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2018/06/15 COPP Contracting, Inc. Certficiate of Liability Insurance
Ac" CERTIFICATE OF LIABILITY INSURANCE EDATE(MMIDDIYYYY' 212112019 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). CONTACT PRODUCFR Compass Direct Insurance Services, Inc- NAME: ,Jeremy Seltzer 13681 Newport Ave., Ste 8#622 PHONE FAX Tustin, CA 92780 _AICc 14%Ex* 714-665-9800 _ ,JArc,No): 714-665-9801 EMAIL ADDRESS: jeremy@c�disl.com INSURER(Sl AFFORDING_COVERAGE NAIC# www.cdisi.com License#01116100 _- INsuRean: Great American Assurance Company 26344 INSURED INSURER B: Everest National Insurance Com Jpany 10120 Copp Contracting, Inc. INSURER C: Wesco Insurance Com an 25011 6751 Stanton Ave INSURER - ..- �-.Y . Buena Park CA 90621 INsuRER 0: Travelers Casualty Company_ 41769 INSURER E AGCS Marine Insurance_Company 22837 INSURER F: COVERAGES CERTIFICATE NUMBER: 47161092 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. INSR TYPE OF INSURANCE ADDL SUER! POLICY EFF POLICY EXP LIMITS LjR POLICY NUMBER - MM DDIYYYY MM DDIYYYY A ✓ COMMERCIAL GENERALLIABILtTY / ✓ GLP2869852 1111f2018 11/1/2019 EACH OCCURRENCE__ $1,000,000 -— DAMAGE'rO RENTED CLAIMS-MADE _./ OCCUR PREMISES tEa-o_ccurranreJ $50,000 ✓ Owner's/Cant.Pro MED ExP(Any one person) s Exciuded ✓ $5,000 Ded._$Z500_Bi.Ded PERSONAL a AOV INJURY S 1,000,000 GEN'L AGGREGATE LIMET APPLIES PER. GENERAL AGGREGATE 1 s 2,000,000 POLICY: ✓ JECT .-,__. LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER. Employee Benifits S 1 000 000 C AUTOMOBILE LIABILITY WPP1588321 01 111112018 111112019 COMBINED SINGLE LIMIT $ ✓ ✓ IEacident ac __ 1,OOD,000 ✓ ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED - BODILY INJURY(Per accident).S AUTOS ONLY .- AUTOS HIRED NON-OWNED - ... . I PROPERTVpAMAGE $ ✓ AUTOS ONLY -✓-, AUTOS ONLY Per acciden[L . ✓ Comp/Coll De' $11000 Is p uMaRELLAuge ✓ 1 OCCUR ✓ ✓ ZUP-81M8816A-18-NF 111112018 11/1/2019 EACHOCCURRFNCE $4,000,000 ✓ EXCESSLIAB _ - — - i CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ B WORKERS COMPENSATION ✓ 7600015069181 6/15/2018 6/15/2019 ✓ srATUTE OfH. AND EMPLOYERS'LIABILITY Y 1 NER ANYPROPRIETORlPARTNERIEXECUTIVE i E.L.EACH ACCICENT $1,000,000 _ I OFFICEWMEMBEREXCLUDED? FN] NIA s-- ---- -- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE'' S QQD 000 If yaS,describe under ....__._._..—._._..__ .. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIM97 S 1,000000 E 'BPP/Building SML93079179 111112C1R 11/1/2019 $65,0001$153,900 E Equipment Leased Renter}or Borrowed SML93079179 11/1/2018 11/1/2019 $100,000 Deductible$1.000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space is required) Re:City of Menifee Miralago and Lake Pointe Communities Street Resurfacing PMP 19-01 City of Menifee and its elected officials,officers,employees,agents,representatives,consultants,contract employees and volunteers are hereby added as additional insures but only as respects work done by,for,or on behalf of the named insures CERTIFICATE HOLDER CANCELLATION City of Menifee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cityy Hall ACCORDANCE WITH THE POLICY PROVISIONS. 29714 Haun Rd Menifee CA 92586 AUTHORIZED REPRESENTATIVE Jeremy Seltzer 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Great American Assurance Company CG 20 33 GLP2869852 iEd. 07 C4i Copp Contracting, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II - WHO IS AN INSURED is This insurance does not apply to: amended to include as an Additional Insured any person or organization for whom you are 1. "Bodily injury," "property damage' or "per- performing operations when you and such sonal and advertising injury" arising out of person or organization have agreed in writing the rendering of, or the failure to render, in a contract or agreement that such person any professional architectural, engineering or organization be added as an Additional In- or surveying services, including sured on your policy. Such person or or- ganization is an Additional Insured only with a. the preparing, approving, or failing to respect to liability for "bodily injury," "prop- prepare or approve, maps, shop erty damage' or "personal and advertising in- drawings, opinions, reports, surveys, jury" caused, in whole or in part, by: field orders, change orders or draw- ings and specifications; or b. supervisory, inspection, architectural 1. your acts or omissions; or or engineering activities. 2. "Bodily injury," or "property damage" oc- 2. the acts or omissions of those acting on curring after: your behalf; a. all work, including materials, parts or equipment furnished in connection in the performance of your ongoing oper- with such work, on the project (other ations for the Additional Insured, than service, maintenance or repairs) to be performed by or on behalf of the Additional Insuredls) at the location A persons or organization's status as an Ad- of the covered operations has been ditional Insured under this endorsement ends completed: or when your operations for that Additional In- b, that portion of "your work" out of sured are completed. which the injury or damage arises has been put to its intended use by any person or organization other than an- B. With respect to the insurance afforded to other contractor or subcontractor en- these Additional Insureds, the following addi-- gaged in performing operations for a tional exclusions apply: principal as a part of the same project. Copyright. ISO Properties, Inc, 2004 CG 20 33 (Ed. 07/04) xS 4"1161092 1 16/19 GL AU WC UM6 I Nina Lautensch lager 12l21J2C19 3:23:05 PM 4FST) I Page 2 01 10 Great American Assurance Company GLP2869852 Copp Contracting, Inc. CG 20 37 !Ed 07 04) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Schedule Name of Additional Insured Person(s) or Organ ization(s): Location and Description of Completed Operations: Any person or organization that Per Certificate ( s ) of Insurance "you" and such person or organiza - tion have agreed in writing in a contract or agreement that such Your work " performed during this policy person or organization be added as perind . an additional insured or "ynur " policy , but only for "your wcrk " performed during this policy period . Additional Premium: Included Information required to complete this Schedule, if not shown above, will be shown in the Declarations. SECTION II - WHO IS AN INSURED is amended to include as an Additional Insured the person(s) or organizationls} shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that Additional Insured and included in the "products-completed operations hazard" Copyright, ISO Properties, Inc. 2004 CG 20 37 (Ed. 07l04) PRO {Page 1 of 1 ;:� - ;Y i ' .1- Ju.e�- 1_i: i,'. 1.: : .- . .-- -..-1:d'. .M 17:,-) .. - Great American Assurance Company GLP2869852 CG 25 03 Copp Contracting, Inc. (Ed 03 97) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: Any construction project where "you" are performing nperations when "you" have agreed in writing in a contract or agreement that a separate General Aggregate Limit shall apply to such construction project , but only if "your work " on or at the construction project is performed during the period of this policy , (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. For all sums which the Insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents under COVERAGE C. (SECTION 1), which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Lima applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A. except damages because of "bodily injury" or "property damage" included in the "products—completed operations hazard." and for medical expenses under Coverage C. regardless of the number of: a. Insureds, b. claims made or ''suits" brought, or c. persons or organizations making claims or bringing "suits." Copyright. Insurance Services Office, Inc.. 1996 CG 25 03 (Ed. 03,97) PRO (Page 1 of 2) 3. Any payments made under Coverage A. for damages or under Coverage C, for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above 4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply, However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit B. For all sums which the Insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents under COVERAGE C. (SECTION I), which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above 1. any payments made under Coverage A. for damages or under Coverage C. for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit, whichever is applicable: and 2. such payments shall not reduce any Designated Construction Project General Aggregate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the products-completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of LIMITS OF INSURANCE (SECTION III) not otherwise modified by this endorsement shall continue to apply as stipulated. Copyright, Insurance Services Office, Inc.. 1996 CG 25 03 (Ed. 03l97► PRO (Page 2 of 2) • ...,;8 AU WC TJMB I Ri:,n r.1 _ . Great American Assurance Company GLP2869852 GAC 3649CG Copp Contracting, Inc. (i 1 1 06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY NON-CONTRIBUTORY INSURANCE ENDORSEMENT This endorsement modifies insurance provided under the following- COMMERCIAL GENERAL LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM This insurance is primary to any other insurance held by third parties with respect to work performed by you under written contractual agreements with such third parties and any other insurance which may be available to such third parties shall be non-contributory GAC 3649CG (Ed. 1 1/06) XS Great American Assurance Company CG 24 04 GLP2869852 Copp Contracting, Inc. (Ed. 05 09) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART Schedule Name of Person or Organization- Any person or Organization f❑ r wh❑m or on whose behalf "y❑u" are performing operations when "you" and such person ❑ r ❑ rganizati ❑n have agreed in writing in a contract ❑ r agreement t ❑ waive any right of recovery "we" may have against such pers❑n ❑ r ❑ rganizati ❑n . Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to paragraph 8. Transfer of flights of Recovery Against Others to Us of SECTION IV - CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products—completed operations hazard." This waiver applies only to the person or organization shown in the Schedule above. Copyright, ISO Properties. Inc. 2006 CG 24 04 (Ed 05/09) PRO (Page 1 of 1 i WPP1588321 01 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 11/1/2018 Countersigned By: Named Insured: Copp Contracting, Inc. Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): Blanket as required by written contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑ WPP1588321 01 COMMERCIAL AUTO CA04440310 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Copp Contracting, Inc. Endorsement Effective Date: 11/1/2018 SCHEDULE Name(s) Of Person(s) Or Organization(s): Blanket as required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Oth- ers To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "ac- cident' or the "loss" under a contract with that person or organization. CA 04 44 03 10 © Insurance Services Office, Inc., 2009 Page 1 of 1 0 ,b - WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 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 FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 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: 6115r2018 Policy No. 7600015069181 Endorsement No. 001 Insured: Copp Contracting,Inc. Premium$ INCL. Insurance Company: Everest National Insurance Company Countersigned By: -1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved. From the WCIRB's California Workers'Compensation Insurance Forms Manual-1999. 4-11frI1,152 � 16119 GL AU W-- UMB I iJina La,!t:narhlaget 1 2121 2019 3:23:OS PM (PST) Page 10 of 1P