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C &CC0-1 OP ID: LP
<br />,4`CORO` CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM /2016 Y)
<br />09/03/2016
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Jackson & Jackson Insurance
<br />D. Gene Davis
<br />CONTACT D. Gene Davis
<br />NAME:
<br />PHONE Ext : 626- 914 -9944 FAX No : 626- 914 -1040
<br />E -MAIL
<br />ADDRESS:
<br />302 E Foothill Blvd
<br />San Dimas, CA 91773
<br />COMMERCIAL GENERAL LIABILITY
<br />D. Gene Davis
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A:AMCO Insurance Company
<br />19100
<br />$ 1,000,00
<br />INSURED C &C Concessions, Inc.
<br />INSURER B: State Compensation Ins. Fund
<br />35076
<br />Attn: Charles Giordano
<br />2700 1st Street
<br />La Verne, CA 91750
<br />INSURER C: North American Capacity Ins Co
<br />08108/2016
<br />INSURER D: Nationwide Mutual
<br />23787
<br />INSURER E:
<br />$ 100,00
<br />INSURER F:
<br />$ 1,00
<br />COVERAGES CERTIFICATE 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 />ADDL
<br />UB
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM /DD/YYYY
<br />POLICY EXP
<br />MM /DDNYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE _
<br />$ 1,000,00
<br />CLAIMS -MADE FX]OCCUR
<br />X
<br />GLA03057835930
<br />08108/2016
<br />08/08/2017
<br />DAMAGE
<br />REMISES Ea occurrence
<br />$ 100,00
<br />MED EXP (Any one person)
<br />$ 1,00
<br />PERSONAL & ADV INJURY
<br />$ 1,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,00
<br />X POLICY F PRO JECT ❑ LOC
<br />A PPR O VED
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,00
<br />$
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />D
<br />X ANY AUTO
<br />BA3057835930
<br />08/08/2016
<br />08/08/2017
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />X HIRED AUTOS X AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I I RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR /PARTNER /EXECUTIVE Y/N
<br />OFFICER/MEMBER EXCLUDED? F-1
<br />(Mandatory in NH)
<br />NIA
<br />1957932 -2016
<br />02/11/2016
<br />02/11/2017
<br />X IPER I OTH-
<br />STATUTE 1 ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,00
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,00
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L . DISEASE - POLICY LIMIT
<br />$ 1,000,00
<br />C
<br />Liquor Liability
<br />88G0001886 -08
<br />09/03/2016
<br />09/03/2017
<br />Liquor 1,000,00
<br />Deduct 1,50
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />RE: Fiestas Patrias 2016; Sunday, September 11, 2016; Martha McLean Anza
<br />Narrows Park, Riverside, CA. Liberman Broadcasting, Inc; and City of
<br />Riverside, it's officers, employees and agents are included as additional
<br />insured, with regard to general liability of the named insured per form
<br />CG2033 0413. Liquor liability additional insured per form NAC- GB -R370 12/96.
<br />CFRTIFICATF HOI nFR CANCFI I ATION
<br />©1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Riverside
<br />tY
<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 />�vW �
<br />©1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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