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PROOF OF INSURANCE (2024 - 2024) CLOSED
T 0 A " CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 03/13/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS 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 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 endorsement(s). PRODUCER CONTACT JOHN WILLHITE NAME: WILLHITE INSURANCE AGENCY, INC 951-682-82 v�No): 951 602 .... WC p�. EX11;.. _. 97 _.... � � _ ..... 6117 BROCKTON AVENUE STE 206 � E-MAIL JohnW' ilihit insurance.com ADDRESS: _.................................. RIVERSIDE CA 92506 e wsuRE..................................................................................................................................................,.,,�..,_,_,_,.......__.. R S AFFORDING COVERAGE NAIC # LICENSE #OG67923 .... _.... ...... _........... — --- -- INSURERA: THE HARTFORD INSURANCE COMPANY 29424 INSURED INSURERS. SEQUOIA INSURANCE COMPANY 22985 .... ....... ........ ........._ ............... .... ..,..,.,.. ..... DENNIS GRUBB AND ASSOCIATES INSURER C: UNDERWRITERS AT LLOYDS 32727 ........ ......... .... .... ..... .... 6660 VAN BUREN BLVD. STE. B INSURERD RIVERSIDE, CA 92503 INSURERE: INSURER .F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. YNSR TYPE OF INSURANCE W W W... .. Abbf%'0I§R ......._,. ......__ POLICY EFF �I POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MM/DD A X I COMMERCIAL GENERAL LIABILITY Y Y 83SBANX2247 01/13/2023 01/13/2024 EACHOCCURRENCE 2,000,000 �OCCUUREEN "PRFN#ISES_(Fa $ ..... CLAIMS -MADE OCCUR occurrrnre)_,___...... .... . MED EXP {Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 .. ''.. GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 PRO- X 1 POLICY E I � LOC JECT „„„„„, � -PRODUCTS - COMP/OP AGG $ 2,000,00 0 O Tk9r W $ AUTOMOBILE LIABILITY AU COMBINED SINGLE. LIMIT` $ --- ANY AUTO BODILY INJURY (Per person) $ OWNED ��.� - SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED F NON -OWNED AUTOS ONLY AUTOS ONLY ,.-iaROPGRTY' DAMAC": E.... .. Ped arn.Iq�Pm1 -- .^._ — ......, $ ------ .... .._. UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS �IT CLAIMS MADE AGGREGATE $ C RETENTION $ B.WORKERS COMPENSATION Y QWC1274216 04/01/202304/01/2024 X $TATL,IT OR" AND EMPLOYERS' LIABILITY- Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT EXCLUDED? ❑ N / A .. $ „1,000,000 (Mandatory in NH) E L DISEASE - EA EMPLOYEE $ 1,000,000 If DESCdescribe under OF OPERATIONS below ''1RIPTION E L. DISEASE - POLICY LIMIT _ $ 1,000,000 C PROFESSIONAL LIABILITY PSL0239626064 03117/2023 03/17/2024 OCCURRENCE 1,000,000 AGGREGATE 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THE CITY OF COLTON, ITS DIRECTORS, OFFICIALS, OFFICERS, EMPLOYEES, AGENTS, AND VOLUNTEERS ARE NAMED AS ADDITIONALLY INSURED IN RESPECTS TO GENERAL LIABILITY AND PROFESSIONAL LIABILITY POLICIES PER ATTACHED ENDORSEMENTS. WORKERS COMPENSATION INSURANCE INCLUDES WAIVER OF SUBROGATION. THE INSURANCE IS DEEMED PRIMARY AND CERTIFICATE HOLDER SHALL BE NON-CONTRIBUTORY. laK I IFIGA I L HULUtK THE CITY OF COLTON 650 N. LA CADENA DR COLTON, CA 92324 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 JOHN WILLHITE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.. ACORD 25 (2009/01) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 4/1/2023 Policy No. QWC1274216 Endorsement No. 0 Insured DENNIS GRUBB AND ASSOCIATES LLC Premium $ 1,977 Insurance Company Sequoia Insurance Company Countersigned by WC 04 03 06 (Ed. 04-84)