|
MICH&BR-01 STACEYDWYER
<br />`64� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />11/12/2018
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT Liane Martinelli
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (714) 509-1080 (A/C, No):
<br />NFP Property & Casualty Services, Inc.
<br />1551 North Tustin Avenue
<br />Suite 500
<br />E-MAIL
<br />ADDRESS: liane.martinelli@nfp.com
<br />Santa Ana, CA 92705
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Sentinel Insurance Company Ltd
<br />11000
<br />INSURED
<br />INSURER B: State Comp, Ins Fund of CA
<br />35076
<br />INSURERC:
<br />GENERAL AGGREGATE $ 2,000,000
<br />Michelle & Bruce Williams
<br />INSURER D:
<br />1440 Beaumont Ave Ste A2 PMB316
<br />Beaumont, CA 92223
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CFRTIFICATF 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />(MM/DD/YYYY)
<br />POLICY EXP
<br />(MM/DD/YYYY)
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />x
<br />"T Fmk'
<br />72SBAZB3793
<br />11/17/2018
<br />11/17/2019
<br />EACH OCCURRENCE $ 1,000,000
<br />PAMMAGE TO RENTED
<br />RE ISES (E,
<br />, occurrence) $
<br />MED EXP (Any one person) $ 10,000
<br />APPROVED
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />PRO-
<br />X POLICY JECT LOC
<br />OTHER
<br />GENERAL AGGREGATE $ 2,000,000
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />$
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON-OWNE D
<br />AUTOS ONLY AUTOS ONLY
<br />MBINED SINGLE LIMIT
<br />(CEO, .,dent) $
<br />BODILY INJURY (Per person) $
<br />INJURY (Per accident) $
<br />-BODILY
<br />PROPERTY DAMAGE
<br />(P .
<br />er a dent) $
<br />UMBRELLA LIAB OCCUR
<br />EXCESS LIAB CLAIMS -MADE
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />DED RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y/N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />914813416
<br />12/09/2017
<br />12/09/2018
<br />x Sp OE R H -
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,66-0
<br />11
<br />DESCRIPT ON OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />re: operations as usual to named insured.
<br />The City of Riverside, and its officers, employees and agents are added as additional insureds under this general liability policy with respect to liability arising
<br />out of the 2018 Festival of Lights from Friday, November 23, 2018 thru January 5, 2019 per form SS 00 08 04/05 attached.
<br />CFRTIFICATF HOLnFR CANCELLATION
<br />ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />The City of Riverside
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />3900 Main Street
<br />Riverside, CA 92522
<br />AUTHORIZED REPRESENTATIVE
<br />"T Fmk'
<br />ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|