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A� D CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 7/19E(MM/ 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 have ADDITIONAL INSURED provisions or 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 Arthur J. Gallagher & Co. Insurance Brokers of CA, Inc. LIC #0726293 3697 Mt. Diablo Blvd, Suite 300 Lafayette CA 94549 CONTACT NAME: PHONE 925 - 299 -1112 FAX 925 - 299 -0328 (A/C, No, Ext): (A /C, No): ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Tokio Marine Specialty Ins Co 23850 INSURED CISERVI -01 C.I. Services, Inc. 26861 Trabuco #353 Mission Viejo CA 92691 INSURER B :Nationwide Mutual Insurance Company 23787 INSURER C : 2/18/2018 INSURER!) : $1,000,000 INSURER E : INSURER F : X COVERAGES CERTIFICATE NUMBER: 2003819903 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 AWL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM /DD /YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y PPK1613572 2/18/2017 —1 2/18/2018 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE (RENTED PREMISES ( (Ea occurrence) $ 100,000 MED EXP (Anyone person) $5,000 APPROVED ` PERSONAL &ADV INJURY $1,000,000 GEN'L X AGGREGATE POLICY OTHER: X LIMIT APPLIES jEF PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OPAGG $2,000,000 Ded(Each Occurance) $5,000 B AUTOMOBILE X )( LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY ACP BA 30 -3- 8125303 2/18/2017 2/18/2018 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Comp & Coll Ded $1,000 A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PUB573386 2/18/2017 2/18/2018 EACH OCCURRENCE $6,000,000 AGGREGATE $6,000,000 DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requi ed) ADDITIONAL INSURED(S): The City of Riverside and its officers, employees, and agents. CERTIFICATE HOLDER CANCELLATION City of Riverside Risk Management 3900 Main Street Riverside, CA 92522 I 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 �� ter. ACORD 25 (2016/03) © 1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD