|
CERTIFICATE OF LIABILITY INSURANCE
<br />oAT1l/3/2t}1�� 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 Pllone: (707)996.2912
<br />Fax: (707)996-7912
<br />Apollo General Insurance Agency, Inc. (1)
<br />P. 0. Box 1503
<br />CONTACT Jerllce Lelvis
<br />NAME:
<br />fAIGPHG No. Ext): FAX UM.
<br />E-MAIL jerileel i apgen.com
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />Sonoma, California 95476
<br />WAI
<br />INSURER A : Interstate Fire & Casualty Company 22829
<br />INSURED
<br />INSURER B: American Automobile Insurance Company 21849
<br />.J&G Industries, Me.
<br />INSURER C : Torus Speciality Insurance Company 44776
<br />INSURER D: State Compensation trIsurance Fund Of California 35076
<br />18627 Brookhurst Street
<br />PYiB 302
<br />Fountain Valley, CA 92708 p
<br />INSURER E: AGCS Nlarine Insurance Company 22337
<br />cam
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 481 REVISION NUMBER:
<br />THIS 13 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />NSD
<br />SUBR
<br />O
<br />POLICYNUMBER
<br />POLICY EFF
<br />Mf,VDDIYYYY
<br />POLICY EXP
<br />MMIDWYYYY
<br />LIMITS
<br />A
<br />,f COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 0 OCCUR
<br />WAI
<br />DAN1000347
<br />� _ 45'5' <'��` hfit.rm l it
<br />11/1/2014
<br />8 rCd ,€<
<br />111/1/2015
<br />tt
<br />�1 Sl (Ally
<br />EACH OCCURRENCE $ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Eaoccunenre $ 300,000
<br />h4ED EXP (Anyone person) $ 5,000
<br />cam
<br />q7
<br />? 3 l'( .}Y,ra ,;i r �,'"dil�T ,''
<br />k ri' k�f_�
<br />C,,itd
<br />iPERSONAL&ADVINJLJRY $ 1,000,000
<br />GENIAGGREGATE LIMIT APPLIES PER:GENERAL
<br />POLICY � ECT LOC
<br />OTHER:
<br />AGGREGATE $ 2,000,000
<br />1"i,t'_S
<br />t
<br />€It1.c �.3€.if. I( 4,if's iin��
<br />4
<br />-
<br />Ser
<br />PRODUCTS - COMPIOP ACG $ 2,000,000
<br />Is
<br />LIABILITY
<br />f ANY AUTO
<br />IvI�1S030RS26
<br />I I/1/2014
<br />11/1/2015
<br />COBAUTOMOBILE
<br />EahaccodeotSfNGLE LIMITi3 is 1,000,000
<br />BODILY INJURY (Per person) $
<br />BODILY INJURY (Per accident) $
<br />ALL OWN EDSCHEDULED
<br />AUTOS AUTOS
<br />✓ HIRED AUTOS �/ NON -OWNED
<br />AUTOS
<br />PR O'd tDAPAAGE $
<br />$
<br />f 4tiltosSpecified
<br />C
<br />RvEXCESS
<br />UMBRELLALIAB ✓ OCCUR
<br />LIAB CLAWS -MADE
<br />i
<br />37639CI42ALI
<br />It/l/2014
<br />11/1/2015
<br />EACH OCCURRENCE $ 7,000,000
<br />AGGREGATE $ 7,000,000
<br />DED I I RETENTIONS
<br />Peraccitlent $ 7,000,000
<br />I)
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS`LIABILITY YIN
<br />ANY PROPRIETORIPARTNERJEXECUT IVE ❑
<br />OFFiCERJMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />NIA
<br />302347-20Id
<br />10/l/2014
<br />10/1/2(}15
<br />✓ STATUTE EDRH
<br />_-
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE $ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT I S 1,000,000
<br />If yes, disc ibe under
<br />DESCRIPTION OF OPERAT:CNS befow
<br />E
<br />Equipment FIoater
<br />NLV93045900
<br />I t/l/2014
<br />11/1/2015
<br />Rented1eased Perftem 750,000
<br />Rewed)Leased Pur Oce. 750,000
<br />DESCRIPTION OF OPERATIONS LOCATIONS/ VEHICLES (ACORD 161, Additional Remarks Schedule, maybe attached If more space Is required)
<br />RE: Demolition Services Contract. Additional Insured coverage is included if required by written contract per
<br />endorsement hereto.
<br />CERTIFICAIL HULUtK t:ANt;tLLAIIUN
<br />Holder's Nature of Interest : Certificate Holder
<br />City of Santa Arta Public Works Dept.
<br />20 Civic Center Plaza NI -36
<br />Santa Ana, CA 92701
<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 REAR 'OTA VE
<br />Ccs 1988-2014 ACORD inORPORATtON. All riahts reserved.
<br />ACORD 25 (2014!01) The ACORD name and logo are registered marks of ACORD
<br />
|