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Client#: 390819 OSTS ACORDr. CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 10/10/2012 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 CONTA NAME: CT Tami Hamlin USI of Southern California SC PHONE 949 - 790 -9297 FAX 484- 652 -5079 A/C No Ext : A/C No Lic # 0351162 E - R i ess: tami.hamlin @usi.biz 29A Technology Drive Irvine, CA 92618 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Golden Eagle Insurance Corp 10836 INSURED OSTS, Inc. dba: Occupational Safety 14650 Central Avenue Chino, CA 91710 INSURER B: Preferred Employers Ins Company 10900 INSURER C: Underwriters at Lloyd's London 15792 INSURER D: INSURER E: COVERAGES CERTIFICATE Nl1MRFR- RFVlclnhi futIMRFR- 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDE THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY VE BE REDUCED BY P LAIMS. INSR TYPE OF INSURANCE ADDL SUBR LTR INSR WVD POLICY BER POLICY EFF ICY EXP MM /DD/YYYY M /DD/YYYY LIMITS • GENERAL LIABILITY CBP841196 4/17/ 2 04/17/2013 EACH OCCURRENCE $1,000,000 COM X MERCIAL GENERAL LIABILITY qpp OVED CLAIMS -MADE OCCUR DAMAGE TO REND Q RENTED IS FlO PREMISES Ea occurtence $500,000 D EXP (Any one person) s5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: / GENERAL AGGREGATE $2,000,000 / PR UCTS - COMPIOP AGG $2,000,000 POLICY PRO LOC RU ! $ • AUTOMOBILE LIABILITY CBP8411963 4/17/2012 04/17/201 COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X NON -OWNED HIRED AUTOS Ix AUTOS PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB X OCCUR CU8412263 4/17/2012 04/17/2013 EACH OCCURRENCE s2,000,000 AGGREGATE s2,000,000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION $10000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 5y] N/A WKN10574512 4/17/2012 04/17/201 X WC STATU- OTH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $1,000,000 C Professional 453775 8/31/2012 08/31/2013 $1,000,000 Liability DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) The City of Riverside is named as additional insureds as respects General Liability as per written contract, per attached policy form. nu City of Riverside SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Public Utilities ACCORDANCE WITH THE POLICY PROVISIONS. 5901 Payton Ave Riverside, CA 92504 AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S8055725/M7886552 TJHJB