2022/04/02 Advance Refrigeration & Ice Systems, Inc.--lA,CORD CERTIFICATE OF LIABILITY INSURANCE 03t24t2022
THIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGIiTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PROOUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lf the certificate holde. is an ADDITIONAL INSURED, the policy(ies) must have AOOITIONAL INSUREO provisions or be endoBed.
lf SUBROGATION lS WAIVEO, subject to the terms and conditions of the policy, certain policigs may .equire an endorsement. A statement on
this ce.tificate does not confer rights to the certificate holder in lieu ot such endorsement(s)
coNtActl,latlE-
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EmEss sarah@silverstoneins.com
INSURER{5) AFFORDING COVERAGE
909-980-4211
27847nsuaea a , lnsurance Company of the West
INSURER B:
r!9!E (q i
'ISCEEE S !
INSURER E:
INSURER F :
INSUREDAdvance Refrioeration & lceSvstems. lnc. _
1i133 W Linden St Ste ARiverside, CA 92507-6816
PRODUCERSilverstone lnsurance Services
Advantage lnsurance
PO Box 1200
Rancho Cucamonga, CA 91729
Robert W. Young
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOO
INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH 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 CONOITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
'itff rypr oF rNsuRANcE i,o"o.t tJ""f poucy NUrrsER ,figi-JBlrtttrtt, #9)-J"")ri\,"",ufrs
EACH OCCURRENCE s
s
s
COMMERCIAL GENERAL LIABILITY
crArirs.MADF occllR DAMAGE TO RENTEOPREMSES (Ea occ!fiencel
MED EXP (Any one person)
PERSONAL & AOV lNJURY
GEIiEBAL&GGEEGAIE Lq
pRoolrcTs - coMP/oP aGG I
.i
GEN'L AGGREGAIE LIMIT APPLIES PER
I "o.,"" I I!88; f l.o"
OTHER
OWNEDAT]'TOS ONLY
HIREOAI-ITOS ONLY
COMBINED SINGLE LIMIT(E edent) , $
BOOIIY INJURY (Pdo€en) I
BOorl-Y TNJURY (Pe. accde.l) 3
NON-OWNED
AUTOMOBILE IIAAIfITY
SCHEDULEOAUTOS
$
$
UMARELLA LIAB
EXCESS L|AA
RFTENT ON $
$
h
EACH OCCURRENCEOCCUR
CLAIMS,MADE AGGREGATE
WORXERS COfPENSAIIONANO EMPLOYERS' LIABILITY
ANY PROPR ETOR/PARTNEREXECUTIVE
OFFICER/MEMSER O(CLIJOED'
DFscRlPTloN nF OnFA TIONS below
E-t EAC.!. 8eel,D_E!r
E L OISEASE . EA EMPTOYEE
€_L .Or85AEt , POLtCY LtMtr
1,000,000
1,000,000
1.000.000
o4t02t2022 0410a2023fl n,o
A
X WSA505482602
v PER OTH-
^ STATTITE i ER
DESCRIPTON OF OFERA1ONS / IOCAT|ONS / VEHTCLES (ACORO 1Ol , Addlrlo..r F.n.rt. S.h.dur., m.y b. .tt .h!d ll moo tp.cr l. dqulrod)
RE: Contract #5285. WCWOS per rllrc990634 800 attached.
''10 Day notice of cancellation in the event of non-payment of premium.*30 Da, written notice for policy cancellation.
CITMENI
City of Menifee and
its offi cers, employees,agents
and authorized volunteers
29714 Haun Road
Menifee. CA 92586
SHOULD ANY OF THE ASOVE DESCRIBEO POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. iIOTICE WILL BE DELIVERED IN
ACCORDANCE wlTH THE POLICY PROVISIONS.
AI]THORIZEO REPRES€NTATIVE
U,*a Lln-
O 1988-2015 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORD
ACORD 25 {2016/03)
ADVRE-3
WORKERS COMPENSATION ANO EMPLOYERS LIAEILITY INSURANCE POLICY
WAIVER OF OUR BIGHT TO RECOVEH FROM OTHERS ENOOFSEMENT . ELANKET
The addilional prenium for this endorsenEnt shall be 2 % ol the total California Worksrs' Compensation premium
otherwise due.
Schedule
wcs0m34
(Ed.84o)
We have the righl to rscover our paym€nts trom anyone liaue lor an injury covered by lhis policy. \Ab.will nol enforce
our right agajnst ths person or oigailzation named in th6 Schedule. (This agreernent appfues only to the extent that
you perform work under a written contract that requirss you to obtajn this agreernont lrom us).
Person or Organization
ANY
PERSON/ORGANIZAT ION
WHEN REOUIRED BY
WRIEIEN CONTRACT
lnsured Advance Refrigeration & lce Syslems,lnc.
ln8urance Company INSITRIANCE COMPAIIY OF THE wEsT
Countersigned BY
wc 90 06 34
(Ed. e{0)
Job Description
AI.L CAIIE'ORNIA
OPERATIONS
This Gndorsornsnl changes the policy to which it is attached and is effective on the date issued unless otherwise staled.
(The lnrofila0on belo 18 requh€d only when thb ondorssnEnl ls lssuod subsequent to prsparation of the po[cy.)
Endorsornenl Elteclive O4tO2t2O22 Policy No. WSASOO4B2602 EndorsenEnt No.
Premium S INCL .