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DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/19/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND C CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND O BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONT REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, If SUBROGATION IS WAIVED, subject to the terms and conditions of this certificate does not confer rights to the certificate holde CONTACT PRODUCER NAME: Marsh USA Inc. FAX PHONE (A/C, No): 1301 5th Avenue, Suite 1900 (A/C, No, Ext): E-MAIL Seattle, WA 98101 ADDRESS: Attn: Seattle.CertRequest@marsh.com / F: 212-948-4326 INSURER(S) AFFORDING COVERAGE NAIC # 16535 21340 -NAES-GAWUE-17-18 Zurich American Insurance Company INSURER A : 40142 INSURED American Zurich Insurance Co. INSURER B : NAES Corporation N/A N/A Attn: Kim Lemaster INSURER C : 1180 NW Maple Street, Suite 200 Berkley Assurance Company INSURER D : Issaquah, WA 98027 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: SEA-003507112-02 REVISION NUMBER: 4 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW H INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION O CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAV ADDL SUBR INSR POLICY EFF POLICY EXP TYPE OF INSURANCE LIMITS POLICY NUMBER LTR (MM/DD/YYYY) (MM/DD/YYYY) INSD WVD A 05/20/2017 05/20/2018 X GLO5574116-04 1,000,000 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED X 1,000,000 CLAIMS-MADE OCCUR $ PREMISES (Ea occurrence) 10,000 X SIR $200,000 MED EXP (Any one person) $ 1,000,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- 2,000,000 X POLICY LOC PRODUCTS - COMP/OP AGG $ JECT $ OTHER: BAP9830191-07 05/20/2017 A 05/20/2018 COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY $ (Ea accident) X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ (Per accident) AUTOS ONLY AUTOS ONLY 5,000 COMP/COLL DED $ UMBRELLA LIAB EACH OCCURRENCE $ OCCUR EXCESS LIAB CLAIMS-MADE AGGREGATE $ $ DED RETENTION $ 05/20/2017 B WC5574117-04(AOS) PER OTH- 05/20/2018 X WORKERS COMPENSATION STATUTE ER AND EMPLOYERS' LIABILITY Y / N B 05/20/2017 05/20/2018 WC5574118-04 (WI) 1,000,000 E.L. EACH ACCIDENT $ N N / A 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 A OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under 1,000,000 E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below D Professional Liability Limit: 1,000,000 PCAB-5001981-0517 05/20/2017 05/20/2018 SIR: $200,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Ad The City of Riverside is included as additional insured (except workers compensation) where required by written contract and allowed by law. This insurance shall be primary and non-contributory and limited to liability arising out of the operations of the named insured when required by written contract. Waiver of subrogation is applicable where required by written contract and allowed by law. CERTIFICATE HOLDER CANCELLATION City of Riverside SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Risk Management THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3900 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Riverside, CA 92522 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Beverly A. Wold © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD