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'4` °RO® CERTIFICATE OF LIABILITY INSURANCE =6/27/2013 /DD/YWY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and 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 endorsement(s). PRODUCER NAME: Jill Barry Van Wyk Risk & Financial Management PHONE -5070 (616)942 2237 Wealthy Street SE E -MAIL FAX N (616)942 -8199 Suite 200 A DRE ;Jillb @vanwykcorp.com INSURERS AFFORDING COVERAGE NAIC # Grand Rapids MI 49506 INSURER A:HartfOrd Fire Insurance Company 19682 INSURED INSURER B :Travelers Insurance Com an Goforth &Marti 19038 INSURER C G/M Business Interiors of San Diego, LLC INSURERD: 110 West A Street, Ste 140 INSURER E: San Diego Cpl 92101 INSURER F : COVERAGES CERTIFICATE NU CL13 THIS INDICATED. CERTIFICATE EXCLUSIONS INSR LTR IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY AND CONDITIONS OF SUCH I TYPE OF INSURANCE GENERAL LIABILITY OF PERTAIN, POLICIES. ADDL INSR INSURANCE =1 MBER. 62610098 LISTED BELOW HAVE BEEN TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY LIMITS SHOWN MAY HAVE BEEN POLICY NUMBER ISSUED TO CONTRACT THE POLICIES REDUCED BY MM/DDY THE INSURED OR OTHER DESCRIBED PAID CLAIMS. M DDS REVISION NUMBER: NAMED ABOVE FOR DOCUMENT WITH RESPECT HEREIN IS SUBJECT LIMITS THE POLICY PERIOD TO WHICH THIS TO ALL THE TERMS, $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X No Deductible 81 UEN OH0225 /1/2013 /1/2014 EACH OCCURRENCE PREMISES ER )RENTED nte $ 300, 000 MED EXP (Any one person) $ 10,000 PERSONAL &ADVINJURY $ 1,000,000 1='` °"' rr� D MR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PE RO LOC AUTOMOBILE GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 A X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS �;- ;._� 81 UEN OH0226 T /1/2014 COMBINED SINGLE LIMIT Ea accident $ 1,00 000 ___ BODILY INJURY (Per person) $ /1/2013 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ EACH OCCURRENCE B X 4EXCESS UMBRELLA LIAR X OCCUR LIAR CLAIMS -MADE UP- 14R9619 -12 -NF 07/01/201303/1/2019 $ 10, 000, 000 AGGREGATE g 10,000,000 ED I I RETENTION $ N/A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? r9l (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 81 WC OH0224 /1/2013 /1/2019 X WC STATUS OTH- S E.L. EACH ACCIDENT $ 1 000 000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) City of Riverside is named as additional insured per the insured's policy forms. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Riverside ACCORDANCE WITH THE POLICY PROVISIONS. 3900 Main Street Riverside, CA 92522 AUTHORIZED REPRESENTATIVE Jill Barry /JILL ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INSf195 rgmnnsi m Thn Amon nama and Inn^ era rani -ararl marke ^f Amon