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ACCORD® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />6/21/2019
<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: Arthur J. Gallagher & Company
<br />Arthur J. Gallagher & Co.
<br />PHONE FAX
<br />Insurance Brokers of CA, Inc. LIC #0726293
<br />A/C No Ext): 949-349-9800 A/c, No): 949-349-9962
<br />ADDRESS:
<br />18201 Von Karman Ave Suite 200
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />Irvine CA 92612
<br />INSURERA: Old Republic Insurance Company
<br />24147
<br />INSURED VORTIND-01
<br />INSURER B: Great American Insurance Company
<br />16691
<br />VORTEX INDUSTRIES, INC.
<br />DAMAGE TO
<br />PREMISES (E.ccurrence)$
<br />occurrence)
<br />VORTEX COLORADO, INC.
<br />INSURERC:
<br />INSURER D
<br />20 Odyssey
<br />Irvine CA 92618
<br />INSURER E:
<br />INSURER F:
<br />$ 5,000
<br />COVERAGES CERTIFICATE NUMBER: 1126424050 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
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />MWZY30779919
<br />7/1/2019
<br />7/1/2020
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE � OCCUR
<br />DAMAGE TO
<br />PREMISES (E.ccurrence)$
<br />occurrence)
<br />100,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />APPROVED
<br />� PRO -
<br />POLICY F-1 LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />Ultimate Gen Agg
<br />$ 10,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />MWTB30780019
<br />7/1/2019
<br />7/1/2020
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X
<br />HIREDX NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />B
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />T00033756506
<br />7/1/2019
<br />7/1/2020
<br />EACH OCCURRENCE
<br />$5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />Y
<br />MWC30779819
<br />7/1/2019
<br />7/1/2020
<br />X PER OTH-
<br />STATUTE ER
<br />ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.
<br />EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICE R/M EMBER EXCLUDED? FN]
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Certificate Holder is included as additional insured on the General Liability policy, per the attached forms CG20100413, CG20370413. Certificate Holder is
<br />included as additional insured applies on the Auto Liability policy, per the attached forms PCA0481013. Waiver of Subrogation applies to the certificate holder
<br />on the Workers Compensation, per the attached form WC0403060484.
<br />RE: Work performed by the Named Insured as required per written contract with respect to City of Riverside.
<br />Certificate Holder(s) Continued: The City of Riverside and its officers, employees and agents.
<br />CERTIFICATE HOLDER CANCELLATION
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Riverside
<br />3900 Main Street
<br />AUTHORIZED REPRESENTATIVE
<br />Riverside CA 92522
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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