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DATE (MM /DDNYYY) CERTIFICATE O LIABILITY I 06/22/2016 �--- 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 INSURERS), 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 endorsements). CONTACT PRODUCER NAME: Ebrahim Sabeti Common Sense insurance 24295 Swartz Dr Lake Forest, CA 92630 [PHONE FAX Na : 949 - 460.9404 AAJQ,N0 - E -MAIL ADDRESS: Udaethealthins irance_ccm�_ - _ — PRODUCER OUST ER I❑ : _ INSURER (S) AFFORDING COVERAGE NAIC # INSURED u f INSURER A: Preferred Contractors Insuranace COm an RRG ATUNAISA VAIPULU INSURER B: DBA : VAIPULU CONSRUCTION INSURER C: 8269 Verbena Drive INSURER D: -- RiverSide CA 92594 l INSURER E: - INSURER F: COVERAGES CERTIFICATE NUMBER: 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, NOTVVITHSTANDINO 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. IN5Ft — ADDL S BR POLICY EFF POLICY EXP LIMITS LTA TYPE OF INSURANCE iNSR WVDI POLICY NUMBER MM D❑ MMiDD GLNERAL LIABILITY PC2 0 BB1� -00 05/11/16 05/11/17 EACH OCCURRENCE $ AM O RENT rx- COMMERCIAL GENERAL LIABILITY ? Subject to Deductible: PREMISES Ea occurrence ��Q +QQQ I CLAIMS -MADE OCCUR Property Damage $1,090 MEd E7CP (Any one person) $ 5 aQ� I Bodily Injury $1,000 PERSONAL & ADV INJURY $ 1 900 000 Per Claim GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: �l F PRO - POLICY JF_CT LOC AUTOMOBILE LIABILITY Y ' ANY AUTO ALL DINNED AUTOS SCHEDULED AUTOS HIRED AUTOS I NON -OWNED AUTOS r-Irl I APPROVED UMBRELLA LIAB _ ° OCCUR i EXCESS LIAB CLAIMS -MADE —i DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y t N ANY PROPRIETOKPARTNEWEXECUTIVE 0r7FICER!MEMBER EXCLUDED? F-1 N/A s (Mandatory in NH) If yes. describe under on DESCRIPTION OF OPERATIONS..' LOCATIONS [ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Riverside, and its officers, employees and agents are added as additional insureds 3900 Main Street Riverside CA, 92522 CERTIFICATE HOLDER Additional Insured City of Riverside 3990 Main Street Riverside CA, 92522 ACORD 25 (2009109) CANCELLATION PRODUCTS - COMP/OP AGG $ 1.00 +00 AGGREGATE $ COMBINED SINGLE LIMIT $ (Ea accident) $ $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) $ $ EACH OCCURRENCE $ AGGREGATE $ $ WC STATU- OTH- R L, ITS ER E.L. EACH ACCIDENT $ $ E.L. DISEASE - EA EMPLOYE $ E,L- DISEASE - POLICY LIMIT $ SHOULD ANY OF THE ABOVE DES IBED j0LICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTIC ILL B ELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 198$_ 2009 ACO R ORATION. All rights reserved. The ACORD name and logo are registered marks of ACOR