J K Miklin, Inc dba Yamada Enterprises (2019-2020)

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CERTIFICATE OF LIABILITY INSURANCE DATE (MM/5/4/22020020 Y) 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 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 NAME: Debra Barnes Conrey Ins Brokers & Risk Managers ACNE. Ext: (714)838-5835 A/C, NO: (719)838-8166 E-MAIL debrab@conreyins.com ADDRESS: 2522 N. Santiago Blvd. Lic#0543173 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Ohio Security Insurance Comp 24082 Orange CA 92867 INSURED INSURER B: American Fire And Casualty 24066 INSURER C: Technology Insurance Co 42376 J K Miklin, Inc. INSURER D: dba Yamada Enterprises APPROVED INSURER E: 16552 Burke Ln 11 1 INSURER F: Huntingtn Bch CA 92647 COVERAGES CERTIFICATE NUMBER:19-20 GL AU WC UM 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP MM/DDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑OCCUR DAMAGE TO RENTED 500,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 15,000 X Deductible/SIR = $0.00 X Y BKS55667154 8/21/2019 8/21/2020 (No Deductible/SIR) PERSONAL &ADV INJURY $ 1,000,000 AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 nGEN'L POLICY ❑XPRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 $ OTHER: Defense outside limits* AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident BODILY INJURY (Per person) $ A X ANYAUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS X Y BAS55667154 8/21/2019 8/21/2020 PROPERTY DAMAGE $ Per accident NON -OWNED HIREDAUTOS AUTOS Medical payments $ 5,000 X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 B EXCESS LAB CLAIMS -MADE DED X RETENTION $ 10,000 $ X Y USA55667154 8/21/2019 8/21/2020 WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? FYI (Mandatory in NH) N /A Y TWC3806676 8/21/2019 8/21/2020 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 A Builders Risk / Inland BKS55667154 8/21/2019 8/21/2020 Per Jobsite/Catastrophe Limit $250,000 Marine Installation Floater Deductible $1,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE Description of work performed for the City of Riverside, Reference to event or description of operations. AS RESPECTS GENERAL LIABILITY: CERTIFICATE HOLDERS ARE NAMED AS ADDITIONAL INSUREDS WHEN REQUIRED BY WRITTEN CONTRACT PER BLANKET FORMS CG2037(04/13) & CG2010(04/13). ADDITIONAL INSURED APPLIES ON A PRIMARY AND NON-CONTRIBUTORY BASIS PER GENERAL LIABILITY EXTENSION CG88100413 AS RESPECTS THE OPERATIONS OF THE NAMED INSURED AS COVERED UNDER THIS POLICY. TRANSFER OF RIGHTS TO RECOVERY AGAINST OTHERS (WAIVER OF SUBROGATION) APPLIES. WITH RESPECTS TO AUTO LIABILITY, BLANKET AUTO COVERAGE EXTENSION APPLIES, INCLUDING CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) INS025 (201401) © 1988-2014 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 Risk Management ACCORDANCE WITH THE POLICY PROVISIONS. 3900 Main Street AUTHORIZED REPRESENTATIVE Riverside, CA 92522 Debra Barnes/LKW_ p�vr pow ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD