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H&HGENE-01 SASMITH <br />ACORO' CERTIFICATE OF LIABILITY INSURANCE <br />`•--�� <br />DATE(MM/DDIYYYY) <br />5/15/2020 <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(les) 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 License # OC36861 <br />Inland Empire-Alliant Insurance Services, Inc. <br />685 Carnegie Dr Ste 265 <br />San Bernardino, CA 92408 <br />CONTACT Christina M MOuntz <br />NAME: <br />HO No, Ext): (909) 886-9861 FA/c, Ne):(909) 886-2013 <br />ADMDRIESS: cmountz@alliant.com <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURER A: Associated Industries Insurance Company Inc 23140 <br />INSURED <br />INSURER B: General Casualty Company of Wisconsin 24414 <br />INSURER C: Benchmark Insurance Company 41394 <br />H&H General Contractors Inc <br />INSURER D: <br />PO Box 536 <br />Highland, CA 92346 <br />INSURER E <br />INSURER F: <br />3/15/2020 <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 />MM/DDIYYYY <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $ 1'000'000 <br />CLAIMS -MADE X OCCUR <br />X <br />AES1194160 00 <br />3/15/2020 <br />3/15/2021 <br />DAMAGE TO RENTED 1 OO,000 <br />PREMISES Ea occurrence $ <br />5,000 <br />MED EXP An one person)$ <br />X $2,500 BI/PD Ded/Occ <br />PERSONAL & ADV INJURY $ 1'000'000 <br />GEN'L AGGREGATE LIMIT APPLIES PER:APPROVED <br />GENERAL AGGREGATE $ 2'000'000 <br />POLICY JECT LOC <br />PRODUCTS - COMP/OPAGG $ 2,000,000 <br />PER PROJECT POL $ 5,000,000 <br />OTHER: <br />B <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT 1,000,000 <br />Ea accident $ <br />BODILY INJURY Per person)$ <br />X <br />ANY AUTO <br />X <br />BCA0004933-00 <br />3/15/2020 <br />3/15/2021 <br />OWNED SCHEDULED <br />1X <br />AUTOS ONLY AUTOS <br />BODILY INJURY Per accident $ <br />PROPERTY DAMAGE <br />Per accident $ <br />X <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />$ <br />$500 Comp Ded X $500 Comp Ded <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />EXCESSLIAB <br />CLAIMS -MADE <br />DED RETENTION$ <br />$ <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />YIN <br />E.L. <br />OFFICER/MEMBOERANY /EXCLUDED? ECUTIVE <br />(Mandatory in NH) <br />NIA <br />X <br />CST5018141 <br />1/1/2020 <br />1/1/2021 <br />X STATUTE EERH <br />EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE $ 1,000'000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Re: Agreements for Bid 7696 - Iowa Avenue Improvements from MLK Blvd to University Ave. <br />City of Riverside, it is agreed that the City of Riverside, Riverside Transit Agency and their officers, employees, agents and Riverside Transit Agency <br />employees are additional insureds as respects to general liability and auto liability per endorsements attached; waiver of subrogation as respects to workers' <br />compensation per attached endorsement. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Cit of Riverside THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Y ACCORDANCE WITH THE POLICY PROVISIONS. <br />Public Works Department <br />Attn: Edward Lara / Christopher Nieto <br />3900 Main Street 4th Floor AUTHORIZED <br />REPRESENTATIVE <br />� <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 />