|
CERTIFICATE OF 1-1.4
<br />Z111!! -Z::1:- . .... . , ::: '' I i:
<br />0 i !IP: 5W�ORMATION ONL
<br />THIS CERTIFICA ' : !ii,ii Ni1I!55T:::I,i1 ii 11,111II'l
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND
<br />BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITU
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />re, ;p�r!
<br />lMP?5R
<br />1 certificate �INSURED, the p
<br />SUBROGATION I'S WAIVED, subject to the terms and conditions of the
<br />certificate does not confer rights to the certificate holder Inl Lieu of such
<br />PRooucER
<br />Aon Risk Services Northeast, inc,
<br />New York NY Office
<br />199 water Street
<br />New York NY 1.0038-3551 USA
<br />INSURED
<br />Konica Minolta BUSinesS solutions
<br />U.S.A_ Inc,
<br />Attn: Lynne Ransom
<br />500 Day Hill Road
<br />Windsor CT 06095 USA
<br />BDAT
<br />ILITY INSURANCE 07;2012018E(MM/DD/Yyyy)
<br />F—AN—D —CONFERS NO —RIGHTS UPON THE CERTIFICXT–E–HOLDER
<br />, THIS
<br />EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />rE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />Dlicy(ies) must have ADDITIONAL
<br />"- – be endorsed. if
<br />Policy, certain policies may require an endorsement. A statement on this
<br />ndorsement(s),
<br />U11 I II
<br />AME:
<br />H
<br />(A/C.NN
<br />a.Exl). (866) 283-7122 FAX (8011) 363-0105
<br />E-MAIL
<br />ADDRESS:
<br />I INSURER($) AFFORDING COVERAGE NAIL NSURER'$) AFFORDI ( OVERAGE NAIC
<br />INSURER A'.' 2 1 IT , u ra Company 111�26
<br />SOMPO America s
<br />R
<br />INSURER B:
<br />INSURER C
<br />INSURER D:
<br />INSURERS;
<br />N.
<br />�NSUWER E
<br />.-
<br />INSURER r:
<br />?r
<br />r
<br />::::: I:: �� :: rr .......
<br />L)LIWES OF INSURANCE LISTED
<br />BELOW
<br />:: !T: ISSUED TO THE INSURED ED NAMED ABOVE FOR THE P57CY —PERIOD
<br />INDICATED. 6TCZTED.NOTWIT STA D'iING ANY W
<br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT dTH RESPECT TO WHICH THIS
<br />- ' " T � n"NINIt I'
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS.
<br />I
<br />'R TYPE OF INSURANCE Limits shown: are as requestf
<br />4.NSD WVD POLICYI�VM—BER MMd POuCYSFF-7TM77t"7---,---
<br />X COMMERCIAL GENERAL LIABILITY CPL 210 MMIDDIYYYY LIMITS
<br />KO
<br />C I SMA -E OCCUR
<br />L 'LITY EACH OCCURRENCE $1, 000, 0C
<br />CLAIMS -MADE OCCUR
<br />X CONTRACTUAL LIABILITY ..PREMISELL��� $500,OC
<br />MED EXP (Any one person) $15,00
<br />E LIMIT APPLIES wR-7
<br />PR._
<br />P'T X Lc
<br />-7
<br />PERSONA(. & ADV ZURY
<br />GENTAGGREGATE LIMIT APPLIES PER: APPRO�EDI $1000, 00
<br />POLICY [:] PRO- rTJ LCC GENERALACGREGATE $T1 —0001 00
<br />OTHER: JECT D1 0IDUC1S----11.1AGG r �2,'000,'()o
<br />AUTOMOBILE LIABILITY
<br />Lqvdu
<br />OPTION OF OPERATIONS I LOCATIONS i VrN1ULt5 (ACORD 101, Additional Roma rks Schedule, may be attached I more (space is required)
<br />Of Riverside and Orange Terrace Cominonit Centeraro included as Additional Insured in accordance witty the policy
<br />sions of the General Liability and Umbrella LLiability Policies with respect to Konica Mirolta's work and/or Operations.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />City of Riverside POLICY PROVISIONS,
<br />Orange Terrace Community Center AUTHORIZED REPRESENTATIVE
<br />6927 magnolia Avenue
<br />Riverside CA 92506 USA
<br />,@11988-201115 ACORD CORPORATION. All rights reserved,
<br />ACORD 25 (2016/03) The ACORN name and logo are registered marks of ACORD
<br />ANY AUTO
<br />-'-Y
<br />—
<br />—
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIREDAUTOS NCN-OWNED
<br />ONLY AUTOS ONLY
<br />BODILY INJURY � Per person,
<br />INJURY
<br />0
<br />z
<br />dB
<br />0
<br />EODILY INJURY �Per amdont)
<br />PROPERTY DAMAGE
<br />Per acdcont
<br />EACH OCCURRENCE $16 00-0,000
<br />'000,000
<br />X
<br />UMBRELLALIAB X OCCUR
<br />EXCESS LIAR CLAIMS -MADE
<br />Y
<br />CPU405 9NO
<br />—10/01/ 017'..10101.2018
<br />t
<br />U
<br />AGGREGATE S10,000,000
<br />OE�L.DISEASE-POUCYUMIT
<br />DEC X RETENTION $10 000
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS'LIABILITY
<br />ANY PROPRIETOR f PARTNER f EXECUTIVE Yd N''.,
<br />OFFICERMETASER EXCLUDED?
<br />(Mandatory in, NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS lb�lo,
<br />WA
<br />PER OTH�
<br />STATUTE
<br />E.A. LACH ACCIDENT
<br />F, L. DLSEASE-EA EMPLOYEE
<br />OPTION OF OPERATIONS I LOCATIONS i VrN1ULt5 (ACORD 101, Additional Roma rks Schedule, may be attached I more (space is required)
<br />Of Riverside and Orange Terrace Cominonit Centeraro included as Additional Insured in accordance witty the policy
<br />sions of the General Liability and Umbrella LLiability Policies with respect to Konica Mirolta's work and/or Operations.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />City of Riverside POLICY PROVISIONS,
<br />Orange Terrace Community Center AUTHORIZED REPRESENTATIVE
<br />6927 magnolia Avenue
<br />Riverside CA 92506 USA
<br />,@11988-201115 ACORD CORPORATION. All rights reserved,
<br />ACORD 25 (2016/03) The ACORN name and logo are registered marks of ACORD
<br />
|