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<br />L_s CERTIFICATE OF LIABILITY INSURANCE
<br />L
<br />DATE ;MMIDa CM)
<br />I I/V7011 ;
<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: B the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsemeni(s).
<br />PRODUCER Phone: (7071996-2912
<br />Fax: (7071996-7912
<br />Apollo General Insurance. Agency, 1.
<br />CON
<br />NONE; Jerilee Lewis
<br />PHONE Fax
<br />NI,
<br />ncDaEss: Jctticcl@apgcn.com
<br />P. 0. Box 1508
<br />INSURERS) AFFORDING COVERAGE NAICx
<br />Sonoma, CA 95476
<br />_
<br />INSURER A : Interstate Fire dL Casualty Company 22929
<br />INSUREO ^— MA '^
<br />INSURER a: American Automobile Insurance Company 7 21849
<br />J&G Industries, Inc.
<br />;NsuRERc: Torus Speciality Insurance Company 44776
<br />18627 Brookhurst Street 0302
<br />Fountain Valley, CA 92708
<br />INSURER O: Westchester Surplus Lines Insurance Company 101?2
<br />INSURERE;
<br />INSURER r:
<br />CnVFRAGFS CFRTTFIrATF NUMBER, ISO 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 />1LTF TYPE OF INSURANCE
<br />I
<br />POLICYNUMBER MM/V00/W V11 MS1ID--DNVYYtI
<br />UNITS
<br />IGENERAI UABILRY
<br />A COMMERCIAL GENERALUAEIL!TY WARNING-�I
<br />CLV MS-AMDE OCCUR
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<br />I �DAI11000223
<br />,id'irrequirtd
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<br />by written
<br />[i1 the toy;s. (,overa, e
<br />and conditions in po
<br />jtl/l/=011
<br />tired st.i
<br />contract
<br />rs I imite
<br />icy.
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<br />us Only;
<br />execute
<br />: as per
<br />EACH OCWRRENC£ S n _o_
<br />rS(Eaocr�mMN I eMI S 300.000
<br />MEO E%P Art an , 5 5,000
<br />V ERSCNALBADV1NJVRY IS 100(Wflo
<br />jPr
<br />I GENERAL AGGREGATE f 2.OW 000
<br />GENT AGGREGATE L'MIT APPLIES PER:
<br />POLICY -, PRO i7 LOC ', tC
<br />: PRODUCTS• COMPrO? AGO is 2,000.000
<br />I S
<br />AUTOMOBILE LIABILITY
<br />mfxAso_s7lll tlnoll
<br />jI11:/lnolz
<br />I 4.J
<br />l,oxl,aoaB rAi
<br />EOOLY INURY (Per peson) 3
<br />ANAUTO
<br />ALL CWNCDSCHEDULED
<br />• AUTOS AUTOSi✓ I HIRED AUTOS AUTON £D I
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<br />EMILY I WURY leer acct:erol S
<br />lPRw amd_n I f
<br />✓;.Aaip Spd'Sed CC
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<br />UMBRELLA LIAB ✓
<br />EXCE_ 551-!i'9
<br />OCCUR
<br />CL.47?AS•7AADE
<br />06SO-Al 12AL!
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<br />IV1,,01I II/InO',2 I
<br />EACH OCCURRENCE s 5.000,000
<br />:AGGREGATE f 5,000,000
<br />i CF.D ! RETENTION S
<br />13
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<br />I
<br />WORMERS COMPENSATION
<br />V,C STATV- OT,,, -;ANO
<br />I ER -
<br />EMPLOYERS'UAINUTY
<br />ANYPROPRWrOAJP,ARTNM'EXECUTIVE YIN
<br />OFFICERIIMEMBER E(CLUDED1 I N t
<br />(MwKwar) in NHI
<br />it ii'h, 1,undor
<br />DESCRIPT!ON CF OPERATIC14S wow
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<br />-
<br />I
<br />I
<br />' E.L EACH ACCIDENT { 3
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<br />E.L. DISEASE • EA EMPLOYEE S
<br />E.L. DISEASE - Pa!CY UMI I S
<br />D • Polluliun Lidbilay I
<br />i G220635390085,000,000
<br />11/1/2011
<br />111/1/2012
<br />Ic.dealAygrescr. 5,000,000
<br />@uh 7rliuscn Con6:ian:
<br />DESCRIPTION OF OPERATIONS ILOCATIONSIVEHICLES (Atls hACORD tat, Additional Rsmarta SchWule, amaresspadeismqulred)
<br />Re, Nuri Sice Dem,14c'CrI 2 Project. Tie City of Sanca Ara, it's of,icsrs, agents, employe". Additicra= Insured
<br />coverage is 'included is reauired by written contract per endorsement 'hereto.
<br />A%i'ROV i:,tj AS i'(-)
<br />GER 1 Il'IGA I t H V LL7tK
<br />Holder's haturc of Int, -TCS[ CCnitiCale ki der
<br />Ciry of Sana Ana
<br />20 Civic Center Plaza M1 36
<br />Santa Ana. CA 92701
<br />ACORD 25 (2010105)
<br />La U I, St.- C 4 i't(:C(j SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />1/ THE EXPIRATION DATE THEREOF, NOTICE WILL BE OELIVERFO NJ
<br />\5315 G. 1 ; : f l i f I I • 'I ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REP ?
<br />E . S
<br />01988-2010 ACORD'CORPORATION. All rights reserved
<br />The ACORD name and logo are registered marks of ACORD
<br />V/
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