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M4CON -1 OP ID: MUNT CERTIFICATE OF LIABILITY INSURANCE 1 D 0 4//2828 /122014 014Y) 0 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 Phone: 916- 784 -9793 CONTACT NAME: Builders Advantage Insurance Fax: 916 - 784 -9799 107 Main Street PHONE FAX A/c No Ext : A/c No): E -MAIL ADDRESS: Roseville, CA 95678 Toni Luker X COMMERCIAL GENERAL LIABILITY X XN102275802 05/19/2014 INSURER(S) AFFORDING COVERAGE NAIC p INSURER A:Amtrust International INSURED M 4 Construction Steve Mitchell INSURER B: $ 5,000 PERSONAL& ADV INJURY $ 1,000,00 2249 Trafalgar Ave. INSURER C : INSURER D: Riverside, CA 92506 INSURER E: GENERAL AGGREGATE $ 2,000,00 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUB POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS ACCORDANCE WITH THE POLICY PROVISIONS. GENERAL LIABILITY 3900 Main Street AUTHORIZED REPRESENTATIVE EACH OCCURRENCE j $ 1,000,00 PREMISES Ea occurrence $ 100,000 A X COMMERCIAL GENERAL LIABILITY X XN102275802 05/19/2014 05/19/2015 CLAIMS -MADE FX1 OCCUR MED EXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,00 $ X POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROI a BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE .S AGGREGATE 5 EXCESS LIAB CLAIMS -MADE DIED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN N STATU- OTH- TOR WC Y LIMITS ER ANY PROPRIETORIPARTNER /EXECUTIVE E.L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? ❑ NO A (Mandatary in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Riverside is named as additional insured under commercial general liability per attached endorsement. RE: Various locations throughout the City of Riverside, CA. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Riverside 3900 Main Street AUTHORIZED REPRESENTATIVE Riverside, CA 92522 - John Ealinger ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD