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K&LCONT-01
<br />LWEST
<br />ACORL7µ' CERTIFICATE OF LIABILITY INSURANCE
<br />`.�•-''
<br />DATE(MM/DD/YYYY)
<br />2/7/2019
<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 />PRODUCER
<br />CONTACT
<br />NAME:
<br />PHONEFAX -5083
<br />(A/C, No, Ext): (951) 281-5353 No):(951) 737
<br />Orion Business Insurance and Risk Management Services, Inc.
<br />1250 Corona Pointe Court, Suite 302
<br />Corona, CA 92879
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Associated Industries Insurance Co. Inc.
<br />23140
<br />INSURED
<br />INSURER B: West American Ins CO
<br />44393
<br />INSURERC: Kinsale Ins.CO.
<br />38920
<br />K & L Contracting, Inc.
<br />INSURER D: The Insurance Company of the State of Pennsylvania
<br />19429
<br />P.O. Box 310326
<br />Fontana, CA 92337
<br />INSURER E: Ohio Casualty
<br />24074
<br />INSURER F:
<br />MED EXP (Any oneperson)
<br />$ 1,000
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />AES1041561 02
<br />9/9/201$
<br />9/9/2019
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />100 000
<br />$
<br />X
<br />MED EXP (Any oneperson)
<br />$ 1,000
<br />Ded $5,000 Per Occ
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />POLICY � jECT LOC
<br />PRODUCTS-COMP/OPAGG
<br />$ 2,000,000
<br />POLICY AGG
<br />$ 5,000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />X
<br />ANY AUTO
<br />X
<br />BAW56152675
<br />6/21/2018
<br />6/21/2019
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />X
<br />Liab Deductible $0
<br />C
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />0100064315-1
<br />9/9/201$
<br />9/9/2019
<br />AGGREGATE
<br />$ 1'000'000
<br />DED X RETENTION $ 0
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE [Y]
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />X
<br />WC033571513
<br />8/27/2018
<br />8/27/2019
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE- EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />E
<br />Leased&Rented Equip
<br />:177
<br />152675
<br />6/21/2018
<br />6/21/2019
<br />Deductible $500
<br />160,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: 2109 Arroyo Drive Drainage Improvements
<br />Additional Insured Endorsement is granted as to General Liability policy, naming City of Riverside, its officers, employees and agents as additional insured,
<br />per attached endorsement #CG20100704 and #CG20370704. Additional Insured Endorsement is granted as to Automobile Liability policy, naming City of
<br />Riverside, its officers, employees and agents as additional insured, per attached endorsement #CA88100113. Waiver of Subrogation Endorsement as to
<br />Workers' Compensation policy is granted in favor of City of Riverside, per attached endorsement #WC040361 11/90.
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Ci of Riverside
<br />City
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />3900 Main Street
<br />Riverside, CA 92522
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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