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AC �� DATE {MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/20/2016 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 INSURER(5), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT' If the Certificate holder is an ADDITIONAL INSURED, the policy(ies) most 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 Corlter rights to the certificate holder in lieu of such endorsement(*). PRODUCER CON 1ACT Craig Timothy ISU - Service Insurance Agency of Roosevelt, Inc. PHONE Fax (AIQ 40, Ertl, AdC No PO Sox 997 A'DDR� S :ctimothy @srvins.com 610 E 200 N INSURERS AFFORDING COVERAGE NAIC 0 Roosevelt UT 84056 INSURERA:Falls Lake I,lat.ional Insurancs Co INSURED INSURER B :NatiQnail 5 ecialt Insurance ESB Oilfield Service, Inc. INSURERC: Rt 1 Box 1112 IIJt -liFrx n - Roosevelt UT 84066 1 INSURER F: COVERAGES CERTIFICATE NUMBER:16 /17 certs 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 PAIL] CLNMS. INSR LTR TYpE OF INSURANCE D RI �� POLICY EFF P LlCY NUMBER MMIDDIYYYY POLICY ERP MMI DIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY OLAIMSQADE i n i OCCUR Pollution --s Craig Timothy /SN CPP0267270 8/9/2016 8/9/2017 EACH OCCURRENCE $ 1,000,000 E TO RENTEO PREMISE a occurrence $ 100,000 X MEDEXP[Any one persoa) $ 5,000 X XCU Included PERSONAL & ADV INJURY $ 1,000,000 APPROVED ¢EN'L AGGREGATE LIMIT APPLIES PER- X POLICY 1-1 PRO JECT 171 LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - CONIPIOP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED TES ri4R�p AiSS AUTOS la"0253177 8/9/2016 8/9/2017 8441 9 thuL 5 LN11 Ea acc dens $ 11000,000' , 000, 000 001) ILYINJURY (Per person) $ BODILY INJURY (Par accidenl) $ PRQERTY DAMAGE $ PIP -aasic $ 3,000 X $ UMBRELLA LIAR x OCCUR EXCE$5 LiAH CLAIMS -MADE ilMg0255463 8/9/2016 8/9/2017 EACH OCCURRENCE $ 10,000,000 AGGREGATE S 10 , 0001000 TIDED I x I RETENTON$ 10,001) Ix _ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN MIN PR4PR4EY4RlPARTNERiESCECLf'r1VE OFRCERlMEMBER EXCLUDED? ❑ [Mandatory in NH) ff yes, describe under DESCRIPTION OF OPERATIONS below NIA CPP0267270 Stop Gap Liability ONLY 8/5/2016 8/9/2017 PER TA T ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE • EA EMPLOYE S 1,000,000 E.L DfSEASE - POLICY LIMIT 1 $ 1 000 1 000 7 nESCRJf>T4ON OF 077 RATIONS { LOCATION$ rYEH1CLE8 [ACORD 101, Addickmal Remarks Schedule, may be attached if mare space is required) C'FRT[FICATF Hni np:p a AMrFl I ATIOM ®1988 -2014 ACORD CORPORATION. All rights reserved_ ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 >:>>am SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Riverside California 3900 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Riverside, CA 92522 AUTHORIZED REPRESENTATIVE --s Craig Timothy /SN ®1988 -2014 ACORD CORPORATION. All rights reserved_ ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 >:>>am