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"R" My At CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 10/28/15 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 CONTACT Thomas Plouffe NAME: PHONE No o Ext : 203 - 931 -7095 A/C No : 203- 931 -0682 Specialty Insurance, LTD. AD RIESS: tplouffe @peoplepc.com P.O. Box 16901 INSURER(S) AFFORDING COVERAGE NAIC # West Haven, CT 06516 INSURERA: United States Fire Insurance 21113 INSURED INSURER B: C & M Amusement INSURER C: 964 East Badillo Street #132 INSURER D: Covina, CA 91724 INSURER E INSURER F: $ 150003000 COVERAGES CERTIFICATE NUMBER: USP177685 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 ADDL IN SD SUBR WVD POLICY NUMBER POLICY EFF MM /DD /YYYY POLICY EXP MM /DD /YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR SRPGPM- 101 -0415 4/3/15 4/3/16 EACH OCCURRENCE $ 15000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 300000 MED EXP (Any one person) $ 51000 PERSONAL & ADV INJURY $ 150003000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 23000,000 POLICY ❑ PRO- ❑ LOC JECT X PRODUCTS - COMP /OP AGG $ 25000,000 $ OTHER: APPROVFr I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS A UMBRELLA LIAB OCCUR USX101429 4/3/15 4/3/16 EACH OCCURRENCE $ 150003000 X AGGREGATE $ 150003000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N PER OTH- STATUTE ER ANY PROPRIETOR /PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Rockabilly Car Show, The City of Riverside is added as an additional insured but only with respect to liability arising out of operations of the named insured during the policy period. Event Date: November 28, 2015 CERTIFICATE HOLDER CANCELLATION City of Riverside SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3900 Main St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Riverside, CA 92522 AUTHORIZED REPRESENTATIVE Thomas A. Plouffe ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD