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<br />, A CORD TM. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YY)
<br />MAR 21 1,17
<br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />CONSTRUCTION SPECIAL TIES INSURANCE SERVICES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />2451,1 VENTURE OAKS WAY, SUITE 220 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />SACRAMENTO CA 95833 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br /> COMPANIES AFFORDING COVERAGE
<br /> RECEIVED COMPANY
<br /> Agency Lic#: DB35752 CITY OF RIVERSIDE A Century-National Insurance Company
<br />INSURED MAR 2 6 2001 COMPANY
<br /> B Penn Star Insurance Company
<br /> J & S CONSTRUCTION COMPANY
<br /> DBA J D SLOAN, INC. RISK MANAGEMENl C U S F INSURANCE COMPANY
<br /> P.O. BOX 684 COMPANY
<br /> YUCAIPA CA 92399
<br /> D
<br />COVERAGES
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
<br /> PERIOD iNDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO
<br /> WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN is SUBJECT TO
<br /> ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
<br />LTR DA TF. (MM/DDIYY) DATE (MMIODIYY)
<br /> GENERAL LIABILITY RCPGL283024 rr'4~~Or07 0 ~ ': W....;MAR 21,1 1,18 GENERAL AGGREGATE $ 2 000 1,11,10
<br /> ~ COMMERCIAL GENERAL LIABILITY :,;',n:'." .,~ 00,0' $ 2 1,11,11,1 DaD
<br /> '~ CLAIMS MADE 0 OCCUR $ 1 1,11,11,1 001,1
<br />C OWNER'S & CONTRACTOR'S PROT. 20 IT EACH OCCURRENCE $ 1.1,11,11,1.1,101,1
<br />-
<br /> FIRE DAMAGE (Any One Fire) $ 11,11,1 ODD
<br /> -
<br /> I.. ." : ];,.:< I ['lnr:d MED, EXP (Any One Person) $ 5,1,11,11,1
<br /> ~OMOBILE LIABILITY BAP153192 APR 10 1,16 APR 10 1,17 COMBINED SINGLE LIMIT 1,1,11,11,1,1,11,11,1
<br /> $
<br /> - ANY AUTO
<br /> I-- ALL OWNED AUTOS BODILY INJURY
<br /> ~ (Per person) $
<br /> SCHEDULED AUTOS
<br />A
<br /> ~ HIRED AUTOS AP PI'CMiO far PFORW BODILY INJURY $
<br /> (Per accident)
<br /> ~ NON-OWNED AUTOS tJ/Iu .V~:Jj ~Olf~o/o7
<br /> - I.. PROPERTY DAMAGE $
<br /> ~RAGE LIABILITY (j AUTO ONLY - EA ACCIDENT $
<br /> ANY AUTO OTHER THAN AUTO ONLY:
<br /> -
<br /> EACH ACCIDENT $
<br /> I--
<br /> AGGREGATE $
<br /> ~ ESS LIABILITY EACH OCCURRENCE $
<br /> UMBRELLA FORM AGGREGATE $
<br /> I--
<br /> OTHER THAN UMBRELLA FORM $
<br /> WORKERS COMPENSATION AND I WC STATU- I 10TH
<br /> EMPLOYERS' LIABILITY EACH ACCIDENT $
<br /> THE PROPRIETORI R INCL DISEASE-POLICY LIMIT $
<br /> PARTNERS/EXECUTIVE $
<br /> OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE
<br /> OTHER: INLAND MARINE CPS5QQ8649 APR 4 1,16 APR 4 1,17 SCHEDULED EQUIPMENT
<br />B LIMIT: $35,1,11,11,1
<br /> ALL RISK - $51,10 DEDUCTIBLE
<br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
<br />*11,1 DAYS NOTICE FOR NON-PAYMENT, 31,1 DAYS FOR ALL OTHER
<br />CITY OF RIVERSIDE IS NAMED ADDITIONAL INSURED ONLY AS THEIR INTERESTS MAY APPEAR PER FORM CG 21,1 10 1,17 1,14.
<br />CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br /> EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL 30' DAYS WRITTEN
<br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
<br /> CITY OF RIVERSIDE
<br /> 391,11,1 MAIN STREET
<br /> RIVERSIDE, CA 92522 AUTHORIZED REPRESENTATIVE
<br />Attention: ?.?PT'(' 4P ~Vv--\
<br />ACORD 25-S (1/95) Certificate # 16816 Srett Webster OS35752
<br />
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