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A4CC)R1:f CERTIFICATE OF LIABILITY INSURANCE
<br />IDD
<br />D�,IM/3I`20'Y17
<br />--''
<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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s),
<br />PRODUCER Phone: (707}996-2912
<br />Fax: (707)996-7912
<br />ApD11a General InsurancetlgenGy, Inc. {1}
<br />P. O. BUY 1508
<br />CONTACT
<br />NAME: Jerilee Lewis
<br />PHONE FAX
<br />A1C o E AIC No):
<br />EMAIL jerileeVdapgeuxonl
<br />ADDRESS:
<br />INSURER($) AFFORDINGCOVERAG£ NAtCH
<br />--------------------------------------------------
<br />Sonoma, California 95476
<br />- -- -- --
<br />INSURER A: Interstate Fire & Casualty Company 22829
<br />DAN1000347
<br />INSURED
<br />INSURER B: American Automobile Insurance Company 21849
<br />J&G Industries, Inc.
<br />18627 BCf101Cltt]r5t StreetPNIBINSURER
<br />FDunFour 302
<br />taitr Valle}`, CA 92708 ©
<br />INSURER C: Torus Speciality Insurance Company 44776
<br />D; State Compensation Insurance Fund Of California 35076
<br />«res€chester Surplus Lines insurance Company 10172
<br />INSURER E : � P Y
<br />INSURER F;
<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 />€NSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WV D
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD
<br />POLICY EXP
<br />MMfDD
<br />LIMITS
<br />✓ COMMERCIAL GENERAL LIABILITY
<br />CLAIMS•MADE Q OCCUR
<br />DAN1000347
<br />11/1/2014
<br />1 1/1/2015
<br />EACH OCCURRENCE S 1,000,000
<br />DAMAGE TO RENTED 300,000
<br />PREA4ISES Eaocvvrrence S
<br />W"'
<br />RNI7�1 ° G • A(. di_ I of i li 11.
<br />'s Cd sfi"Ti'
<br />only
<br />N1ED EXP (Any one person} $ 5,000
<br />PERSONALBADVINJURY $ 1,000,000
<br />Sfr'E
<br />�� le hf'_�Itsi€,'- E 1 =�', ;o.wl?
<br />E t?t t-z`%,s `
<br />E_,Ib k, `a.f
<br />GENL AGGREGATE LIMIT APPLIES PER:!
<br />PRO-
<br />POLICY JECT
<br />OTHER:
<br />GENERAL$ 2,000,000
<br />GENERAL AGGREGATE
<br />�
<br />pl" I nc I rl ?f
<br />,��
<br />-
<br />'r r , _JY• 1
<br />i as !;6`
<br />PRODUCTS -COMPIOPAGG $ 2,000,000
<br />B
<br />AUTOMOBILE
<br />✓
<br />LIABILITY
<br />ANY AUTO
<br />iNFXA80308826
<br />11/1/2014
<br />11/1/2015
<br />,."'2d
<br />.n'1_ INGLEL1hS1T $ 1,000,000
<br />BODILY INJURY (Per person) $
<br />V'HIREDAUTOS
<br />✓
<br />ALL OWNED ✓ SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />✓ AUTOS
<br />uto$ spc6 ied CU
<br />accident BODILY INJURY Per $
<br />{ }
<br />PROPERTY DAMAGE
<br />Peraccdent $
<br />$
<br />C
<br />r/
<br />UMBRELLA LIAB
<br />EXCESSL1AB
<br />✓
<br />OCCUR
<br />CLAIMS-NVrE
<br />37639CI42ALI
<br />11/1/2014
<br />11/1/2015
<br />EACH OCCURRENCE $ 7,000,000
<br />AGGREGATE $ 7,000,000
<br />DED I I RETENTIONS
<br />Per accident S 7,000,000
<br />D
<br />WORKERS COMPENSATIN
<br />AND EMPLOYERTLIABILITY YIN
<br />ANY PROP RI ETOR/PARTNERIEXECUTNE
<br />OFF[CERIMEMBER EXCLUDED? ❑
<br />N f A
<br />802347-2014
<br />10/1/2014
<br />10/1/2015
<br />✓ STATUTE °R"
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />-
<br />E.L. DISEASE - EA EMPLOYE S 1,000,000
<br />(MondatorylnNH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000
<br />E
<br />Pollution Liability
<br />024334004003
<br />11/1/2014
<br />11/1/2015
<br />GaneraiAegregate 1,000,000
<br />Exch Pollution Conditions 1,000,000
<br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached If more space Is required)
<br />Re: All operations of the Named Insured. The City of Santa Ana, its officers, agents, & employees are named as
<br />additional insureds and additional insured coverage is provided if required by written contract per endorsements
<br />hereto attached.
<br />CERTIFICATE HOLDER CANCELLATION
<br />Holder's Mature of Interest : Certificate Holder
<br />City of Santa Ana
<br />20 Civic Center Plaza N136
<br />Santa Fina, CA 92701
<br />ACORD 25 (2014101)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />AUTHORIZED REPRES TATIVE
<br />07 F 7I:bi1y [! C•I.7 7�;
<br />The ACORD name and logo are registered marks of ACORD
<br />RATION. All rights reservPd
<br />
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