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OCCUM-1 OP ID: AM
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />ATE (MMIDDIYYYY)
<br />r 08/21/2018
<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 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 endorsemerl
<br />PRODUCER
<br />Anthony Stornetta Ins Agency
<br />410 West Fallbrook Avenue #202
<br />CONTACT
<br />NAME: TONY STORNETTA
<br />PHONE FAX
<br />559-492-1361 (,C -354-0190
<br />C No, Exfl: No): 559
<br />E-MAIL
<br />ADDRESS: TONY@STORINS.COM
<br />Fresno, CA 93711
<br />Tony Stornetta
<br />COMMERCIAL GENERAL LIABILITY
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURER A: Hanover 31534
<br />INSURED OCCU-MED, LTD
<br />INSURER B: CNA 35289
<br />2121 W BULLARD AVE
<br />CLAIMS -MADE FxIOCCUR
<br />FRESNO, CA 93711
<br />INSURER C
<br />OHF9262847
<br />08/13/2018
<br />INSURER D
<br />INSURER E
<br />PRAEIMG E TO RENTLED
<br />ISES (E. occ �,,ence) $ 300,000
<br />INSURER F:
<br />MED EXP (Any one person) $ 5,000
<br />COVERAGES CERTIFICATE 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 />INSIR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />(MMIDDIYYYY)
<br />POLICY EXP
<br />(MMIDDIYYYY)
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 2,000,000
<br />CLAIMS -MADE FxIOCCUR
<br />Y
<br />OHF9262847
<br />08/13/2018
<br />08/13/2019
<br />PRAEIMG E TO RENTLED
<br />ISES (E. occ �,,ence) $ 300,000
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL & ADV INJURY $
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE $ 4,000,000
<br />APPROVED,
<br />PRO-
<br />POLICY JECT
<br />F-1 F-1 LOC
<br />PRODUCTS - COMP/OP AGG $ 4,000,000
<br />OTHER
<br />EMPLBENE $ 1,000,000
<br />AUTOMOBILE LIABILITY
<br />NED SINGLE LIMIT
<br />COMBI ident)
<br />(Ea acc $ 1,000,000
<br />BODILY INJURY (Per person) $
<br />A
<br />ANY AUTO
<br />Y
<br />D268906
<br />06/16/2018
<br />06/16/2019
<br />ALL OWNED SCHEDULED
<br />AUTOS FX AUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE
<br />(per accident) $
<br />F NON -OWNED
<br />HIRED AUTOS AUTOS
<br />X Hired Car x Non Owned
<br />X
<br />$
<br />X
<br />UMBRELLA LAB
<br />OCCUR
<br />EACH OCCURRENCE $ 4,000,000
<br />AGGREGATE $ 4,000,000
<br />•
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />OHF9262847
<br />08/13/2018
<br />08/13/2019
<br />DED RETENTION$
<br />$
<br />•
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />D268679
<br />06/06/2018
<br />06/06/2019
<br />PER OTH-
<br />X I STATUTE ER
<br />E. L. EACH ACCIDENT $ 1,000,000
<br />E. L. DISEASE - EA EMPLOYEEI $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />•
<br />EMPL PRACTICES LIA
<br />OHF9262847
<br />08/13/2018
<br />08/13/2019
<br />AGGREGATE 250,000
<br />B
<br />PROFESSIONAL LIAB
<br />426437068
<br />08/22/2018
<br />08/22/2019
<br />AGGREGATE 5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />NOTICE OF CANCELLATION IS 30 DAYS EXCEPT IN THE EVENT OF CANCELLATION FOR
<br />NON-PAYMENT OR NON -REPORTING WHICH IS 10 DAYS. THE CITY OF RIVERSIDE IS
<br />ADDED AS ADDITIONAL INSURED AS RESPECTS TO OPERATIONS AND ACTIVITIES OF, OR
<br />ON BEHALF OF THE NAMED INSURED PERFORMED UNDER CONTRACT WITH THE CITY OF
<br />RIVERSIDE.
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITYRIV
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CITY OF RIVERSIDE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />HUMAN RESOURCES DEPARTMENT
<br />JEANNA COMBS
<br />3900 MAIN STREET
<br />RIVERSIDE, CA 92522
<br />AUTHORIZED REPRESENTATIVE
<br />Tony Stornefta
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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