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Samantha Digitally signed by
<br />1., '. Samantha M. Lambert
<br />112.05.12
<br />M. Lambert Dat4:18-07'00'
<br />11:44:18 -OTDO'
<br />Goi CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDD/YYYY)
<br />5/9/2022
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an. ADDITIONAL INSURED, the polley(los) 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 Ileu of such endorsement a .
<br />PRODUCER Phone: (707)996-2912
<br />Fax: (707)996-7912
<br />Apollo General Insurance Agency, Inc. (1)
<br />P. 0. Box 1508
<br />Sonoma, California 95476
<br />NOT Ieritee Carpenter
<br />HONE FAX
<br />AX Mich
<br />' odE . jerilew @ apgen.eom
<br />INSURER S AFFORDINO COVERAOE
<br />NAIOH
<br />SURERAI Everest Usual Insurance Company
<br />16044
<br />INSURED
<br />INSURERS: Everest Indemnity insurance Company
<br />TOSS]
<br />American Wrecking, lnc,
<br />INSURER c 1 State Compensation Insurance Fund Of California
<br />35076
<br />2459 Lee Avenue
<br />South El Monte, CA 91733
<br />INSURER D: Tokio Marino Specialty Insurance Company
<br />23850
<br />INSURER E 1
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 1248 REVISION NUMEFRI
<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 />INR
<br />T
<br />pEOF INSURANCE
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<br />OLIOYNUMBER
<br />POOipYFF
<br />MM oom—MP
<br />LIMITS
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<br />COMMERCIALGENERAL DABILITY
<br />CLAIMS -MADE E OCCUR
<br />CF40LO1371.221
<br />4/28/2022
<br />4/28/2023
<br />FACHOCCURRENCE
<br />$ 1,000,000
<br />ESE Eccune
<br />It 300,0 0
<br />MED FXP (Any oneperson)
<br />$
<br />✓
<br />Y
<br />PERSONAL &AOV INJURY
<br />$ 1,000,000
<br />AGGREGATE UMIT APPLIES PER:
<br />POLICY O YPO F1 LCC
<br />GBNERALAGGREGATE
<br />$ 2,000,000
<br />GENL
<br />PRODU(TTS-COMPIOPAGG
<br />$ 2,000,000
<br />$
<br />OTHE14:
<br />B
<br />gUTOMOBILELIABILItt
<br />✓
<br />ANYAUTO
<br />C174CA01390-211
<br />9/1/2021
<br />9/1/2022
<br />EO COMBINED SINGLE LIMIT
<br />§ 1,000,000
<br />BODILY INJURY (Per person)
<br />§
<br />✓
<br />OWNED SCHEDULED
<br />HIRED ONLY LION-OMED
<br />AUTOS ONLY ✓ AUTOS ONLY
<br />✓
<br />Y
<br />BODILY INJURY (Per Accident )
<br />§
<br />eFeedR�Y IMAGE
<br />$
<br />$
<br />B
<br />✓
<br />UMBRELLA LIAR
<br />EXCESS LIAR
<br />✓
<br />OCCUR
<br />CLAIMS -MADE
<br />✓
<br />Y
<br />�XCIIIX01101-221
<br />4/28/2022
<br />4/28/2023
<br />EACHOCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ S,000,OOO
<br />BED ETENTION
<br />CWORKERS
<br />COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICE RIMEMBEREXCLUDED4
<br />(Mandatory In NH)
<br />if yyes dascdbe Untler
<br />DESCRIPTION OF OPERATIONS bow
<br />NIA
<br />y
<br />9161690.21
<br />10/1/2021
<br />10/1/2022
<br />✓ R E
<br />EL, EACH ACCIDENT
<br />§ 1,000,000
<br />El, DISEASE -EA EMPLOYE
<br />§ 11000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />S 1,000,000
<br />D
<br />Pollution Liability
<br />✓
<br />Y
<br />PPK2381628
<br />2/18/2022
<br />2/18/2023
<br />Perocmmaaca
<br />5,000,000
<br />Por AavtcAsb;
<br />5,000,00
<br />DESCRIPTION OF OPERATIONS LOCATIONS / VEHICLES (ACOND iel, Additional Remarks Schedule, maybe attached If more space Is required)
<br />Re: Operations of the Named Insured. City of Banta Ana, its officers, employees, agents, and volunteers are hereby
<br />named as Additional Insured, if required by written contract, per endorsement hereto. waiver of Subrogation is
<br />provided, as required by written contract with the insured as respects coverage evidenced herein. Coverage evidenced
<br />herein is primary and non-contributory. 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 />Holder's Nature of Interest: Additional Insured
<br />SHOULD ANY OF THE ABOVE DESCRIBED POL
<br />City of Santa Ana THE! EXPIRATION DATE THEREOF, NOTIC
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />Risk Management Division
<br />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE �,�,
<br />Santa Ana, CA 92702 ////J
<br />o [
<br />©1988.2016 ACOR 0RPOI
<br />ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />reserved.
<br />
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