Loading...
2019/04/02 Advance Refrigeration & Ice Systems, Inc. Certificate of Liability Insurance (3)ADVRE-3 ACORO' [q�TE fIDYYY) CERTIFICATE OF LIABILITY INSURANCE 04/02/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC*TRFf4&§El !"is O' CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE PIC ES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER 909-980-4211 CONTACT NAM.E� _ Silverstone Insurance Services PHONE 909-980.4211 - FAX Advantage Insurance Cit1 r,/!r ,licee 1 (AJC,No.E�d)r (Alc,No): P.O. Box 1200 E ^' saralt s vers�ane ns.com Rancho Cucamonga, CA 91729-1200 Robert W. Young INSURRAM AFFORDtNG COVERAGE NAICA It Falls Lake Fire & Casualty 115884 INSURED Advance Refrigeration & Ice - -- INSURER B: Systems, Inc. 1433 W Linden St Ste A INSURER c Riverside, CA 92507-6816 Received INSURER D : INSURER E : INSURER F PfI►►I;CiAC»FC r PPTIFIr:ATF kII IMRPQ I7F%IlginkI All IMRPp THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER pO EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ . MED EXP (Any one person) - $ PERSONAL & ADV INJURY GENT AGGREGM APPLIES PER: GENERAL AGGREGATE _ATELI�IT� POLICY JECT LOC PRODUCTS - COMPIOPAG OTHER AUTOMOBILE LIABILITY COMBINEOSWGLEiiWT {ER.siLCIdEDI)_ $ ANY AUTO B DILYJNJURY Per OWNED SCHEDULED AUTEO�S ONLY AUTOS B�OtDILY INJUpRpY (Per accident) p AUTOS ONLY AUTOS ONY MAGIEE (�rO�d�] — UMBRELLA LIAR OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS -MADE DED RETENTION $ A WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN Y IFLA01124800 04/02/2019 04/02/2020 E_I._EACHAGCIAENT 1,000,000 RFICER/MEMBEREXCLUDED? NIA andatory in NH) E L DISEASE - EA EMPLOYEE 11000,000 If yes, describe under DE CRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 j 1 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) RE: Contract #5285. WCWOS per #WC040306 484, attached. :10 Day notice of cancellation in the event of non-payment of premium. 30 Day written notice for policy cancellation. IElfla:41l2LNG111a CITMENI City of Menifee and its officers, employees,agents and authorized volunteers 29714 Haun Road SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE aye ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 .��.� ..�.......... ..-.. n,r.r..a.r,.....,�.�� PCt 4-94) WAIVER Cr OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We have the right to recover our paym nCs Croat anyone liable for an injury covered by this policy. Vve will not entorce Otar right ragainst the person car ornan17F1tion nampil irl the 8checb_Ila, `Thi_, ini-pprriant ;Rnniiwc nnly to the extent that YOU perform work under a "vritten contract that requires you to obtain 'his agreement from (is.) You must maintain payroll records aoc_iraately segregating the remuneration of your employees while engaged in the vvortc described in 11-1e 3CTIedule. The additional premium for this endorsement shall be 2_-,% of tee California ,workers' compensation premium othennrive due on such remunei-ation. Sched ttie Person or organization *Job Description Blanket Waiver of Subrogation As respects to all CA jobs performed by the named insured during the policy period where by written contract a %;waiver Of subrogatiori is rec aired prior to the c.ornmpnr.Qmt�nt a` work. This endorsement changes the policy to which it is attached and is effective on the date i55U d unless atke NIse stated (The inrormatlon below is required only when this ondorsement is issued subsequent to preparation of the policy.) -ndorsement Fffeefive 04/02/19 Pn,imy Nn FLA01124800 Endorsement Flo 001 insured Insurance Company Advance Refrigeration & Ice Systems, Inc. Falls Lake Fire 4. Casualty Company Countersigned Ry U1998 by the Workers' Cornpensatior) Insurance Rating 0ureau of California. All rights reservad.