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O �®
<br />ACC�
<br />�V/CERTIFICATE OF LIABILITY INSURANCE
<br />DATE /YYYY)
<br />07/25/2019/2019
<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 />Marsh USA Inc.
<br />500 Dallas Street, Suite 1500
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />A/c No Ext): A/C, No):
<br />E-MAIL
<br />ADDRESS:
<br />Houston, TX 77002
<br />Attn: Houston.Certs@marsh.com
<br />COMMERCIAL GENERAL LIABILITY
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: National Union Fire Ins Cc Pittsburgh PA
<br />19445
<br />01 4166-AIRGA-GAWU- 19-20
<br />INSURED
<br />American Air Liquide Inc.
<br />INSURER B: N/A
<br />N/A
<br />INSURER C : Illinois National Insurance Company
<br />23817
<br />Airgas Specialty Products, Inc.
<br />2530 Sever Rd, Suite #300
<br />Lawrenceville, GA 30043 APPROVED
<br />INSURER D: American Home Assurance Company
<br />19380
<br />INSURER E: New Hampshire Insurance Company
<br />23841
<br />INSURER F:
<br />$ 1,000
<br />COVERAGES CERTIFICATE NUMBER: HOU-003008205-17 REVISION NUMBER: 11
<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 />GL 7032369
<br />07/01/2019
<br />07/01/2020
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE 1XI OCCUR
<br />DAMAGE TO RENTE
<br />PREMISES Ea occur ence
<br />$ 2,000,000
<br />MED EXP (Any one person)
<br />$ 1,000
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER :
<br />GENERAL AGGREGATE
<br />$ 6,000,000
<br />X
<br />POLICY❑ JECT PRO ❑ LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 6,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />CA 7269735 (AOS)
<br />07/01/2019
<br />07/01/2020
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 5,000,000
<br />A
<br />X
<br />ANY AUTO
<br />CA 7269736 (VA)
<br />07/01/2019
<br />07/01/2020
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />OWNED SCHEDULED
<br />AUTOSONLY AUTOS
<br />CA 7269787 (MA)
<br />07/01/2019
<br />07/01/2020
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOSONLY AUTOSONLY
<br />UMBRELLALIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />C
<br />E
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N/A
<br />WC 031132411 (FL)
<br />WC 031132408 (MA,ND,OH,WA,W, WY)
<br />WC 031132410 CA
<br />( )
<br />07/01/2019
<br />07/01/2019
<br />07/01/2019
<br />07/01/2020
<br />07/01/2020
<br />07/01/2020
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 2,000,000
<br />E.L. DISEASE- EA EMPLOYEE
<br />$ 2,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />Please see Acord 101
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The City of Riverside, its officers, employees, and agents are included as additional insured (except Workers Compensation) but only to the limits and extent specified in and required by the referenced written
<br />contract. Waiver of subrogation is applicable where required by written contract and subject to policy terms and conditions. Commercial General Liability includes Sudden & Accidental Pollution subject to policy
<br />terms, conditions and exclusions.
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITY OF RIVERSIDE
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />RISK MANAGEMENT
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ATTN: JAIRO CORTEZ
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />3900 MAIN STREET
<br />RIVERSIDE, CA 92522
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Freeman M. Wade i��GtG+ra A4. AAs- -
<br />@ 1988-2016 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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