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ACc •RO® CERTIFICATE OF LIABILITY INSURANCE et.....----- DATE(MMIDDIYYYY) 06/12/2017 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(S), 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 endorsement(s). PRODUCER Veracity Insurance Solutions, LLC. 260 South 2500 West, Suite 303 Pleasant Grove UT 84062 CONTACT FLIP Program Support wC,Ne ). (888) 568 -0548 FAX,NOl: ADDRESS: info @fliprogram.com INSURER(S) AFFORDING COVERA3E NAIC # INSURER A: Great American Alliance Insurance Co. 26832 INSURED South by Southeast Catering, DBA Waffalusa 4150 Merrill Ave Riverside CA 92506 INSURER B : PL9952071- F026865 03/1712017 INSURER C: EACH OCCURRENCE INSURERD: DAMAGE IO HENIEU PREMISES (Ea occurrence) INSURER E: INSURER F: MED EXP (Anyone person) 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. 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 PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER (MI POLICY (M POLICY LIMITS A GENERAL X LIABILRY COMMERCIAL GENERAL LIABILITY r I 7 PL9952071- F026865 03/1712017 03/17/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE IO HENIEU PREMISES (Ea occurrence) $ 300 000 CLAIMS -MADE X OCCUR MED EXP (Anyone person) $ 5,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: X POLICY JEC LOC PRODUCTS - COMP /OP AGG $ 2,000,000 ANIMAL BAILEE $ / APPROVED] 1 (Ea acadentSINGLE LIMIT _$ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNED BODILY INJURY (Per person) BODILY INJURY (Per accident) $ (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE I n EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' UABILI1Y YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICE /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ EL. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ FL DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more Space IS required) Certificate holder had been added as additional insured regarding the above mentioned policy per attached Additional Insured - Designated Person or Organization (CG 20 26 Ed. 04 13) CERTIFICATE HOLDER CANCELLATION City of Riverside 3900 Main Street Riverside, CA92522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �t7 ACORD 25 (2014/01) INS025 (201401) © 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD