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D� F�T12M8/2025
<br /> MD/YYYY)
<br /> CERTIFICATE 4F LIABILITY INSURANCE
<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: It the certificate holder Is an ADDITIONAL INSURED,the policy((es)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 CONTACT lerilee Carpenter
<br /> Fax; (707)996-7912 NAME: I
<br /> Apollo General Insurance Agency,Inc.(I) PHONE FAAJC No):. I
<br /> P.O.Box 1508 EMAIL jerileec@apgen.com
<br /> ADDRESS.•
<br /> Sonoma,California 95476 INSURERS AFFORDING COVERAGE NAIC N
<br /> INSURER A: Everest Indemnity Insurance Company 10851
<br /> INSURED INSURER B: Everest National Insurance Company 10120
<br /> American Wrecking,Inc. INSURER c: State Compensation Insurance Fund Of California 35076
<br /> 2459 Lee Avenue INSURER D: Tokio Marine Specialty Insurance Company 23850
<br /> South El Monte,CA 91733
<br /> INSURER E
<br /> INSURER F; 1
<br /> COVERAGES CERTIFICATE NUMBER:1558 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 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 /> INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER PMIDDY EFF MMl00 EXP LIMITS
<br /> LTR
<br /> ✓ COMMERCIAL GENERAL LIABILITY CF4GL01371-251 4/28/2025 4/28/2026 EACHOCCURRENCE S 1,000,000
<br /> A CLAIMS-MADE OCCUR OAEMI ES Ea occurrence S 300,000
<br /> TO RENTED
<br /> V Y MED EXP(My oneperson) $ '
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE g 2,000,000
<br /> POLICY a JEGT LOC PRODUCTS-COMPIOPAGG S 2,000'000
<br /> OTHER: S
<br /> AUTOMOBILELIABILITY CF4CA01390-251 9/1/2025 9/1/2026 Ea e1W1IdeI1,sINGLE LIMIT S 1,000,000
<br /> B
<br /> ✓ ANY AUTO 130DILY INJURY(Per person) S
<br /> OWNED F UTOSULED ✓ �( BODILY INJURY(Per eccident) S
<br /> AUTOS ONLY AS
<br /> r/ HIRED ✓ NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per acaden1
<br /> S
<br /> UM13RELLALIAB ✓ OCCUR XWSEX00092-251 4/28/2025 4/28/2026 EACHOCCURRENCE $ 5,000,000
<br /> A ✓ EXCESSLIABCLAIMS•MADE AGGREGATE S 5,000,000
<br /> `
<br /> DED RETENTION$ ✓ Y $
<br /> WORKERS COMPENSATION �/ PER OTH-
<br /> C AND EMPLOYERS'LIABILITY 9I61690.24 10/1/2024 10/1/2025 ER
<br /> ANYPROPRMTOPJPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ 1+000,000
<br /> OFFICER1MEMnEREXCLUDED? NIA Y 1'000,000 E
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ €
<br /> If s,descr
<br /> ibe under 1,000,00')
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ E
<br /> D Pollution Liability '� Y PPK2657314.001 2/18/2025 2/18/2026 PerrnddcoL 5,000,000 F
<br /> A=egate: 5,000,00 If€k
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarke Schedule,may be attached It more spate Is required)
<br /> i
<br /> Re: Operations of the Named Insured. City of Santa Ana, its officers, employees, agents, and volunteers are hereby
<br /> i
<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 /> 11
<br /> 1
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Holder's Nature of Interest:Additional Insured
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES t31:CANCELLED BEFORE
<br /> City of Santa Ana,M-93 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza
<br /> Santa Ana,CA 92702 AUTHORIZEAREPRESEN TIVE
<br /> 411y ..
<br /> 01988.2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br /> Tu Tran Digitally signed by APPROVED
<br /> Tu Tran Nguyen
<br /> Date:2025.09.04 By Tu Tran Nguyen at 3:47 pm,Sep 04,2025 I
<br /> Nguyen 15:48:31-07'00'
<br />
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