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.. DATE. (MMIDDIYY'YY)
<br />CERTIFICATE F LIABILITY INSURANCE
<br />4/17/201.9
<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 be endorsed. if SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER CONTACT
<br />NAME:
<br />Commercial Associates Insurance PHONfE mak). (714) 524-4949 APC No,(714)524-4940
<br />1.594 N. Batavia, Street E-MAIL
<br />ADDRESS:
<br />Orange, CA 92867 - INSURER(S) AFFORDING COVERAGE NAIC ft
<br />INSURERA:Travelers Indemni,t'v Ccs of CT 425682
<br />INSURED INSURER B
<br />W.A. Rasic Construction Co., Inc. INSWRERc:
<br />4150 Long" Beach Blvd. INsuRER D
<br />Long Beach, CA 90807 INsuRERE:
<br />COVERAGES CERTIFICATE NUMRFR_- REVISION NI11h RFIR-
<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 />(NSR
<br />LTR
<br />I
<br />TYPE OF INSURANCE
<br />ADDL
<br />lN512
<br />S't1BR
<br />VVVD
<br />POLICY NUMBERM!MIDDMYYYYI
<br />POLICY EFF
<br />I POLICY EXP
<br />1 (MMIDONYYYI
<br />I LIMITS
<br />Xf
<br />lI COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 2,000,000
<br />A
<br />CLAIMS -MADE l OCCUR
<br />DAMAGE TO RENTC=Y�������..
<br />PREMISES (Ea occurrence) $ 310,000
<br />_ _ _... 10 000
<br />MED EXP (Any one person) $ r
<br />X.
<br />`I
<br />DT22-CO-8670X247-TCT-19
<br />5/1/'2019
<br />5/1/2020
<br />PERSONAL & ADV INJURY $ 2,000,000
<br />GEN"L
<br />GENERAL AGGREGATE $ 4 000, 000
<br />.............
<br />'
<br />AGGREGATE LIMIT APPLIES PER
<br />-
<br />POLICY X "'TLOC
<br />PRO[APPROVED]
<br />PRODUCTS COMPFOP AGO $ 4,000,000
<br />OTHER:
<br />$
<br />...000
<br />AUTOMOBILE LIABILITY
<br />COM1c1cNED SINGLE LIMIT
<br />Ea a adent $ 2, r L700
<br />BODILY INJURY (Per person) $
<br />_.
<br />BODILY INJURY (Per accident) $
<br />B
<br />ANY AUTO
<br />X ..,,,.
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />X
<br />y
<br />''..cT-810-8670X247-TIL-19
<br />5/1/2019
<br />5/1/2020
<br />PROPERTY DAMAGE .._..........
<br />Per $
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />:
<br />UMBRELLA UAB
<br />OCCUR
<br />'..
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />LIAR
<br />CLAIIMS-MADE
<br />L�EXCESS
<br />DED I I RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS" LIABILITY YIN
<br />ANY PROPRIETORIPARTNERFEXECU.—
<br />STATUTE pRiH
<br />- --
<br />E.. L. EACH ACCIDENT $
<br />I OFFICERIMEMBER EXCLUDED?
<br />NFA
<br />._._._._...� ....�... ...,
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYE $
<br />If yes, descrbe under
<br />..,..___. ...................
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DBSEASE - POHCY LIMIT 1 $
<br />B
<br />Installation Floater
<br />,2T--660-03178186--TIL--19
<br />5/1/2019
<br />5/1/2020
<br />POLICY OMIT $ 2,000,000
<br />,Excludes EQ & Flood
<br />STORAGEITRANSIT $ 2,000,000
<br />DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: Operations usual to the named insured. Master Agreement for Electrical Utility Construction Work. for
<br />Various City Locations on an As -Needed Basis - The City of Riverside, its City Council and all of its
<br />respective officials, officers, directors, employees, managers, commission members, representatives,
<br />agents and council members are added as additional insured including primary wording & waiver of
<br />subrogation where, required by written contract as respects general liability & auto per attached CGD246
<br />4/19, CGT100 2/1,9, CGD316 2/19, CAT353 2/15 & CAT474 2/16 and loss payee as respects installation
<br />floater, Notice of cancellation per attached ILT405 3/11.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Riverside THE EXPIRATION DATE THEREOF, NOTICE WILL BE (DELIVERED IN
<br />Riverside Public Utilities ACCORDANCE WITH THE POLICY PROVISIONS.
<br />c/o George Hanson
<br />3900 lain. Street AUTHORIZED REPRESENTA
<br />Riverside, CA 92522
<br />;��/�
<br />1 88-2014 Ab RCI CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are regis ered ar ,,clf ACORD
<br />I NS025 (201401) " _
<br />
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