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<br />DATE (MM/DD/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />11/20/2018
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />CONTACT
<br />PRODUCER
<br />Hong Ta
<br />NAME:
<br />Gaspar Insurance Services, Inc.
<br />FAX
<br />PHONE
<br />818.302.3060818.436.6122
<br />(A/C, No):
<br />(A/C, No, Ext):
<br />23161 Ventura Blvd. Suite 100
<br />E-MAIL
<br />hong.ta@gasparinsurance.com
<br />ADDRESS:
<br />Woodland Hills, CA 91364
<br />INSURER(S) AFFORDING COVERAGENAIC #
<br />License #: 0G66626
<br />INSURER A :
<br />Arch Insurance CompanyArch Insurance Company1115011150
<br />INSURED
<br />INSURER B :
<br />Starnet Insurance Company40045
<br />Dunn Enterprises, Inc
<br />INSURER C :
<br />DBA Icetown
<br />INSURER D :
<br />10540 Magnolia Avenue
<br />INSURER E :
<br />Riverside, CA 92505
<br />INSURER F :
<br />COVERAGESCERTIFICATE NUMBER:00000000-321975 REVISION NUMBER:17
<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.
<br />ADDLSUBR
<br />INSRPOLICY EFFPOLICY EXP
<br />TYPE OF INSURANCELIMITS
<br />POLICY NUMBER
<br />LTR(MM/DD/YYYY)(MM/DD/YYYY)
<br />INSDWVD
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE$
<br />11/23/201811/23/2019
<br />1,000,000
<br />AXYSNCGL0403901
<br />DAMAGE TO RENTED
<br />CLAIMS-MADEOCCUR$
<br />1,000,000
<br />X
<br />PREMISES (Ea occurrence)
<br />MED EXP (Any one person)$
<br />5,000
<br />PERSONAL & ADV INJURY$
<br />1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$
<br />5,000,000
<br />PRO-
<br />POLICYLOCPRODUCTS - COMP/OP AGG$
<br />5,000,000
<br />X
<br />JECT
<br />$
<br />OTHER:
<br />COMBINED SINGLE LIMIT
<br />AUTOMOBILE LIABILITY
<br />$
<br />11/23/201811/23/2019
<br />ASNAUT00489011,000,000
<br />(Ea accident)
<br />ANY AUTO
<br />BODILY INJURY (Per person)$
<br />OWNEDSCHEDULED
<br />BODILY INJURY (Per accident)$
<br />AUTOS ONLYAUTOS
<br />NON-OWNED
<br />HIREDPROPERTY DAMAGE
<br />$
<br />XX
<br />(Per accident)
<br />AUTOS ONLYAUTOS ONLY
<br />$
<br />UMBRELLA LIAB
<br />EACH OCCURRENCE$
<br />OCCUR
<br />EXCESS LIAB
<br />CLAIMS-MADEAGGREGATE$
<br />$
<br />DEDRETENTION$
<br />PEROTH-
<br />WORKERS COMPENSATION
<br />X
<br />12/01/201812/01/2019
<br />BBNUWC0142409
<br />STATUTEER
<br />AND EMPLOYERS' LIABILITY
<br />Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE 1,000,000
<br />E.L. EACH ACCIDENT$
<br />N / A
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />1,000,000
<br />E.L. DISEASE - EA EMPLOYEE$
<br />If yes, describe under
<br />1,000,000
<br />E.L. DISEASE - POLICY LIMIT$
<br />DESCRIPTION OF OPERATIONS below
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The Certificate Holder shall be an Additional Insured, but only with respect to the operations of the Named Insured, and
<br />subject to the provisions and limitations of Form CG 2010 Additional Insured - Owners, Lessees or Contractors-Scheduled
<br />Person or Organization, but only with respect to 10540 MAGNOLIA AVENUE, RIVERSIDE, CA 92505.
<br />The General Liability policy includes Form CG 2135 Exclusion - Coverage C - Medical Payments, Scheduled Description
<br />and Location of Premises or Classification: For any locations shown on the declarations page Medical Payments and all
<br />(continued on ACORD 101 Additional Remarks Schedule)
<br />CERTIFICATE HOLDERCANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Riverside City Hall Plaza
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Level 3900 Main Street
<br />AUTHORIZED REPRESENTATIVE
<br />Riverside, CA 92522
<br />(HOT)
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
<br />Printed by HOT on November 20, 2018 at 08:25AM
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