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ncoRV® CERTIFICATE OF LIABILITY INSURANCE 44.� DATE IMMlDDIYYYYj 1 111 312 01 6 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(les) 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 Ed ewood Partners Insurance Center (EPIC) 19000 MacArthur Blvd. PH Floor Irvine, CA 92612 www.edgewoodins.com CONTACT NAME: PHONE (949) 263 -0606 AX No): 949 263 -0906 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC e INSURER A: Libert y Mutual Fire Insurance ComRaDy 23035 INSURED G M Sager Construction Co Inc/Gary Sager G M Sager Construction Co 1380 South East End Ave Pomona CA 91766 INSURER a: Liberty Insurance Co oration 42404 INSURER c: Travelers Property Casual!y Co of America 25674 INSURER D: EACH OCCURRENCE INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 28119994 REVISION 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 ADD MID S BA WV1 POLICY NUMBER MWODIYYYY POLICY MIIYYYY LIMITS A COMMERCIAL GENERAL LIABILITY TB2Z91462398025 4/1912015 4119/2016 EACH OCCURRENCE s 1,000,000 CLAIMS-MADE I r : OCCUR ENTED PR WISES a occurrence $ 300,000 J BIlPD Ded - 55,000 MED EXP IAn one person S 5,000 PERSONALSADVINJURY S 1,000,000 APPROVED GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000000 POLICY E] PE0. 7 LOC PRODUCTS - COMPIOPAGG S 2,000,ODO Is OTHER: A AUTOMOBILE LlAalurY AS2Z91462398015 4/19/2015 4/1912016 =SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ ✓ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS V, H RED AUTOS AUTOS BODILY INJURY (Per accident) S War ac PROPERTY DAMAGE $ 9 ✓ 1000 ded CO & Coll B UMBRELLA LIAR OCCUR 4/19/2015 4/19/2016 EACH OCCURRENCE S 3,000,000 AGGREGATE S 3,000,000 EXCESS LIAB CLAIMS -MADE H �TH7Z91462398055 1 DED I ✓ I RETENTIONS 10,000 Is C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIFXECUTiVE Y❑ OFFICER/MEMBER EXCLUDEDT (Mandatory In NH9 N f A DTJ- UB- 80398082 -16 1/1/2016 1!1!2017 P I OTH- STAT E ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE S 1,000,000 If DESCRIIPTIObN under F OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1,000,000 A �RentedlLeased Equipment YM2Z91462398045 411912015 4/19/2016 8165,000, per item DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: All Operations Certificate Holder Is named as Additional Insured with respects to General Liability per form LCO443 0512 and Automobile Liability per form AC8407 0713. Coverage is written on a Primary & Non - Contributory Basis Waiver of Subrogation applies to GL per LCO443 0512, Waiver of subrogation applies to Workers Compensation per WC99 0376 (00) if required by written contract. '30 Days Notice of Cancellation will be given, 10 Days for Non - Payment of Premium' City of Riverside its officers and employees Public Utilities Dept. 3901 Orange Street Riverside CA 92501 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 a 01988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2D14101) The ACORD name and logo are registered marks of ACORD " -- -9994 1 1$ -16 Master I Denise 7er444 1 32 :016 9:67:32 AM 1PST1 I Page 1 of 14