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AC6R H CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMID 16 Y) <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 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 endorsement(s). <br />PRODUCER Phone: (707)996-2912 <br />Fax: (707)996-7912 <br />Apollo General Insurance Agency, Inc. (I) <br />P. 0. Dox 1508 <br />CONTACT Jerilee Lewis <br />NAME; <br />A ONN E • A/C No: <br />ADDRESS: Jerileel@apgen.com <br />INSURERS) AFFORDING COVERAGE NAIC S <br />Sonoma, California 95476 <br />INSURER A: Interstate Fire & Casualty Company 22829 <br />DAN1000415 <br />INSURED <br />INSURER B ; Torus Speciality Insurance Company 44776 <br />American Wrecking, hic. <br />INSURER C: Philadelphia Insurance Company 23850 <br />2459 LCC Avenue <br />South El Monte, CA 91733 <br />INSURER D: <br />NSURER E <br />[INSURER <br />F: <br />COVERAGES CERTIFICATE NUMBER: Dvtt 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 />1LTR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />MMIDDY EFF <br />MM/DDS <br />LIMITS <br />V/ COMMERCIALGENERALLIABILITY <br />DAN1000415 <br />4/28/2016 <br />4/28/2017 <br />EACH OCCURRENCE $ 1,000,000 <br />A <br />57 ] <br />300,000 <br />CLAIMS -MADE OCCUR <br />PREMISES(Ea occurrence) $ <br />a <br />MED EXP (Any one person) $ 5,000 <br />PERSONAL & ADV INJURY $ 1,000,000 <br />i ` i" <br />V g @ / 9 (.I <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE $ 2,000,000 <br />POLICY [Z]JEC LOC <br />('�� <br />'� ' rr5Y�Z4.°( aY 'z.i6C �1 <br />t,p'F ?}} <br />PRODUCTS - COMP/OPAGG $ 2,000,000 <br />$ <br />OTHER: <br />- <br />AUTOMOBILE <br />LIABILITY <br />Y . <br />lIC6 iyltdY i ^o Ili) <br />a)I/. �, <br />COMBINED SINGLE LIMIT $ <br />(Ea accident) <br />BODILY INJURY (Per person) $ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />P <br />BODILY INJURY (Paraccident) $ <br />( ) <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />PROPERTY DAMAGE $ <br />Per accident <br />UMBRELLA LIAR✓ <br />OCCUR <br />29256EI60ALI <br />4/28/2016 <br />4/28/2017 <br />EACH OCCURRENCE $ 10,000,000 <br />B <br />EXCESS LIAR <br />CLAIMS -MADE <br />AGGREGATE $ 10,000,000 <br />DED I I RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />PER OTH- <br />I I <br />AND EMPLOYERS' LIABILITY y I N <br />STATUTE ER <br />E.L. EACH ACCIDENT $ <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />N I A <br />E.L. DISEASE - EA EMPLOYE $ <br />(Mandatory in NH) <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT I $ <br />DESCRIPTION OF OPERATIONS below <br />C <br />Pollution Liability <br />PPK1457582 <br />2/18/2016 <br />2/18/2017 <br />Peroccunence: 5,000,000 <br />Polive Aeereanle: 5,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) <br />Re: Operations of the Names Insured. Certificate Holder is hereby added as Additional Insured if required by written <br />contract per endorsement hereto. Waiver of Subrogation is provided, as required by written contract with the insured <br />as respects coverage evidenced herein. 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 />� <br />1�"r.V� WED Yr Y._f�'. ... :.�._r til lit i lLit r t k u a / c t .:. <br />umm 1 Ir it A I C muLUCK <br />Holder's Nature of Interest : Certificate Holder <br />City of Santa Ana <br />PO Box 1988 M-36 <br />Santa Ana, 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 REPRES THE <br />s� , ' <br />©1988-2014 ACORD <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />n 7 <br />odew. <br />PORATION. All rights reserved. <br />