|
ne ACuisu name line logo are registered marks 01 ACORD
<br />DATE (MM /DD /YY)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />04r 0612 0"
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES
<br />NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE
<br />DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. It SUBROGATION IS WAIVED, subject to the terms and
<br />conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such
<br />endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />Aon Risk Insurance Services West, Inc.
<br />NAME
<br />PHONE
<br />FAX
<br />707 Wilshire Blvd., Ste. 2600
<br />(A/C No EXI). (213 ) 630.3200
<br />(A/C, No).
<br />Los Angeles. CA 90017
<br />E -MAIL
<br />ADDRESS?
<br />PRODUCER
<br />CUSTOMER ID #:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURED
<br />INSURER A ACE American Insurance Company
<br />22667
<br />Valley'Cresl Desi GrOLtp
<br />3242 1'lalladay Sr., Suite 203
<br />Sunlit Ana, CA 92701
<br />INSURER B ACE American Insurance Company
<br />22E67
<br />INSURER C: ACE Ameliwn insurance Company
<br />22667
<br />INSURER 0:
<br />INSURER E• ACE Amencan Insurance Company (PL)
<br />22657
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 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 LIN11 IS SI10%u ♦ ARI1 AS ItFQt'I S I1 I )
<br />WSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADOL
<br />WSR
<br />SUER
<br />YYVD
<br />POLICY NUMBER
<br />POLICYEFFECTIVE
<br />DATE (MMIDDIYYYYI
<br />POLICY EXPIRATION
<br />DATE(MWDDNYYY)
<br />LIMBS
<br />GENERAL LIABILITY
<br />EACH OCCURREN
<br />$1,000,000 00
<br />0 COMMERCIAL GENERAL LIABILITY
<br />❑ CLAIMS MADE 0 OCCUR
<br />HDO G24547528
<br />04/0112011
<br />04/01/2012
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />$1,000,000 00
<br />A
<br />0 CONTRACTUAL LIABILITY
<br />MED CXP (Any one person)
<br />$5,000.00
<br />0 XCU HAZARD
<br />PERSONAL B ADV INJURY
<br />$1,000,000 00
<br />CENt AGGREGATE LIMIT APPLIES PLR
<br />GENERAL AGGREGATE
<br />$2,000,000 DO
<br />0 POLICY 121 PROJECT ❑ LUC
<br />PRODUCTS - COMPIOP AGG
<br />$2,000,000.00
<br />AUTOMOBILE LIABILITY
<br />0 ANY AUTO
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$2 °00 00
<br />❑ ALL OWNEDAUTOS
<br />ISAH08601422
<br />04/01/ 11
<br />04/01/2012
<br />BODILY INJURY
<br />B
<br />❑ SCHL OULED AUTOS
<br />(Per person)
<br />BODILY INJURY
<br />❑ RInEO AUros
<br />[] NON OWNED AUTOS
<br />AP OVED
<br />S �1
<br />�( 01W
<br />(Per accident)
<br />PROPFRTY DAMAGE
<br />Ireracueen0
<br />0 UMBRELLA LIAR 0 OCCUR
<br />EACH OCCURRENCE
<br />❑ EXGESSLIAD ❑CLAIMS•MADE
<br />AGGREGATE
<br />/(FICIID For
<br />Z
<br />/
<br />❑ DEDUCTIBLE
<br />❑ RETENTION f
<br />S
<br />C
<br />WORKERS' COM PENSATION AND
<br />EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARINERJEXECUINE
<br />YJLR 046790
<br />0n Dg2I
<br />WC STATUTORY LIMITS
<br />❑ OTHER
<br />OFFICERIVEMBER EXCLUDEn� No
<br />IManaamry ., rFH)
<br />nyos. IPTI N OrO
<br />OPERATIONS DESCRIPTION Or O below
<br />NIA
<br />EL EACH ACCIDENT
<br />$1,000,000.00
<br />E.L DISEASE -EA EMPLOYEE
<br />$1,000,0000°
<br />L DISEASE - POLICY IIMIT
<br />$1,000,00000
<br />Olhe,
<br />$1.000.000
<br />E
<br />Professional Liability
<br />G23831817 006
<br />04/01/2011
<br />04/01/2012
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space is required)
<br />See Attached For Additional Insured, Calif WC Endorsement, GL Waiver of Subrogation, Primary Insured, AIDS Auto Add insured, Waiver of Subrogation
<br />Auto (AOS)
<br />173869 City of Riverside RFP 1243 Qualifications, Riverside, Riverside, CA 92522. It is agreed that the City of Riverside, and its officers, employees and
<br />agents. are added as additional insureds under this policy, solely for services performed by and on behalf of the named insured for the City of Riverside.
<br />All policies provide for a 30 day notice of cancellation, termination, or non - renewal
<br />CERTIFICATE_ HOLDER
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE OE.SCRIBFD POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE
<br />THEREOF' NOTICE WILL BF DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS
<br />City of Riverside
<br />3900 Main Street, 6th Floor
<br />AUTHORIZED REPRESENTATIVE
<br />Riverside, CA 92522
<br />n
<br />t{or� �r� �rsac�cucce SEJrviced Zfled�, 7�rC.
<br />ACORD 25 (2009/09)
<br />01988.2009 ACORD CORPORATION. All rights reserved.
<br />ne ACuisu name line logo are registered marks 01 ACORD
<br />
|