S 5,000,000
<br /> A ✓ EXCESS LIAR 5,000,000
<br /> CLAIMS-MADE AGGREGATE S <
<br /> f
<br /> DEO RETENT€ON$ ✓ Y S
<br /> WORKERS COMPENSATION 9346758-25 10/1/2025 10/1/2026 ✓ PTATUTE ERH `
<br /> C AND EMPLOYERS'LIAaIL€TY
<br /> ANYPROPRIETORIPARTNERIEXECUTfVE V 1 N l000000
<br /> ,,
<br /> E.L.EACH ACCIDENT S _
<br /> OFFICERIMEMBEREXCLUDED? NIA Y 1,aa0,a0a
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S
<br /> If yes,describe under 1,000 000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S
<br /> D Inland Marine(Commercial) CPP6412447-01 11/1/2025 11/1/2026 Renledrt.raud:Perrtem 750,000
<br /> I
<br /> RentedtLeased:Per Occurrence 750,00
<br /> DESCRIPTION OF OPERATION31 LOCATIONS/VEHICLES(ACORD 101.Additional Remarks Schedule,maybe attached It mare apace Is required)Continued on Attached Supplement.
<br /> E
<br /> Re: Agreement A-2025-047-04 - Citywide On-Call Demolition Services for Abatement. City of Santa Ana, its City
<br /> ouncil, officers, officials, employees, and volunteers are hereby named as Additional Insured, if required by
<br /> ritten contract, per endorsement hereto. Waiver of Subrogation is provided, as required by written contract with the I
<br /> insured as respects coverage evidenced herein. Coverage evidenced herein is primary and non-contributory. Excess is
<br /> follow form to the underlying General Liability, Pollution, Professional, Commercial Auto and Workers Compensation
<br /> Coverage listed. A 30-day written notice shall be mailed to the certificate holder at the address provided herein,
<br /> should a described policy(s) be cancelled before the expiration date thereof; 10-day notice for non-payment of
<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 /> Digitally signed
<br /> Planning and Building Agency Tu Tran by Tu Tran
<br /> 20 Civic Center Plaza Nguyen
<br /> Nguyen AUTHORIZEDREPRESEIfT�1
<br /> Date:2025.11.12 }�j��ff}J J///
<br /> Santa Ana,CA 92701 09:00:38-08'00' /.der.
<br /> APPROVED ®1988.2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) By Tu Tran Nguyen at 9:00 am,Nov 12,2025 go are registered marks of ACORD
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