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1 0
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />AC"R" CERTIFICATE OF LIABILITY INSURANCE
<br />F----T-(--,DDNYYY)
<br />INSIR
<br />LTR
<br />12/16/2019
<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 Sue Lusic
<br />NAME:
<br />Cornerstone Specialty Insurance Services, Inc.
<br />p H CN E., (714) 731-7700 (714) 731-7750
<br />I
<br />EACH OCCURRENCE $ 2,000,000
<br />(FAX
<br />N Ext): C, No):
<br />14252 Culver Drive, A299
<br />E-MAIL sue@cornerstonespecialty.com
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURERA: Travelers Property Casualty Co 25674
<br />Irvine CA 92604
<br />INSURED
<br />INSURER B: Travelers Indemnity Co of Conn 25682
<br />C BELOW, INC.
<br />INSURER C: Continental Casualty Company 20443
<br />14280 Euclid Avenue
<br />INSURER D:
<br />INSURER E:
<br />PERSONAL &ADV INJURY $ 2,000,000
<br />Chino CA 91710
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER. 19/20 COVERAGES REVISION NUMBER:
<br />THIS ISTO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOWHAVE BEEN ISSUEDTOTHE INSURED NAMEDABOVE FORTHE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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 />INSIR
<br />LTR
<br />TYPE OF INSURANCE
<br />AUULbUbK
<br />INSD
<br />WVD POLICYNUMBER
<br />POLICY EFF
<br />(MMIDDfYYYY)
<br />POLICY EXP
<br />(MMIDDNYYY)
<br />LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 2,000,000
<br />—1 OCCUR
<br />_7 CLAIMS -MADE FX
<br />DA AG To TE
<br />PREMISEES (EREoN.urDren.) $ "000'000
<br />M ED EXP (Any one person) $ 10,000
<br />X ADDTL I NSRD/P & NC
<br />X BLNKTWVROFSUBRO
<br />PERSONAL &ADV INJURY $ 2,000,000
<br />A
<br />Y
<br />Y 680-5H559891
<br />12/18/2019
<br />12/18/2020
<br />LAGGREGATE LIMITAPPLIES PER
<br />GENERAL AGGREGATE $ 41000,000
<br />PRO-
<br />POLICYFX LOC
<br />MOTHER
<br />PRODUCTS - COM P/OP AGG $ 4,000,000
<br />$
<br />AUTOMOBILE
<br />—APPROVED
<br />LIABILITY
<br />COMBINED SINGLE LIMIT $ 1,000,000
<br />(Ea accident)
<br />BODILY INJURY (Per person) $
<br />X
<br />ANYAUTO
<br />B
<br />OWN ED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Y
<br />Y
<br />BA -7D687122
<br />12/18/2019
<br />12/18/2020
<br />BODILY INJURY (Per ccident) $
<br />PROPERTY DAMAGE
<br />(per accident) $
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />X
<br />_��l
<br />UMBRELLA LIAB
<br />X
<br />ITAIMS-MADE-
<br />OCCUR
<br />01
<br />EACH OCCURRENCE $ 10,000,000
<br />AGGREGATE $
<br />A
<br />EXCESS LAB
<br />Y
<br />Y
<br />CUP -4181T634
<br />12/18/2019
<br />12/18/2020
<br />X1
<br />DED I I RETENTION $ 0
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABI LI TY Y/N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y
<br />OFFICER/MEMBER EXCLUDED
<br />(Mandatory in NH)
<br />N/A
<br />Y
<br />XJUB-8J675252
<br />12/18/2019
<br />12/18/2020
<br />X1 SPTER I OTH-
<br />A UTE ER
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />Ifyes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />Each Claim $2,000,000
<br />C
<br />Professional Liability
<br />Claims Made
<br />MCH288306745
<br />12/18/2019
<br />12/18/2020
<br />Annual Aggregate $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 and its officers, employees and agents, are Additional I nsured for General & Auto Liability including Primary and Non -Contributory
<br />Wording and Waiver of Subrogation applies per attached
<br />endorsements, but only if required by written contract with the Named I nsured prior to an occurrence. Coverage is subject to all policy terms and conditions.
<br />*30 days notice of cancellation, except for 10 days notice for non-payment of premium. For Professional Liability, the aggregate limit is the total insurance for
<br />all covered claims reported within the policy period.
<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 />City of Riverside
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />3900 Main Street
<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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