|
J & G INDUSTRIES A-2014-1133 REVIEWED BY
<br />/4 411 11 t-
<br />EUNICE HEREDIA (PG 1 OF 4)
<br />AC -"I?& CERTIFICATE OF LIABILITY INSURANCE
<br />�... "'1
<br />FDATE(MMIDD)YYYY)
<br />9129/2015
<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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certaln policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in ileu of such endorsement(s).
<br />PRODUCER Phone: (707)996-2912
<br />Fax: (707)996-7912
<br />Apollo General Insurance Agency, Ine. (1)
<br />P. 0. Box 1508
<br />CONTACT JerilLe Lexis
<br />NAME:
<br />__
<br />lO}Es�xa . iAXC._Nl_- -l-
<br />ADDRESS: jerileel�rtapgcn.conl
<br />INSUREllSIAFFORDING COVERAGE
<br />NAIC k
<br />SonOLtla, California 95476
<br />INSURER A: lntelSt3le Fire& CUSUUIty Company
<br />22829
<br />INSURED
<br />INSURER B: American Automobile Insurance Compauly
<br />21849
<br />J&G Industries, Inc.
<br />18627 BrookhUrst Street
<br />INSURER C: Torus Speciality Insurance Company
<br />44776
<br />INSURER D: State Compensation Insurance Fund Of Calirornia
<br />35076
<br />PNIB 302
<br />Fountain Valley, CA 92708
<br />_�.—.-
<br />INSURER E: AGCS itfarine Ltsurancc Compinly
<br />— —
<br />22837
<br />—
<br />(
<br />I�� k l ` f �7 �f .rlr.l l
<br />iir)(i<-
<br />ialf I (
<br />INSURER F:
<br />MED EXP (Any one person)
<br />F=Mill►7 C8 ix9-1?j =LTA L9rr7J■311Lt.fiR4
<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 />MSR
<br />LTR
<br />TYPE OF INSURANCE
<br />Ab L
<br />S BR
<br />�'�—���---_-._.—..__._
<br />POLICY NUMBER
<br />POLICY EFF
<br />fMWDDIYYYYL
<br />POLICY EXP
<br />(MM/DDNYYY)LIMITS
<br />1,/
<br />COMMERCIAL GENERALLIABILITY
<br />DAN1000347
<br />It/1/2014
<br />11/1/2015
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />TE6 —
<br />PREM SES a oaourrenoo
<br />��
<br />�- 3O0 OOO
<br />S ,
<br />A
<br />CLAIMS -MADE 1:1 OCCUR
<br />(
<br />I�� k l ` f �7 �f .rlr.l l
<br />iir)(i<-
<br />ialf I (
<br />MED EXP (Any one person)
<br />_
<br />$ 5,000
<br />liliri''i
<br />p
<br />C)tiO' Viilit, l�. I"q, �I
<br />t
<br />II'L:( ;".rt,!
<br />PERSONAL & ADV INJURY
<br />S 1,000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />S 21000,000
<br />POLICY ✓ JECOT• LOCk�.`'i,
<br />IV.2 ,f
<br />(iI.L'.� i..°'i.
<br />I'
<br />PRODUCT'S - COMPIOPAGG
<br />$ 2,000,000
<br />OTHER:
<br />('"
<br />n:k 'Ind cojlaa'Ilt`n,; it
<br />nnhic:`1,
<br />$
<br />13
<br />AUTOMOBILE
<br />LIABILITY
<br />NUXAS0308826
<br />1111120i4
<br />I I/l/2015
<br />COMBINED S SINGLELIMITnt)$
<br />1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />✓_
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (PC( accident)
<br />S
<br />✓
<br />NIREDADTOS ✓ NON•O4YNED
<br />AUIOS
<br />PROPER DAT. GE
<br />Per acddent
<br />$----�
<br />U61BRELLALIAO
<br />✓
<br />OCCUR
<br />37639C142AIA
<br />11/1/2014
<br />11/1/2015
<br />EACH OCCURRENCE
<br />$_ 7,0001000
<br />AGGREGATE
<br />$ 7,000,000
<br />1/
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I I RETENTION$
<br />Per accident
<br />$ 7,000,400
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />802547-2i)1>
<br />IO/U2OIS
<br />l0/1/2016
<br />TH-
<br />✓ STATUTE ER
<br />Y/N
<br />ANY PROPRIETOR/PARTNEWF.XECI)TNe'.
<br />E.L. EACH ACCIDENT
<br />$ —1,000,000
<br />OFFECEELTAEtdBER EXCLUDED'
<br />(Mandatory in NH)
<br />N/A
<br />.--
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />I(y'os, doscdbo under
<br />DESCRIPTION OF OPERATIONS be!o,v
<br />E.L.DISEASE • POLICY Lih41T
<br />_._ _
<br />$ 1,000,000
<br />G
<br />Equipment Floater
<br />I I/I/2.014
<br />l l/112015
<br />ItenteI'l—A Petha,v 750,000
<br />Reme,ilea:m: Per Occ 750,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may bo attached If more spaco Is required)
<br />RE: Operations of the Named Insured, Additional Insured coverage is included if requ.ired by written contract per
<br />endorsement hereto,
<br />%,C—m i tri,,, I v- riy"uL IR \,JANI.,CLL/A I IUN
<br />HoIder's N:nure Di Interest Certiticale iloicier
<br />7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cite of`ianla Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza - Ross Annes
<br />Santa Ana, CA 92701
<br />ACORD 25 (2014/01)
<br />AUTHORIZED REPRESENT
<br />a
<br />©1988-2014 ACORD C
<br />The ACORD name and logo are rogistorod marks of ACORD
<br />RATION. All rights reserved.
<br />
|