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LIP CERTIFICATE OF LIABILITY INSURANCE DATE(MNUDDIYYYY) x/21/2019 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(les) 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 Commercial Associates Insurance 1594 N. Batavia Street Orange, CA 92867 CONTACT PHONE (714) 524-4949 FAX (714)524-4940 -MAIL EA DRESS. INSUIRER(51 AFFORDING COVERAGE NAICB INSURER A.Travelers Prop Cas Co of Amer 25674 INSURED W.A. Rasic Construction Co., Inc. 4150 Long Beach Blvd. Long Beach, CA 90807 INSURER 8: INSURERC: APPROVED INSURER D : EACH OCCURRENCE $ INSURER E MED EXP (An one erso• 1 $ INSURER F. GENERAL AGGREGATE $ rnveoer_oc CGRTICer`ATF NI IMRPR• 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 PAD CLAIMS INSR TR TYPE OF INSURANCE ADDL SUOR POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LABILITY CLAIMS -MADE E] OCCUR City Hall AUTHORIZED REPRESENTATIVE 3900 Main Street Riverside, CA 92522 EACH OCCURRENCE $ DAMAGE TO RENTIED $ MED EXP (An one erso• 1 $ PERSONAL & ADV iN:URY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER rl POLICY PRO LOC PRODUCTS - COMP.'OP AGG $ $ AUTOMOBILE LIABILITY ANY AJ TO ALL OWNED SCHEDULLD AUTOS AUTOS NOWOWNED HIREDAUTOS AUTOS COMBINED SINGLE LIM T (Ea accident) S BODILY INJURY .Per pers:xa $ BODILY INJURY (Per acbdent) $ PROPERTY DAMAGE $ UMBRELLA UAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTiVEE.L. OFFICERIMEM13EREXCLUDED7 (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below NIA y -715520795-18-26-G /1/2018 /1/2019 X wC STATU• OTH. EACH ACCIDENT $ 1 000 000 E.L. DISEASE - EA EMPLOYE $ _1,000,000 E.L. DISEASE - PnLICY LIMIT 1 $ 1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule H more space is required) Re: Operations usual to the named insured - Master Service Agreement for City of Riverside for Electrical Utility Work for Various City Locations on an As -needed basis. Blanket waiver of subrogation applies where required by written contract per attached WC 99 03 76 (A)-001. 30 days notice of cancellation except LO days for non-payment. CERTIFICATE HOLDER CANCELLATION ACORD 25 {2010105} 1 ®1 8-2010 ACND CORPORATION. All rights reserved. INS02S (201W5 The ACORD name and logo are ragas ed of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Riverside Risk Manager City Hall AUTHORIZED REPRESENTATIVE 3900 Main Street Riverside, CA 92522 ACORD 25 {2010105} 1 ®1 8-2010 ACND CORPORATION. All rights reserved. INS02S (201W5 The ACORD name and logo are ragas ed of ACORD