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1--_111111 ® A� DATE(MM/DD/YYW) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Hawk's Bay Insurance Agency NAME: CONTACT Veronica Hussain ONE FAX No: 951-588-0761 A/C No Ell: 9515880757 5800 Van Buren Blvd Suite 108 ADDRESS: hawksbay2@yahoo.com INSURER(S) AFFORDING COVERAGE NAIC# Riverside, CA 92503 INSURERA: Fireman's Fund Insurance Company 21873 OLP1040574 INSURED INSURER B: INSURERC: Lizette Moreno INSURER D: 7911 Arlington Ave Apt 3 INSURER E Riverside , CA 92503 INSURER F: rnvoDnr_oe ftPRT19:ICATF M IMRPR• REVISION NUMB[ --K: vTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I LTR TYPE OF INSURANCE ADDL INSR SUBR D POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY ✓ COMMERCIAL GENERAL LIABILITY ✓ OLP1040574 08/31/2019 09/02/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ None CLAIMS -MADE FI(I OCCUR PERSONAL & ADV INJURY $ 1,000,000 ✓ Host Liquor Incl GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 $ POLICY PRO -CT E OT - LOC AUTOMOBILE LIABILITY (Ea accidentAPPROVED_ COMINEDSINGLE LIMIT $ ANY AUTO BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ' ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS — PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE WC STATU- O R T R I IT ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Date of Event: From 12:01AM on 08/31/2019 to 12:01AM 09/02/2019 Type of Event: Birthday Party Additional Insured: City Of Riverside Wording: the City of Riverside, its officers, employees and agents" as additionally insured THIS CERTIFICATE IS NOT VALID WITHOUT THE RVNA ADDITIONAL INSURED ENDORSEMENT FORM rCRTIGIre TF Nnl nil CANCFI I ATION City Of Riverside SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3900 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Riverside , CA 92522 AUTHORIZED REPRESENTATIVE /...,w Robert V. Nuccio� J L ©1988-2010 ACORD GORPURATIUN. All ngnts reserve0. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD