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AWRO" CERTIFICATE OF LIABILITY INSURANCE OCHOA -1 OP ID: RH DATE (MM /DD/YYYY) 06/08/2015 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 Kosich Insurance Agency, Inc. 3435 Mt. Diablo Blvd. Ste. 300 Lafayette, CA 94549 Kosich Insurance Agency, Inc. INSURED Ochoa's Backflow Systems Sergio Ochoa 14430 Laurel Drive Riverside, CA 92503 NAMEACT Kosich Insurance Agency, Inc. PHONE 925 - 284 -3911 INC. No. Est): E -MAIL ADDRESS: FAX No): 925 484 3919 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Scottsdale Insurance 41297 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF 4MM /DD/YYYYL(MM POLICY EXP /DD/YYYYL LIMITS A GENERAL LIABILITY X CPS2236421 06/20/2015 06/20/2016 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY pREM SES Ea occcu ence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 X Owner /Cont Prot. PERSONAL & ADV INJURY $ 1,000,000 X E & 0 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n j T n LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY accident) ( ) $ PROPERTY DAMAGE JPERACCIDENT) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y WC STATU- TORY LIMITS OTH- ER $ Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N / A E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space Is required) "The City of Riverside, and its officers, employees and agents, are included as additional insured for General Liability as required by written contract per the attached endorsement form, CG2038 04/13. CERTIFICATE HOLDER CANCELLATION City of Riverside Parks Division Finance /Accounts Payable 3900 Main Street 6th Floor Riverside, CA 92522 ) 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 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD