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y �ry B-.y�> DATE(Mt.11DDNYYY)
<br />A Yui" CERTIFICATE OF LIABILITY INSURANCE 10/31/2017
<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 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 policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in liou of such ondorsemont(s).
<br />PRODUCER Phone (707)9962912NAo lerilcc L lvis
<br />Fav: (707)9967912 NAME:
<br />PHONE IFAX
<br />Apollo General Insurance Agency, Inc. (1) G�tie t 2Y -__-- —1LIC Nol:
<br />P. 0. Bos 1503 ADORE--,--__erileel(i ipgen.com
<br />I
<br />Sonoma, California 95,176 INSURER(S)AFFORDING COVE.,RAGE _- NAlcn
<br />NSURERA: hueratate Piro S Casualty Connpan 22329
<br />---- - - --- - !_ — -- _-
<br />INSURED INSURER B: American Automobile Insurance Company ( 21349
<br />1&,G Industries, Ine. INSURERC: Tokio Marine Specialty Insurance Company 23350
<br />18627 Drookhurst Street INSURER D: State Compensation Insurance Fund Of California 3507Ci
<br />IIN1 1 B 302 INSURER — —-_..--- - . __ — . m _.. - -- --
<br />URER E: 1VcslchSu
<br />cstcr rplus 1 uu^, Insurance Copany 101'12
<br />Fountain Valley, CA 92708 INS— —----"—`—
<br />INSURER F: _
<br />nr,I r co n n_cc w.. .�..._._.__._.....�._� rCDTICI( ATG nit rMaF0. 311 RFVISiION Nl1MRFR-
<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, TERN! 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 />—
<br />TYPE OFI INSURANCE E
<br />AODLSUBR
<br />21SR_(ii`1P
<br />POLICY NU!dBER _
<br />POLICYEFF
<br />ht tANDDfYYYY �
<br />POLICY EXP
<br />fd M7DOMfYY LIMITS
<br />✓ COMMERCIALGENERALLIA01LITY
<br />DA?1100t)515
<br />11/1/1.017
<br />I l/1(20(3 [EACHOCCURR NCE
<br />IS 1,000,0(10
<br />A
<br />CI A. t,1S-.'ADE OCCUR
<br />PRNf 15EFRi oc LD --.—
<br />� rrencn3
<br />300,00
<br />f
<br />t='------
<br />MED ERP (Any one Person)
<br />PERSONAL v AOV INJURY
<br />S I,000,OW
<br />GEN L AGGREGATE LIY;T APPLIES PER
<br />GENERAL AGGREGATE
<br />5 2,000,000
<br />5 2,000,OlR)
<br />POLICY PRO.
<br />�✓ l -.--_._.- LOC
<br />PRODUCTS F50P AGG
<br />$
<br />OTHER,
<br />AUTON,tOBIt.E DABILfTY
<br />i41XAS0323391
<br />11/1/2017
<br />11/1/2013
<br />CO .EINEO 61 NGLE LIMIT
<br />.La arcdenl,L
<br />S_ I,OOO,OOn
<br />✓ ANYAOTO
<br />j
<br />BODILY INJURY(Per person)
<br />S
<br />BOC'ILY IN1U7f (Pe ©<aaent)
<br />S
<br />O'ANED I SCHEDULED
<br />I
<br />_ AUTOS ONLY 1UTCS
<br />V HIRED V1 NONl-O'A„_J
<br />PRO PE RTY ('A! 1G —
<br />---- --- ---
<br />5
<br />_. UTOS ONLY AUTOS ONLY
<br />A
<br />tP r aF,c, dem -
<br />.. .--- .......--- —
<br />I........_.
<br />UMBRELLA LAB
<br />✓
<br />OCCUR
<br />PU13606,)Ci7
<br />II/I/2UI7
<br />1UI/2013
<br />EACH OCCURRENCE
<br />S 2,000.000
<br />✓
<br />EXCESS LAB
<br />CLAMIS-MADE.
<br />AGGREGATE
<br />S 2,000 OtX)
<br />7CCit!ent
<br />S 2,000,0(0
<br />DED RETENT'ONSPer
<br />VJORKERSCOMPENSATiON
<br />--,
<br />5028'1)-17
<br />10/1/2017
<br />10/1/2013
<br />STATUTE 1ORH
<br />)) IAND
<br />�ANYPROPRI=TORrPARTN
<br />ENdpLOYERS'LIABILITY YIN
<br />E°UEX SCUT III
<br />`
<br />_✓
<br />-
<br />EL EACH ACCIGEM
<br />-
<br />$ 1,000,000
<br />EL 03E,1SE-EA EMPLOYEE
<br />S 1,000000
<br />I(Mandatory
<br />0FFIC ER, %IE M. B ER EXC LU DED? L_f
<br />fit N)I) -
<br />NlA
<br />1
<br />E L DISEASE-PGLICY L!N IT
<br />_ I,00(J,0(70
<br />S
<br />Pyas,descnbeunder
<br />DESCRIPTION OF OPF.RATIONJS Le'a:r
<br />I
<br />E
<br />Pollution Liability
<br />G24333(0:06
<br />11/112017
<br />II/l/2018
<br />G°°rr�al'rz="°
<br />5,000,000
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS N LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 4 metre space is required)
<br />Re: "A--2017-036 TGG AC`IT" an,,i "A-201.1-183 TGG AG,,i". City of Santa Ana, its of t'ice:'s, e;np.L oyees, agents, volunteer:?
<br />and _e.l:resenttaive,, art's eiry ni11Ed as Addl.tiona'_ Lnsr.l:ed, i` ienuired by wr-i.t:tRn I-ont:racc, neer endo) e:,',writ. hor:eCo.
<br />waiver of. Subrogation is provided, a> required b7 written contract wiLh the insured as respects cave .age evidenced
<br />herr!lil. C.OveraEJP- evidenced herein is primary and non-contributory, e::cept Auto Liabil.it:7' which is primary; it is IIOt
<br />n071-C'Un Lribl.ltO G'y, t7Ut 01117 13 rP'.5rf(:t tD "bodily injury" Or "property 4a.mar3er _Liability arising out Of "your 4f �I )4. A
<br />30 Liar ':mitten notice hall h0lcicr at the 3dfllf pita ✓1C.CQ herein, should . d de:i l:i iJECi
<br />ma -!Cd f7 the CCr 1 .7.Cd4C�E`/IEi�l.7
<br />`„
<br />t .ion date r, their"ar 1O 1 tto v c 01 r _
<br />ria ic' (s) be cancel le i befor; tale r. �_r2` on eat Of pl eLIiUPI.
<br />_ � EUNICE HEREDIA (PG ii OF
<br />I3Y: n
<br />CERTIFICATE HOLDER
<br />Holder's Nature of lhterest : Cenificate Holder
<br />City of'Santa Ana
<br />Clerk ot'the City Council
<br />20 Civic Center Plaza A1-30
<br />PO Laos 1988
<br />Santa Ann, 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 REPRESENNTATIVE
<br />Oc 1980-2015 ACC R -CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name anti logo are registered marks of ACORD '
<br />
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