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AC"R�0 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 1� 4 1 2014 I �12112D 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 may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockton Insurance Brokers, LLC CONTACT NAME: PHONE FAX (A/C, No 725 S. Figueroa Street, 35th Fl. CA License #OF 15767 Los A ngc le s CA 90017 E -MAIL ADDRESS: ENV�2694912�2 411120I2 (213) 689 -0065 INSURERS AFFORDING COVERAGE NAIC # INSURER A : American Safety Indemnity Company 25433 A INSURED liar -Bro, et al; Har -Bro, Inc.; 1301799 Har -Bro of Northern California Inc.; Har -Bro INSURER B: INSURER C: INSURER D: MED EXP (Any one person) Construction & Consulting, Inc.; I Iar -Bro West Inc and Har -Bro of Washington 2750 Signal Pkwy. INSURER E CLAIMS -MADE X OCCUR INSURER F COVERAG�S HARaR01 CERTIFICATE NUMBER: 12639660 REVISION NUMBER: XXXXXXX 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 MMfDDfYYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY N ENV�2694912�2 411120I2 4 I20I4 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) $ 101000 A X COMMERCIAL GENER BILITY Poll /Prof. Liability Induded MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1 ,000,000 Ded: $20,000 X Contractual Liab. GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: $ POLICY X PRO- LOC JECT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS NOT APP L I t A BSI:...:,.....,,,.,. �. I ; ;J e �x,.3 ; - 1 t .�,,� r-,� i ! �» [Ea accident] $�{{�{�{ BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY Per accident $ XXXXXXX PROPERTY DAMAGE $ xxxxxxx $ XXXXXXX I A UMBRELLA LIAB X OCCUR r.�• Y -. f .w . rT1 a �� ENU0269501303 iTr 4 � '2013 � y r 4/1/2014 EACH OCCURRENCE $ $6 000 O A EXCESS LIAB CLAIMS -MADE GL/CPL/AL/EL Included X AGGREGATE $ 6 000 000 DE❑ RETENTION $ 1 0,000 $ XXXXXXX WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y N ANY PROPRIETOR /PARTNER /EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) N NOT APPLICABLE TU_ TORY LIMITS ER E.L. EACH ACCIDENT $ xxxxxxx E.L. DISEASE - EA EMPLOYEE $ XXXXXXX If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ XXXXXXX DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Riverside and Community Development Department are Additional Insured(s) as per the attached endorsement or Policy language. CERTIFICATE HOLDER CANCELLATION See Attachment 12639660 City of Riverside Community Developrnent Department Attn: David Welch 3900 Main Street 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 7*4�'O, ", 00d1A*0P---