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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 />7/1/2019
<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: Nancye Jordan
<br />Alliant Specialty Insurance Services, Inc.
<br />PHONE FAX
<br />PO Box 609015
<br />A/C No Ext): 303-824-1416 A/C, No): 559-437-3385
<br />E-MSan
<br />ADDRESS: Nancye.Jordan@alliant.com
<br />Diego CA 92160
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />$1,000,000
<br />INSURERA: Westchester Surplus Lines Insurance Co
<br />10172
<br />INSURED J&HDRIL-01
<br />INSURER B: Zurich American Insurance Company
<br />16535
<br />J & H Drilling Co., Inc.
<br />DAMAGE S(RENTED
<br />ccurrence)$
<br />PREMISES Ea occurrence)
<br />dba M R Drilling
<br />INSURER C: New York Marine And General Insurance Company
<br />16608
<br />INSURERD:
<br />7431 Walnut Ave
<br />Buena Park CA 90620
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 116304216 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 />C
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />PK201900018216
<br />7/1/2019
<br />7/1/2020
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGE S(RENTED
<br />ccurrence)$
<br />PREMISES Ea occurrence)
<br />100,000
<br />X
<br />MED EXP (Any one person)
<br />$ 5,000
<br />$2,500 PD Ded
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:APPROVED
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />X
<br />POLICYEl jE [:]LOC
<br />''.....
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />OTHER:11
<br />BF Property Damage
<br />$ 100,000
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />AU2019000137038
<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 />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />C
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />UM201900008281
<br />7/1/2019
<br />7/1/2020
<br />EACH OCCURRENCE
<br />$9,000,000
<br />AGGREGATE
<br />$ 9,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ 1 n nnn
<br />$ EX: GL, AL, EL
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />Y
<br />WC038638701
<br />1/1/2019
<br />1/1/2020
<br />X PEROTH-
<br />STATUTE ER
<br />ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.
<br />EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICE R/M EMBER EXCLUDED? FY]
<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 />A
<br />Contractors Pollution
<br />Y
<br />Y
<br />G27106389 007
<br />7/1/2019
<br />7/1/2020
<br />CPL Occurence
<br />$2,000,000
<br />Liability
<br />Aggregate
<br />$7,000,000
<br />Ded
<br />$5,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />GL and Auto Additional Insured Endorsements GL 0202 0218 and AU 0077 1113 attached.
<br />GL, Auto and WC Waiver of Subrogation Endorsements GL 0202 0218, AU 0077 1113 and WC 9904 10B attached.
<br />Pollution Liability Al and WOS Endorsements attached.
<br />Waiver of Subrogation Endorsement as to Worker's Compensation policy is granted in favor of City of Riverside, per attached endorsement #WC 00 03 13.
<br />Additional Insured Endorsements GL 0202 0218 & AU 0077 1113 attached.
<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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