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<br />DATE (MM/DD/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />1/2/2019
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />CONTACT
<br />PRODUCER
<br />Edgewood Partners Insurance Center (EPIC)
<br />Shanna Niemela
<br />NAME:
<br />FAX
<br />PHONE
<br />19000 MacArthur Blvd. PH Floor
<br />949-417-9126
<br />(A/C, No):
<br />(A/C, No, Ext):
<br />Irvine, CA 92612
<br />E-MAIL
<br />shanna.niemela@epicbrokers.com
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGENAIC #
<br />www.edgewoodins.com
<br />INSURER A :Travelers Property Casualty Co of Amer25674
<br />INSURED
<br />INSURER B :Tokio Marine Specialty Insurance Company23850
<br />MS Industrial Sheet Metal, Inc.
<br />INSURER C :
<br />dba Baghouse and Industrial
<br />INSURER D :
<br />Sheet Metal Services, Inc.
<br />1731 Pomona Rd
<br />INSURER E :
<br />Corona CA 92880
<br />INSURER F :
<br />COVERAGESCERTIFICATE NUMBER:REVISION NUMBER:
<br />46320369
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<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 />ADDLSUBR
<br />INSRPOLICY EFFPOLICY EXP
<br />TYPE OF INSURANCELIMITS
<br />POLICY NUMBER
<br />LTR(MM/DD/YYYY)(MM/DD/YYYY)
<br />INSDWVD
<br />COMMERCIAL GENERAL LIABILITY
<br />A630-9M061680-TIL-191/1/20191/1/2020
<br />EACH OCCURRENCE$
<br />33 1,000,000
<br />DAMAGE TO RENTED
<br />CLAIMS-MADEOCCUR$
<br />3 100,000
<br />PREMISES (Ea occurrence)
<br />MED EXP (Any one person)$
<br />3$5,000 Ded per Occ.5,000
<br />PERSONAL & ADV INJURY$
<br />1,000,000
<br />2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$
<br />PRO-
<br />3
<br />POLICYLOCPRODUCTS - COMP/OP AGG$
<br />10,000,000
<br />JECT
<br />$
<br />OTHER:
<br />COMBINED SINGLE LIMIT
<br />AUTOMOBILE LIABILITY$
<br />B810-9M024776-191/1/20191/1/2020
<br />1,000,000
<br />(Ea accident)
<br />3
<br />Comp Ded $1000
<br />ANY AUTO
<br />BODILY INJURY (Per person)$
<br />3
<br />Coll Ded $1000
<br />OWNEDSCHEDULED
<br />BODILY INJURY (Per accident)$
<br />AUTOS ONLYAUTOS
<br />Heavy Trucks:
<br />NON-OWNED
<br />HIREDPROPERTY DAMAGE
<br />$
<br />(Per accident)
<br />AUTOS ONLYAUTOS ONLY
<br />Comp Ded $2000
<br />$
<br />Coll Ded $2000
<br />UMBRELLA LIAB
<br />ACUP-9M259160-191/1/20191/1/2020
<br />EACH OCCURRENCE$
<br />33 OCCUR 5,000,000
<br />EXCESS LIAB
<br />CLAIMS-MADEAGGREGATE$
<br />5,000,000
<br />3 NA
<br />$
<br />DEDRETENTION$
<br />PEROTH-
<br />WORKERS COMPENSATION
<br />AUB-9M025042-191/1/20191/1/2020
<br />3
<br />STATUTEER
<br />AND EMPLOYERS' LIABILITY
<br />Y / N
<br />ANYP ROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT$
<br />1,000,000
<br />N / A
<br />OFFICER/MEMBER EXCLUDED?Y
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYEE$
<br />1,000,000
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT$
<br />DESCRIPTION OF OPERATIONS below 1,000,000
<br />ARented/Leased EquipmentQT6602K971988TIL181/1/20191/1/2020Limit: $250,000/Deductible $1,000
<br />BProfessional LiabilityPPK19246611/1/20191/1/2020$1,000,000 per incident/$5,000,000 agg
<br />BPollution LiabilityPPK19246611/1/20191/1/2020$5,000,000 per incident/$5,000,000 agg
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Certificate holder is additional insured as respects general liability per form CG D6 04 08 13 and as respects to auto
<br />liability form CA T3 53 08 17, but only if required by written contract with the named insured prior to an occurrence.
<br />Subject to policy terms, conditions and exclusions.
<br />CERTIFICATE HOLDERCANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Riverside
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />3900 Main Street
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Riverside CA 92522
<br />AUTHORIZED REPRESENTATIVE
<br />Vincent Perricone
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
<br />46320369 | 19-20 w/AI Auto XS WC | Shanna Niemela | 1/2/2019 8:27:02 AM (PST) | Page 1 of 8
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