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CERTIFICATE OF LIABILITY INSURANCE F DATE(M MiDD1YYYY)
<br />1 9/28/2016
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the lornts and conditions of the policy, certain policies may require an endorsement, A statement on
<br />this certificate does riot confer rights to the certificate holder III IleU of such endorsemant(s).
<br />PRODUCER Phone: (707)996-2912 CONTACT Jefilec Lekvk
<br />Fax; (707)996-791-NAPN ME:
<br />Apollo Celiclal Illsolillice Atlelley, Iric, (1)
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, IERM OR CONDITION OF ANY CONT-RACT
<br />OR OTHER
<br />DOCUMENT WITH RESPECT 'TO
<br />P. 0. Box 1508
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES
<br />E-MAIL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF: SUCH POLICIES, LIMITS SHOWN MAYHAVE SEEN REDUCED BY
<br />Sonoma, Calilornia 95176
<br />INSURE (S) EIING VERAGE
<br />.11—ER qfL ----
<br />NAIG M
<br />--- — ----- --
<br />INSURER A :
<br />--
<br />1111CI-St!" J�jl-C 1�),' CeSll�)ItY C'DiIiiially
<br />. . .......
<br />- --I
<br />22829
<br />INSURED
<br />ACLAWS-NIADE
<br />INSURER B:
<br />Arricrican Automobile Insmance Conipmly
<br />21849
<br />J&CJ IIXILBI[TiCS, Inc.
<br />INSURER C
<br />1'11'1�1('C'Pllill "'Sur"Bee C011111"'By
<br />23E;50
<br />1862713rookl1urst Street
<br />INSURERD
<br />State CompCIISation Insuralwe FUlld OfCalifOrnia
<br />35076
<br />PIN413 302
<br />INSURER L:
<br />Westchester Surplus f,iries Insurmice Company
<br />10172
<br />Fountain Valley, CA 92708
<br />GEN[ AGCREGATL Lith r APPLIES PER:
<br />GENERAL
<br />2,000,000
<br />FoxIcY ✓ J Fl�'�F [771 LOC
<br />,C
<br />INSURERr
<br />2,000,000
<br />-------
<br />OTIFR:
<br />rnVPRAnFS r.PPTIPIr.ATF NI HARPR. 693
<br />PF=XJVqIf)M KIIIKAR;=P-
<br />THIS 13 TO CERTIFY THAI" THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, IERM OR CONDITION OF ANY CONT-RACT
<br />OR OTHER
<br />DOCUMENT WITH RESPECT 'TO
<br />WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES
<br />DESCRIBED HEREIN IS SUBJECT' TO Alk
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF: SUCH POLICIES, LIMITS SHOWN MAYHAVE SEEN REDUCED BY
<br />PAID CLAIMS.
<br />--- -------
<br />INSR TYPE OF INSURANCE ow suaH POLICY EFF
<br />LrR I MvD POLIGYNUMBER LMM�DgLY I'l,
<br />POLICY EXP
<br />AD/YYYY
<br />LIMITS
<br />vl COMMERCIAL GENERAL. LIABILITY DAN 1000394 It/l/2015
<br />II/l/2016
<br />EACH OccuRNPIAcr
<br />I,000,000
<br />——
<br />ACLAWS-NIADE
<br />_UAMAGE
<br />. ........ -VTO
<br />OCCUR
<br />..........
<br />MED EXP (Any one person)
<br />I,000,000
<br />GEN[ AGCREGATL Lith r APPLIES PER:
<br />GENERAL
<br />2,000,000
<br />FoxIcY ✓ J Fl�'�F [771 LOC
<br />,C
<br />PROBUCTS-CONIPIOPAGG 5
<br />- -- —
<br />2,000,000
<br />-------
<br />OTIFR:
<br />AU
<br />OMOBILE LIABILITY
<br />NIXA803 158 10
<br />11 1 /2015
<br />II/l/2016
<br />COMBINED SINGLE LIMI r
<br />I,000,ow)
<br />ANY Ali 1-0
<br />BODILY INJURY (Por person)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />'✓
<br />11L11l1ED NON -OWNED
<br />�Z-
<br />$
<br />AUTOS ONLY AUTOS ONLY
<br />ONLY
<br />Lir -irAprit)
<br />$
<br />UMBRELLALIA11 C,Xurl
<br />PUB520,116
<br />Ii/l/2,015
<br />II/l/2016
<br />FACH OCCURRENCE
<br />$
<br />-
<br />4,000,000
<br />C
<br />EXCESS LIAR CLAIMS-MADF
<br />—"--I
<br />AGGREGATE
<br />4,000,000
<br />I'll, 71—i'L TIONS
<br />Per accident
<br />4,000,000
<br />D
<br />WORKERS COMPENSATION
<br />802�47-2016
<br />10/1/2016
<br />10/l/2017
<br />8 rA I
<br />AND EMPLOYERS' LIABILITY Y/N
<br />ANY11ROFIR IETOR)PAR TNEWL-� UTNE
<br />" "'
<br />0 F FIC FRj M F MHE R EXCLUDED? J_ I
<br />NIA
<br />---- . -J __ _Erl
<br />F.L. EACJ I ACCIDENT
<br />$
<br />1,000,000
<br />(Mandatory In NIT)
<br />I'.[., DISEASE - UA EMPLOYEE
<br />if yo:,, d,,.;cdua under
<br />DESCRIPTION OF OPERATIONS S ledow
<br />E L. DI EASE I lJt ICY f.ihlli
<br />$
<br />1,000,000
<br />L
<br />Pollution Liability
<br />624334004004
<br />111112015
<br />II/l/2016
<br />2,000,000
<br />Pack Pull"time CbnJilieic
<br />2,000,000
<br />DESCRIPTION OFOPERATIONS ILOCATlOt4S[VEIIICLES (ACORD 101, Addillonel Remarks Schedule, may be altaclred If morn spaco Is royulrod)
<br />_
<br />RE: Operat:loyls of tLe Named Ensured. Add!Lianal 111sured coverage i.s illc.luded if raqtilr((J
<br />p�,y-
<br />ondor-sementherot:(.).
<br />GSE VIEVVED BY:
<br />EUNICE HERE D�A
<br />--- - --------
<br />1OF
<br />(P(.-,
<br />I lolder's Kilme offii(crest : Certificate Holder
<br />City ot*Santa Ana
<br />20 Civic Center Plaza - Ross Antics
<br />Santa Ana, CA 92.701
<br />SHOULD ANY OF: THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE wri,wrilE POLICY PROVISIONS,
<br />A UTI I OR IZED REPRESENTATIVE
<br />@. 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD narne and [ago are registered marks of ACORD
<br />
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