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ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYW) 1 lllk.� 03/11/2016 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 CONTACT NAME: Shane Rettberg Timothy Gaspar Insurance Services, Inc. PHONE Y (818)302 -3060 qC No; (818)436 -6122 5900 Canoga Ave. Suite 110 E -MAIL Woodland Hills, CA 91367 ADDRESS: service @gasparinsurance.com $ 1,000,000 License #: OG66626 INSURERS AFFORDING COVERAGE NAIC # INSURERA: Admiral Insurance Company DAMAGE TO RENTED PREMISES Ea occurrence INSURED George Edward Liblin INSURER B MED EXP (Any one person) $ 6,000 6 G F Carriages 2175 South Willow Avenue 217 INSURER C: APPROVED PERSONAL & ADV INJURY INSURER D: Bloomington, CA 92316 INSURER E: GENERAL AGGREGATE $ 2,000,000 INSURER F: X POLICY PRI LOC COVERAGES CERTIFICATE NUMBER: 00000000 - 121520 REVISION NUMBER: 42 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD /WW LIMITS A X COMMERCIAL GENERAL LIABILITY Y CA000016393 -06 12/04/2015 12/04/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 60,000 MED EXP (Any one person) $ 6,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRI LOC PRODUCTS - COMP /OP AGG $ 1,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccident $ NON -OWNED HIREDAUTOS AUTOS $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) This policy includes a Blanket Additional Insured Endorsement — the certificate holder is an additional insured if required by written contract. Please refer to the attached endorsement. CERTIFICATE HOLDER CANCELLATION The City of Riverside Greater Riverside Chambers of Commerce 3900 Main St. Riverside, CA 92501 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,i © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Printed by SRR on March 11, 2016 at 02:31 PM