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'` C(:> ?& CERTIFICATE OF LIABILITY INSURANCE
<br />1*,,:..�'-
<br />FDATE(MMIDDIYYYY)
<br />5/19/2017
<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 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 lieu of such endorsement(s).
<br />PRODUCER Phone: (707)996-2912
<br />Fax: (707)996-7912
<br />Apollo General Insurance Agency, Inc, (I)
<br />P. O. Box 1508
<br />CONTACT Jerilee Lewis
<br />NAME:
<br />PHONE E FAreAX.
<br />No
<br />ADDREAIL SS: jerileelQapgen.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />Sonoma, California 95476
<br />INSURER A : Interstate Fire & Casualty Company
<br />22829
<br />.INSURED
<br />INSURER B : American Automobile Insurance Company
<br />21849
<br />American Wrecking, Inc.
<br />INSURER c : Torus Speciality Insurance Company
<br />44776
<br />2459 Lee Avenue
<br />South El Monte, CA 91733
<br />INSURER D : State Compensation Insurance Fund Of California
<br />35076
<br />Philadelphia Insurance Company
<br />INSURER E: P P Y
<br />23850
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:750 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 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
<br />TYPE OF INSURANCE
<br />AOD
<br />S BR
<br />NUMBER
<br />POLPOLICY
<br />MMID�IYYYY
<br />POLICY
<br />YYY
<br />LIMITS
<br />A
<br />tI
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ✓❑ OCCUR
<br />DAN1000477
<br />4/28/2017
<br />4/28/2018
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DA AGE TO RENTED
<br />PRE ISES Ea occurrence
<br />_
<br />"'"' 300,000
<br />$
<br />MED EXP (Any one arson)
<br />$ �>
<br />PERSONAL& ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGG REGATE LIM IT AP PLI ES P ER:
<br />POLICY V PEt° E LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMP/OP AGO
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />1/
<br />LIABILITY
<br />ANY AUTO
<br />MXA80320884
<br />9/1/2016
<br />9/1/2017
<br />_COMBINEDSINGLE LIMIT
<br />$ 1000000
<br />BODILY INJURY (Per person)
<br />$
<br />I
<br />OWNED SACHEDULED
<br />AUTOS ONLY UT
<br />BODILY ( BODILY INJURY Per accident)
<br />$
<br />1/
<br />HIRED ,/ NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />C
<br />UMBRELLALIAB
<br />EXCESS LIAB
<br />OCCUR
<br />CLAIMS -MADE
<br />29256EI71ALI
<br />4/28/2017
<br />4/28/2018
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />DED I I RETENTION $
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOY RS'LI BILIITY Y/N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBEREXCLUC
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />9161690-16-2
<br />10/1/2016
<br />10/1/2017
<br />I
<br />✓ STATUTE ER
<br />E.L. EACH ACCIDENT
<br />_
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 11000,000
<br />E
<br />Pollution Liability
<br />PPK1615467
<br />2/18/2017
<br />2/18/2018
<br />Per Om.
<br />5,000,000
<br />Policv naa.
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />Re: Operations of the Names Insured. Certificate Holder is hereby added as Additional Insured if required by written
<br />contract per endorsement hereto. Waiver of Subrogation is provided, as required by written contract with the insured
<br />as respects coverage evidenced herein. A 30 day written notice shall be mailed to the certificate holder at the
<br />address.provided herein, should a described policy(s) be cancelled before the expiration date thereof; 10-day notice
<br />for non-payment of premium,
<br />REVIEWED BY: EUNICE HEREDIA (PG OF )
<br />Holder's Nature o£ Interest : Certificate Holder
<br />City of Santa Ana
<br />PO Box 1988 M-36
<br />Santa Ana, CA 92702
<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 Rp$ENTATIVE
<br />77r
<br />©1988.2015 ACORD�PORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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