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ACO TM CERTIFICATE OF LIABILITY INSURANCE (MM Date /DD/YR) 3/19/13 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 require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Heffernan Insurance Brokers 1350 Carlback Avenue CONTACT NAME: Ann MCCants PHONE A/C No,Ext : 925 -934 -8500 FA No): 925 -934 -8278 Walnut Creek, CA 94596 CA License #0564249 EMAIL AnnM @heffins.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Hartford Underwriters Ins. Co. 30104 W.L. Butler Construction, Inc. INSURER B: $ 1,000,000 204 Franklin Street INSURER C: INSURER D: Redwood City, CA 94063 -1929 INSURER E: INSURER F: X ItKaIT14 :i9l;1Ia_A III A►LIETA1:I�: 9�[7��►l�JdiT THIS IS TO CERTIFY THAT 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 INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL L LIABILITY 57CQT2281 3/01/2013 3/01/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY X PREMISES (Ea $ 300,000 CLAIMS -MADE OCCUR occurrence I MED EXP (Any one erson $ 10,000 $3,000 Deductible BI /PD PERSONAL BADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L. AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP $2,000.000 EMPLOYEE BENEFITS $ 1,000,000 POLICY X PROJECT LOC COMBINED SINGLE A AUTOMOBILE LIABILITY 57UENQT22 3/01/2013 3/01/2014 LIMIT $1,000,000 (Ea accident) X BODILY INJURY (Per person) $ ANY AUTO X IL INJURY (Per a cc ide nt) $ ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS �� ®� lD A R RM PROPERTY DAMAGE ( Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB id CLAIMS -MADE °P � `� KI N K AGGREGATE S DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N X WC STATU- TORY LIMITS OTHER E.L. EACH ACCIDENT $ 1,000,000 A ANY PROPRIETOR/PARTNERiEXECUTIVE/ OFFICER/MEMBER EXCLUDED] ❑ (Mandatory In N.H.) N/A 57WEQT2280 3/01 /2013 3/01 /2014 E.L. DISEASE - EA EMPLOYEE 51,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: WLB Project #21308, Fresh and Easy DC Academy TI and Parking Expansion, 1730 Eastridge Avenue, Riverside, CA 92507. City of Riverside are named as additional insured on General Liability policy ifrequired by written contract per attached endorsement and also named as additional Insured on Automobile Liability policy per the attached endorsement. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) 01-8 -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 City of Riverside Public Works Department EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZE REPRESENTATIVE REPRESENTATIVE 3900 Main Street Riverside, CA 92522 ACORD 25 (2010/05) 01-8 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD