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ACORD.. CERTIFICAT~~ APR 0 1 2005 TY INSURANCE OPID C NECAR-1 03 29 THIS CERTIFICATE IS ISSUED fJS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTlFICJfE HOLDER, THIS CERTIFICArE DOES NOT NJlEND, EXTEND OR ALTER THE COVERPGE AFFORDED BY THE POLICIES BELOW 05 PRODUCER California Insurance Center CA Lic. # 0423393 3697 Mt. Diablo Blvd., #300 Lafayette CA 94549 Phone: 925-299-1112 Fax:925-299-0328 ,~:13,'.\ INSURERS AFFORDING COVERPGE NAIC# N.E. Carlson Construction, Inc 150 Middlefield Ct., Suite #F Brentwood CA 94513 INSURER A: INSURER B: INSURER C: INSURER 0: INSURER E: Interstate Fire & Casualty Peerless Insurance Company INSURED State Compensa.tion Insurance 35076 COVERAGES 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ""'" ~~~~ POLICY NUMBER t'_l.!.LJSY EFFE~CJIXE P9LLCY(~XPIRAT~~N LIMITS LTR TYPE OF INSURANCE DATE (MM/DDIYY DATE MM/DDIYY GENERAL LIABILITY EACH OCCURRENCE $1,000,000 - -um)l;GFTORENTEU A X COMMERCIAL GENERAL LIABILITY GL11112071 10/31/04 10/31/05 PREMISES (Ea occurence) $50,000 ~ CLAIMS MADE [!J OCCUR MED EXP (Anyone person) $ exc 1 uded I-- PERSONAL & ADV INJURY $1,000,000 I-- GENERAL AGGREGATE $2,000,000 I-- GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $1,000,000 h !xl PRO- nLOC Emp Ben. 1,000,000 POLICY JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I-- $ 1000000 B X ANY AUTO CBP9640146 10/31/04 10/31/05 (Ea aCCident) I-- ALL OWNED AUTOS BODILY INJURY I-- (Per person) $ SCHEDULED AUTOS I-- HIRED AUTOS APPROV ~ f.i3 TO F< RM BODILY INJURY I-- (Per accident) $ NON-OWNED AUTOS I-- t~ . ~;::lU){Jl,jt1f 10..1 - PROPERTY DAMAGE $ \ (per accident) GARAGE LIABILITY 0 AUTO ONLY - EA ACCIDENT $ ~ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $4,000,000 A :!J OCCUR o CLAIMS MADE UM01606304 10/31/04 10/31/05 AGGREGATE $4,000,000 $ ~ DEDUCTIBLE $ X RETENTION $5,000 $ WORKERS COMPENSATION AND I_VVC STATU- I IOJ~' X TORY LIMITS C EMPLOYERS' LIABILITY 713806304 10/01/04 10/01/05 E.L. EACH ACCIDENT $ 1000000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1000000 If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1000000 SPECIAL PROVISIONS below OTHER B Rntd Equip CBP9640146 10/31/04 10/31/05 ACV 40000 Direct Phy Loss Ded 500 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Per: GLEI014 3/92 City of Riverside is named as additional insured as respects General Liabiltiy. RE: Rain for Rent/ 6400 Fischer Rd. CERTIFICATE HOLDER CANCELLATION APR 0 6 2005 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THERI;OF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR City of Riverside 3900 Main St ,~mance/Risk Mgmt Riverside CA 92522 , ACORD 25 (2001/08) @ ACORD CORPORATION 1988