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CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <br />04/17/2014 <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 be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />CONTACT <br />Professional Insurance Associates Inc. <br />657-667-0225657-667-0227 <br />PRODUCER <br />NAME: <br />FAX <br />PHONE <br />657-667-0225657-667-0227 <br />Professional Insurance Associates Inc. <br />(A/C, No): <br />(A/C, No, Ext): <br />E-MAIL <br />Albert@MatlesIns.com <br />Matles Insurance Agency Inc. (V2) <br />ADDRESS: <br />PO Box 1266 <br />INSURER(S) AFFORDING COVERAGENAIC # <br />San Carlos, CA 94070Liberty Mutual Insurance <br />INSURER A : <br />(877) 404-6787AmTrust North America <br />INSURED <br />INSURER B : <br />Occupational Safety and Training Systems, Inc.Philadelphia Indemnity Insurance Co. <br />INSURER C : <br />14650 Central Ave <br />INSURER D : <br />INSURER E : <br />Chino, CA 91710 <br />INSURER F : <br />COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: <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 />POLICY EFFPOLICY EXP <br />INSR <br />TYPE OF INSURANCELIMITS <br />POLICY NUMBER <br />(MM/DD/YYYY)(MM/DD/YYYY) <br />LTR <br />INSRWVD <br />1,000,000 <br />GENERAL LIABILITY <br />4 <br />EACH OCCURRENCE$ <br />A <br />DAMAGE TO RENTED <br />4 <br />500,000 <br />COMMERCIAL GENERAL LIABILITY$ <br />PREMISES (Ea occurrence) <br />4 <br />BKS55903266 <br />5,000 <br />04/17/201404/17/2015 <br />CLAIMS-MADEOCCURMED EXP (Any one person)$ <br />1,000,000 <br />PERSONAL & ADV INJURY$ <br />2,000,000 <br />GENERAL AGGREGATE$ <br />2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG$ <br />PRO- <br />4 <br />$ <br />POLICYLOC <br />JECT <br />COMBINED SINGLE LIMIT <br />1,000,000 <br />AUTOMOBILE LIABILITY <br />(Ea accident)$ <br />BAS55903266 <br />04/17/201404/17/2015 <br />BODILY INJURY (Per person)$ <br />ANY AUTO <br />ALL OWNEDSCHEDULED <br />A <br />BODILY INJURY (Per accident)$ <br />AUTOSAUTOS <br />NON-OWNED <br />PROPERTY DAMAGE <br />4 <br />4 <br />$ <br />HIRED AUTOS <br />(Per accident) <br />AUTOS <br />$ <br />2,000,000 <br />4 <br />UMBRELLA LIAB <br />EACH OCCURRENCE$ <br />OCCUR <br />04/17/2015 <br />04/17/2014 <br />2,000,000 <br />A <br />USA55903266 <br />EXCESS LIAB <br />CLAIMS-MADEAGGREGATE$ <br />4 <br />10,000 <br />$ <br />DEDRETENTION$ <br />WC STATU-OTH- <br />WORKERS COMPENSATION <br />4 <br />TORY LIMITSER <br />04/17/2014 <br />AND EMPLOYERS' LIABILITY <br />04/17/2015 <br />Y / N <br />1,000,000 <br />ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. EACH ACCIDENT$ <br />SWC1044766 <br />4 <br />BY <br />N / A <br />OFFICER/MEMBER EXCLUDED? <br />1,000,000 <br />(Mandatory in NH) <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 />CProfessional LiabilityPHSD873761$1,000,000 limit/aggregate <br />08/31/201308/31/2014 <br />Claims Made:Retro Date: 08/31/2005$10,000 deductible <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Certificate holder is named as additional insured <br />CERTIFICATE HOLDERCANCELLATION <br />City of Riverside <br />Public Works-RWQCP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />5950 Acron St. <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Riverside, CA 92504 <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05)The ACORD name and logo are registered marks of ACORD <br />