20/20 VISION ASSOCIATES OPTOMETRY INC- CG 19-20

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202OVIS-02 WHANSEN `64� CERTIFICATE OF LIABILITY INSURANCE TE (MM/DD/YYYY) F�tI23/2019 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(ies) must have ADDITIONAL INSURED provisions or 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 License # 0110893 CONTACT Wade Hansen _NAME� PHONE FAX (A/C, No, Ext): (A/C, No): Vista International Ins. 1318 Redwood Way, Suite 250 Petaluma, CA 94954 E-MAIL ADDRESS7 whansen@vistainternational.com INSURER(S) AFFORDING COVERAGE NAIC # 7/1/2020 INSURERA: Citizens Ins. Co. of America 31534 INSURED INSURER B: Hanover American Ins. Co. 36064 20/20 Vision Associates Optometry, Inc. INSURERC: APPROVED PERSONAL & ADV INJURY 7379 Indiana Ave INSURER D 7 GENERAL AGGREGATE INSURER E 7 PRODUCTS - COMP/OP AGG Riverside, CA 92504 INSURER F: $ COVERAGES CFRTIFICATF NUMBER- REVISION NUMBER - THIS 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 LTR TYPE OF INSURANCE ADDLSUBR INSD WVD POLICYNUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [::] OCCUR X OBFD300574 7/1/2019 7/1/2020 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) 300,000 $ GEN'L MED EXP (Any one person) $ 5,000 APPROVED PERSONAL & ADV INJURY $ 2,000,000 AGGREGATE LIMIT APPLIES PER POLICY [::] PRO- JECT [::] LOC OTHER GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP/OP AGG 4,000,000 $ $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON-OWNE D AUTOS ONLY X AUTOS ONLY x OBFD300574 7/1/2019 7/1/2020 BINED SINGLE LIMIT C(E0a Ma , d e n t) 2,000,000 $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (P . t) er a iden $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EAtzuu I Vtz OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A X WZFD489647 2/1/2019 2/1/2020 ER �OTH- X � SPTATUTE I ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000, E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional insured - General Liability is included per form 391-194108 16 as required by written contract. Additional Insured - General Liability: City of Riverside CFRTIFICATF HOLnFR CANCELLATION ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Riverside THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management 3900 Main Street AUTHORIZED REPRESENTATIVE Riverside, CA 92522 ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD