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ACCORD® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />7/24/2020
<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 />Arthur J. Gallagher & Co.
<br />Insurance Brokers of CA. Inc, LIC # 0726293
<br />Oceangate #850
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />A/C No Ext): A/C, No)7
<br />E -M100
<br />ADDRESS: Ruth_Solomon@ajg.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />Long Beach CA 90802
<br />INSURERA: Travelers Property Casualty Co of America
<br />25674
<br />$1,000,000
<br />INSURED
<br />N/S Corporation
<br />235 W. Florence Avenue
<br />INSURER B
<br />1,000,000
<br />INSURERC:
<br />MED EXP (Any one person)
<br />INSURERD:
<br />Inglewood CA 90301
<br />INSURER E:
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:APPROVKEDJ
<br />POLICY � PRO- 1:1 LOC
<br />OTHER:
<br />INSURER F:
<br />$ 2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />COVERAGES CERTIFICATE NUMBER: 245429952 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 />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />Y
<br />Y
<br />6306C539955TIL20
<br />7/1/2020
<br />7/1/2021
<br />EACH OCCURRENCE
<br />$1,000,000
<br />DAMAGE S(RENTED
<br />PREMISES Ea occurrence)
<br />ccurrence)$
<br />1,000,000
<br />GEN'L
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:APPROVKEDJ
<br />POLICY � PRO- 1:1 LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />A
<br />AUTOMOBILE
<br />X
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIREDX NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />Y
<br />Y
<br />8102NO57837-20-14-G
<br />7/1/2020
<br />7/1/2021
<br />COEaMBINEDaccidentSINGLELIMIT
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />A
<br />X
<br />UMBRELLALIAB
<br />EXCESS LAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />CUP6J9405542014
<br />7/1/2020
<br />7/1/2021
<br />EACH OCCURRENCE
<br />$9,000,000
<br />AGGREGATE
<br />$ 9,000,000
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.
<br />OFFICE R/M EMBER EXCLUDED? ❑
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />Y
<br />UB7K6261132014G
<br />7/1/2020
<br />7/1/2021
<br />X PER OTH-
<br />STATUTE ER
<br />EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />City of Riverside, its officers, employees and agents are included as additional insured as respects general liability and auto liability per policy form. Waiver of
<br />subrogation applies to the general liability, auto liability, and workers compensation.
<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 />8095 Lincoln Avenue
<br />AUTHORIZED REPRESENTATIVE
<br />Riverside CA 92504
<br />USA
<br />...... .�
<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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