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<br />OP ID: AM
<br />A`„ ----, Jv' CERTIFICATE OF LIABILITY INSURANCE
<br />I DATE IMr /201 YY)
<br />o6t2a(2o1r
<br />TH18 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(8), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions at the policy, certain policies may require an endorsement. A statement an this certificate does not confer rights to the
<br />certificate holder In lieu of such endorsement(,).
<br />PRODUCER
<br />One Source Health & Wealth Mgt
<br />410 West Falibrook Avenue 9202
<br />Fresno CA 93711
<br />Tony Stornetta
<br />woEACT Tony Stometta
<br />pl1QNe 559 -092.1381 AX xek 558- 354 -0180
<br />1i e, Exit
<br />ADDRESS: Tonyiheaithweaithadvlsory.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NM 5
<br />INSURER A:Hanover
<br />31634
<br />INSURED Occu -Med, LTD
<br />2121 W Bullard
<br />Fresno, CA 93711
<br />INSURER 8sCNA
<br />36289
<br />INSURER C1
<br />08113/2017
<br />INSURER Di
<br />S 2,000,000
<br />INSURER 0 :
<br />$ 300,000
<br />INSURER P:
<br />CLAIMS-MADE © OCCUR
<br />COVERAGES
<br />CERTIFICATE NUMBER:
<br />REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 1 Re ruuuT rettivu
<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 POUCIES 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 />IL1
<br />LTA
<br />TYPO 01' INSURANCE
<br />ADM
<br />INSO
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<br />IAN.
<br />PGUCYNUMBER
<br />I POLtCY DDAYM
<br />IMINDOYYWI
<br />LIMITM
<br />A
<br />X
<br />COMMERCIAL GENERAL UMW?
<br />X
<br />OHF9282847
<br />0811312018
<br />��
<br />08113/2017
<br />EACH OCCURRENCE
<br />S 2,000,000
<br />DuAAOETORENTEO
<br />PREM18E8 tEs ocwraec�l
<br />$ 300,000
<br />■■
<br />CLAIMS-MADE © OCCUR
<br />MED EtP (Any one person)
<br />S 6,000
<br />■
<br />■
<br />OEI1'LAGGREGATE
<br />■
<br />PERSONAL. IL ACV INJURY
<br />$
<br />� ���0 ���
<br />GENERAL AGGREGATE
<br />3 4,000,000
<br />LxAITAPPLIESPEA:
<br />POLICY ❑ JELi El LOC
<br />OTHER.
<br />PRODUCTS • COMP/OP AGO
<br />S 4,000,000
<br />S
<br />A
<br />AUT0330DILB
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<br />Am' AUTO
<br />ALLOWNED
<br />AUTOS AUT08
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<br />MI
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<br />X
<br />SCHEDULED
<br />NO AUTOS
<br />gated
<br />D268905
<br />0511512017
<br />0511512018
<br />COMBIINED SINGLE uMlr
<br />tEa
<br />s 1,000,000
<br />S ONLY INJURY (Perpason)
<br />$
<br />BODILY INJURY (Per acddem)
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<br />PROPERTY0ALCLGE
<br />iPerASadeM1
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<br />OXGES$ LAB
<br />•
<br />OCCUR
<br />CLAIMS•tAOE
<br />OHF9262847
<br />08113(2018
<br />0811312017
<br />EACH OCCURRENCE
<br />s 4,000,000
<br />AGGREGATE
<br />$ 4,000,000
<br />$
<br />OED RETENTION
<br />A
<br />WORKERS COMPENSATION
<br />AN PRO LLASELITY YiH
<br />ANY CCEER:MEMMBEREMCLVDEED?EC Y
<br />IMandatorytn NN)
<br />Eyes, descAbeurWsr
<br />DESCRIPTION OF OPERATIONS Were,
<br />NIA
<br />D268878
<br />0610812017
<br />0610012018
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<br />X 1$ATUIE 1 1RTH
<br />E L, EACH ACCIDENT
<br />I 1,000,0001
<br />Et- OISEASE • EA EJAPLOYEE,
<br />$ 1,000,000
<br />EL DISEASE •POUCYL1L1rr
<br />f 1,000,000
<br />A
<br />8
<br />Empl Practices LIa
<br />Professional Llab
<br />OHF9262847
<br />425437058
<br />0811312016
<br />0812212018
<br />08113/2017
<br />08122/2017
<br />Aggregate 260,000
<br />6,000,000
<br />DESCRIPTION OP OPERATIONS I LOCATIONS 1 VEHICLES (ACORO 101, Additional Rs :narks Schedule, mar be sltuMd If mae space be tquiesdl
<br />Not ce of cancellation Is 30 days except in the event of cancellation for
<br />non - payment or non - reporting which Is 10 days, The City of Riverside is
<br />added as additional Insured as respects to operations and activities of, or
<br />on behalf of the named Insured performed under contract with the City of
<br />Riverside,
<br />66 et r Irt4A 1 R rt Vt -Nt:R
<br />CITYRIV
<br />CITY OF RIVERSIDE
<br />HUMAN RESOURCES DEPARTMENT
<br />JEANNA COMBS
<br />3900 MAIN STREET
<br />RIVERSIDE, CA 92622
<br />t
<br />— ^•- - - - -'" "
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHOMZEDREPRESENTATIVE
<br />Tony Stornetta
<br />ACORD 26 (2014101)
<br />-2014 ACORD CORPORATION. All fights reserved.
<br />The ACORD name and Togo are registered marks of ACORD
<br />
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