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DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/29/2017 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). CONTACT Transit Insurance Services Inc PRODUCER NAME: FAX PHONE (909)390-0035 Transit Insurance Services (909)390-0030 (A/C, No): (A/C, No, Ext): E-MAIL certs@transitinsurance.com CA License # 0679250 ADDRESS: 1155 S. Milliken Ave. Suite B INSURER(S) AFFORDING COVERAGE NAIC # Ontario CA 91761-8157 Sentry Select Insurance Company 21180 INSURER A : INSURED INSURER B : Ian Deffebach INSURER C : 3815 Surfrider Lane INSURER D : INSURER E : Las Vegas NV 89110 INSURER F : 2017-2018 A/I 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. ADDL SUBR INSR POLICY EFF POLICY EXP TYPE OF INSURANCE LIMITS POLICY NUMBER LTR (MM/DD/YYYY) (MM/DD/YYYY) INSD WVD X 2,000,000 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED 100,000 A X CLAIMS-MADE OCCUR $ PREMISES (Ea occurrence) 5,000 A0052421001 1/25/2017 1/25/2018 MED EXP (Any one person) $ 1,000,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- X X 0 POLICY LOC PRODUCTS - COMP/OP AGG $ JECT 0 Employee Benefits $ OTHER: COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY $ (Ea accident) BODILY INJURY (Per person) $ ANY AUTO A ALL OWNED SCHEDULED X BODILY INJURY (Per accident) $ A0052421001 1/25/2017 1/25/2018 AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X X $ HIRED AUTOS (Per accident) AUTOS 100,000 $ Uninsured motorist combined UMBRELLA LIAB EACH OCCURRENCE $ OCCUR EXCESS LIAB CLAIMS-MADE AGGREGATE $ $ DED RETENTION $ PER OTH- WORKERS COMPENSATION STATUTE ER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below A Motor Truck Cargo Deduct/1,000 A0052421001 1/25/2017 1/25/2018 Single Conveyance/$100,000 A Physical Damage Deduct/1,000 A0052421001 1/25/2017 1/25/2018 Fire, Theft CAC & Collision DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Description of Work performed for the City of Riverside, Reference to Event, or Description of Operations. The City of Riverside shall be named as additional insured as respects to the operations of the named insured per attached Endorsement CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Riverside ACCORDANCE WITH THE POLICY PROVISIONS. 3900 Main St Riverside, CA 92522 AUTHORIZED REPRESENTATIVE D Maldonado/DEBBIE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)