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AC�t�L70-
<br />CERTIFICATE �?F LIABILITY INSURANCE
<br />DATE(h!hUDDIYYYY)
<br />11/1/2018
<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(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 lieU Of Such endorsement(s).
<br />PRODUCER Phone: (707)996-2912
<br />FIX: (707)996-7912
<br />Apollo General Insurance Agency, lne. (1)
<br />P. 0. Box 1508
<br />CONTACT Jerilce Lewis
<br />1111— 1111 —
<br />1111 ___ FAX
<br />PHONE
<br />AIC. M.P. ExIY,—.
<br />E-MAIL s: lerilecl,aapgen.com-----
<br />IN SU HER(S) AFFORDING COVERAG E ^—
<br />_ NAIL# —
<br />SOnOnla, California 95476
<br />___ 1111--- —
<br />INSURERA: Interstate Fire &c Casuahy i:0111pany
<br />22829
<br />1111 1111—
<br />114SUREU
<br />INSURER B: American Automobile Insurance Company
<br />21849 —_
<br />JRG Industries, Inc.
<br />18627 I3rooklnlrst Street
<br />INSURER C; I'oklo Marine Specialty Insurance Company —
<br />23850
<br />1111 --...1111 -- ---------3-5076----
<br />INSURER D; State Compensation Insurance Fund Of Cnlilb1111n-iia1111
<br />P,N113 302
<br />Fountain vanes, CA 927os
<br />11111111
<br />INSURER E_ 11 estellester Surplus f.Illcs lilstlrittice COtilpat)y
<br />10172
<br />---------------_-_1111____
<br />—
<br />PERSONAL &ADV INJURY
<br />INSURER F:
<br />I0161TIOrL[@i NgtillarNrl=5 All] Ili :121 i7:LU69relInMIII h1:19
<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 SUCiI POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />- —1111--1111
<br />TYPE OF INSURANCE
<br />-
<br />AOUL
<br />$Q
<br />1113-
<br />SUBR'—
<br />� --- 1111-
<br />POLICY NUMBER
<br />------
<br />POLICY EFF
<br />p,1hVUDIYYYY
<br />1111----...--
<br />POLICY EXP
<br />,jR)AVDDIYYYY
<br />—_—_"_—LIMITS
<br />A
<br />✓
<br />COMMERCIAL
<br />„ ✓
<br />CLAWS -MADS OCCUR
<br />DAN1000581
<br />t vinats
<br />t
<br />1 I/1/zou
<br />EACH OCCURRENCE
<br />s��,,�E To aEtL�o-11__11
<br />PREtdISESLaoccurrenceZ_
<br />$ 1,000+000
<br />--1111--1111 300,0 �
<br />$
<br />MED EXP (Any one person)
<br />PERSONAL &ADV INJURY
<br />S 1,000,000
<br />GEPPLAGGREGATE LIMIT APPLIES PER:
<br />PRO- II II
<br />POLICY JECT L. 1 LOC
<br />_
<br />GENF.:RALAGGREGATE
<br />S 2,000,000
<br />PRODUCTS-COhtPiOPAGG
<br />$ 2+000+000
<br />_—
<br />OTHER:
<br />— -
<br />$
<br />1111----1111----
<br />_
<br />13
<br />AUTOhIOBILE LIABILITY
<br />—
<br />1111 1111--- 1111
<br />hLXr11(0330002
<br />1111
<br />I I/1/2018
<br />1111
<br />1 1/1/2019
<br />COMBINED SINGLE UNIT
<br />Ea acddanl)_—
<br />S — 1,000,000
<br />BOD;LY INJURY (Per person)
<br />S
<br />1/ ANY AUTO
<br />OWNED SCHEDULEDBODILY
<br />.—, AUTOS ONLY AUTOS
<br />✓ HIRED r/ NON-OWNEp
<br />- AUTOS ONLY AUTOS ONLY
<br />INJURY —_ URY_—.—
<br />(Per accident)
<br />— .--......
<br />PRUPERTYDAf.U1GE
<br />Per accldenlJ_.—,__—___
<br />$ --
<br />_1111_
<br />S
<br />✓
<br />UMBRELLA L"'
<br />EXCESS LA
<br />✓
<br />OCCUR
<br />CMMS-MADE
<br />PU13652902—'
<br />)1/1/2018
<br />11/1/2019
<br />EACH OCCURRENCE
<br />AGGREGATE _ 1111—
<br />S 2,000,000
<br />$ 2,000,000
<br />—
<br />—
<br />RETENTION
<br />1)el' accident
<br />y 2 000,000
<br />S +
<br />D
<br />VJORKERSCOMP PISATION
<br />ANDEMPLOYERS'LIABILITY
<br />ANYPROPRIETORIPARTNERIFXECUTIVE r� i
<br />OFFICERIMEIBEREXCLUDED? l J
<br />(Mandatory In Nil) 1111
<br />NIA
<br />802847-1$
<br />—'--
<br />10/1/2018
<br />10/1/2019
<br />✓ PEfi OTH-
<br />— s�J 7UY_j__11--FR -.-
<br />E.LFACHACCIDENT
<br />— ---
<br />$ 1,000,000
<br />— 1111— 1111 1111
<br />E,L DISEASE- F1 E �'.PLOYEE
<br />1111--
<br />S 1+000+000
<br />1111 " "- _1111 —
<br />E.L.DISFASE_POLICY Ln_,IIT
<br />S __1111-11000,000
<br />If yes, do cnba under
<br />DESCRIPTIONOFOPERATIONS be'ov
<br />E
<br />Pollution Liability
<br />02433400.1007 ill/I/2018
<br />11/1/2019
<br />Gencnlrlgsrcgale
<br />5,000,000
<br />Each Ccndainn.
<br />5,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedute, may ho attached Ir more space Is required)
<br />RF,: Operations o- the Named Insured. Additional Insured coverage .is inrluded :Lf required by written contract per
<br />endorsement hereto.
<br />REVIEWED BY: EUNICE HEREDIA (PGI OF45)
<br />CER I IF•IUA I k HL)LLJtK %,AI)I E:LLH I KJIV
<br />Holder's Nature or Interest : Certificate Holder SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Scuta Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />20 Civic Center Plaza - Ross Annes
<br />Santa Alla, CA 92701 AUTHORIZED R PRESENTATIVE
<br />e
<br />©1988-2015 ACdQ D CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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