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OCCUM-1 OP ID: AM
<br />.44c"MtxDATE
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />(MM/DD/YYYY)
<br />07/30/2019
<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 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
<br />Anthony Stornetta Ins Agency
<br />410 West Fallbrook Avenue #202
<br />CONTACT
<br />NAME: TONY STORNETTA
<br />PHONE FAX
<br />A/c No Ext): 559-492-1361 (A/C, No): 559-354-0190
<br />E-MAIL
<br />ss: TONY@STORINS.COM
<br />Fresno, CA 93711
<br />Tony Stornetta
<br />COMMERCIAL GENERAL LIABILITY
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Hanover Insurance Group
<br />31534
<br />$ 2,000,000
<br />INSURED OCCU-MED, LTD
<br />INSURER B: CNA Financial Corporation
<br />35289
<br />2121 W BULLARD AVE
<br />FRESNO, CA 93711
<br />INSURER C: PROGRESSIVE INSURANCE
<br />08/13/2019
<br />INSURER D :Beazley Insurance Company
<br />INSURER E :
<br />300 000
<br />$ ,
<br />INSURER F:
<br />PERSON & ADVERTIS
<br />COVERAGES CERTIFICATE NUMBER: 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/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE � OCCUR
<br />Y
<br />OHF9262847
<br />08/13/2019
<br />08/13/2020
<br />PREMISES (RENTED
<br />PREMISES Ea occurrence
<br />300 000
<br />$ ,
<br />X
<br />PERSON & ADVERTIS
<br />OHF9262847
<br />08/13/2019
<br />08/13/2020
<br />MED EXP (Anyone person)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$
<br />GEN'L
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY PELT � LOCAPPROVED
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 4,000,000
<br />EMPL BENE
<br />$ 1,000,000
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />C
<br />X ANY AUTO
<br />Y
<br />Y
<br />00326025-0
<br />01/17/2019
<br />01/17/2020
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />XX NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />$ 4,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />OHF9262847
<br />08/13/2019
<br />08/13/2020
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y-
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />Y
<br />D268679
<br />06/06/2019
<br />06/06/2020
<br />X PER OTH-
<br />STATUTE ER
<br />E. L. EACH ACCIDENT
<br />$ 1,000,000
<br />E. L. DISEASE- EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E. L. DISEASE- POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />EMPL PRACTICES LIA
<br />OHF9262847
<br />08/13/2019
<br />08/13/2020
<br />AGGREGATE 250,000
<br />B
<br />PROFESSIONAL LIAB
<br />425437058
<br />08/22/2019
<br />08/22/2020
<br />OCCIAGGR 5,000,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />D CYBER LIABILITY, POLICY# V2675C190101, 03/19/2019-20, $5 MIL AGGREGATE
<br />THE CITY OF RIVERSIDE IS ADDED AS ADDITIONAL INSURED AS RESPECTS TO
<br />OPERATIONS AND ACTIVITIES OF, OR ON BEHALF OF THE NAMED INSURED PERFORMED
<br />UNDER CONTRACT WITH THE CITY OF RIVERSIDE. WAIVER OF SUBROGATION APPLIES TO
<br />THE WORKER'S COMP AND AUTO POLICY. NOTICE OF CANCELLATION IS 30 DAY EXCEPT
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITYRIV
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CITY OF RIVERSIDE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />HUMAN RESOURCES DEPARTMENT
<br />JEANNA COMBS
<br />AUTHORIZED REPRESENTATIVE
<br />3900 MAIN STREET
<br />RIVERSIDE, CA 92522
<br />Tony Stornetta
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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