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G HURTADO CONSTRUCTION 19-20, WC 20-21
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2/25/2021 8:03:39 PM
Creation date
6/18/2020 3:14:43 PM
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City Clerk
General - Type
Agendas
General 2 - Date
6/18/2020
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G H U RTAD-01 <br />SHAEM1 <br />ACORO"° CERTIFICATE OF LIABILITY INSURANCE <br />`� <br />DATE(MMIDDIYYYY) <br />6/18/2020 <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 Emal Sharaf <br />NAME: <br />PHONE FAX <br />(A/C, No, Ext): (949) 583-0300 (A/C, No): <br />Solomon & Solomon Insurance Brokers <br />24411 Ridge Route Dr Ste 135 <br />Laguna Hills, CA 92653 <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURER A: Continental Insurance Co <br />35289 <br />EACH OCCURRENCE $ 1,000,000 <br />INSURED <br />INSURER B: Continental Casualty Company <br />20443 <br />INSURER C: Insurance Co. of The West <br />27847 <br />G. Hurtado Construction Inc. <br />INSURER D <br />DAMAGE TO RENTED 700�QQQ <br />PREMISES Ea occurrence $ <br />16130 Reiner Cr. <br />Riverside, CA 92504 <br />INSURER E <br />INSURER F: <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 />MMIDDIYYYY <br />POLICY EXP <br />MMIDDIYYYY <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,000 <br />CLAIMS -MADE X OCCUR6015875040 <br />X <br />9/6/2019 <br />9/6/2020 <br />DAMAGE TO RENTED 700�QQQ <br />PREMISES Ea occurrence $ <br />MED EXP (Any oneperson) $ 15,000 <br />APPROVEJD <br />PERSONAL &ADV INJURY $ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE $ 2,000,000 <br />POLICY JECT F—]LOCPRODUCTS <br />- COMP/OP AGG $ 2,000,000 <br />$ <br />OTHER: <br />B <br />AUTOMOBILE <br />LIABILITY <br />CMBINED SINGLE LIMIT 1,000,000 <br />EaOaccident $ <br />BODILY INJURY Perperson) $ <br />X <br />ANY AUTO <br />X <br />6083410530 <br />6/14/2019 <br />9/6/2020 <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY Per accident $ <br />PROPERTY DAMAGE <br />Per accident) <br />ccident $ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />A <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE $ 2,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />6057025395 <br />9/6/2019 <br />9/6/2020 <br />AGGREGATE $ 2,000,000 <br />DED I RETENTION $ <br />$ <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVEY <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />NIA <br />WSA504866701 <br />6/1/2020 <br />6/1/2021 <br />X PER OTH- <br />STATUTE ER <br />1,000,000 <br />E. L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />1,00 0 000 <br />E.L. DISEASE - POLICY LIMIT $ <br />A <br />Equipment Floater <br />6020259822 <br />7/29/2019 <br />7/29/2020 <br />Limit 600,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />RE: Campbell Ave. sewer replacement and city-wide manhole rehabilitation and replacement <br />Project Location: Riverside, CA <br />City of Riverside is hereby named as additional insured with Primary Non-contributory per blanket additional insured forms CNA75079XX (10-16) & <br />CNA74879XX(1-15). Auto additional insured per CNA63359 (04-2012). <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Cit of Riverside <br />Y <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Public Works Dept <br />3900 Main St <br />AUTHORIZED REPRESENTATIVE <br />Riverside, CA 92522 <br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />
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