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ACORO® CERTIFICATE OF LIABILITY INSURANCE �..---- DATE 02/12/2018 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 NAME: (A/CNE NE Ext): (888) 568-0548 FAX A/C,No): E-MAIL ADDRESS: fli ro infoC P 9 ram.com INSURER(S) AFFORDING COVERAGE NAIC X INSURER A: Great American Alliance Insurance Co. 26832 INSURED Ian Ross, DBA Blizzard Blast Shaved Ice & Goodies 79 Cold Spring Ave Beaumont CA 92223 PL1744427-F039876 INSURERS: j 01/22/2019 INSURER C: $ 1,000,000 DAMAGE TO RENTED PREMISES(Ea occurrence) INSURER D: APPROVED CLAIMS -MADE X OCCUR INSURER E: $ 5,000 J PERSONAL &ADV INJURY INSURER F : GENERAL AGGREGATE 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Fir-, PL1744427-F039876 01/22/2018 01/22/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 300,000 CLAIMS -MADE X OCCUR MED EXP (Anyone person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY jECTRO-LOC PRODUCTS - COMP/OP AGG $ 2,000,000 ANIMAL BAILEE $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS 77 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE I LL I EACH OCCURRENCE AGGREGATE $ $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE/MEMBER EXCLUDED? (Mandatory in NH) Ifyes, RN under DE_L DESCRIPTION OF OPERATIONS below N 1 A I WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ DISEASE - POLICY LIMIT $ ❑n DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if 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 St Riverside, CA 92522 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 ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD