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2019/01/01 STC Traffic, Inc. Certficiate of Liability Insurance
DATE(MMID WYYYY) ACC)► E111' CERTIFICATE OF LIABILITY INSURANCE ka. � 01/03/2019 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(les)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 Jacqueline Byrne NAME: Matsen Insurance Brokers,Inc. PHONE (707)444-9292 FAX (707)444-9529 A No. O Elf: (A,'No): 3101 Concorde Drive,Suite B F' AIL Jackie@matsen.com ADDRESS INSURER(S)AFFORDING COVERAGE NAIC# McKinleyville CA 95519 INSURERA: Atain Specialty Ins. INSURED INSURER B: Nationwide Mutual 23787 STC Traffic,Inc INSURER C: Evanston Insurance Co. 5865 Avenida Encinas,Suite 142-B INSURER D: Hartford Fire Group 00914 INSURER E: Lloyds of London Carlsbad CA 92008 INSURER F: COVERAGES CERTIFICATE NUMBER: CL191307998 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 CONTRACTOR 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 POLICYEXP TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/ppY� MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000.000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A Y CIP351747 01/01/2019 01/01/2020 PERSONAL&ADV INJURY $ 2,000.000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4.000,000 X POLICY❑JEC LOC PRODUCTS-COMP/OPAGG $ 2,000,000 O7HER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED ACPBA3016931702 01/01/2019 01/01/2020 BODILY INJURY(Per accident) $ AUTOSONLY AUTOS HIRED NON-OWNED PROPERTY OHMAGE AUTOS ONLY AUTOS ONLY Per aceJden! $ LC X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 6,000,000 EXCESS LIAB HCLAIMS-MADE XOBW7952219 01/01/2019 01/01/2020 AGGREGATE $ 6,000,000 DED I I RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE r NIA 57WECGI9278 01/01/2019 01/01/2020 EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ 1,000,000 IF yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ Professional Liability E Claims Made Basis 1114251 01/01/2019 01/01/2020 Aggregate Limit $3,000,000 Per a Claim $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Menifee and its officers,employees,agents,and authorized volunteers are included as additional insureds on the General Liability policy per attached Form AF000859. General Liability coverage is primary and noncontributory per the attached form AF0013970712. Waiver of subrogation applies to the General Liability policy per the attached form CG24040509. Waiver of subrogation applies to the workers compensation policy per the Extended Broad Form WC990303 attached to this policy. 30 days'advance written notice,10 days for non-payment of premium,prior to cancellation or material change in policy coverage(s), CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Menifee ACCORDANCE WITH THE POLICY PROVISIONS. 29714 Haun Road AUTHORIZED REPRESENTATIVE Menifee CA 92586 401�n ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON ORORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Additional Insured Person(s) Or Organization(s): Location(s) of Covered Operations ,ANY PERSON OR ORGANIZATION AS LOCATION AS REQUIRED BY WRITTEN REQUIRED BY WRITTEN CONTRACT WITH THE CONTRACT NSURED A. SECTION II-WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such a person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury","property damage" or"personal and advertising injury" caused, in whole or in part, by: 1.Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations forthe additional insured(s) at the location(s) designated above. A persons or organizations status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability " Bodily injury" or"property damage" forwhich the"additional insured(s)" are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations or Work "Bodily injury" or"property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (2) That portion of"your work" out of which the injury or damage arises has been put to its intended use by any person or organization. Negligence of Additional Insured "Bodily injury" or"property damage" directly caused by or resulting from the negligence of the"additional insured(s)". ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED Thisendorsement is effective on the inception date of the policy unless otherwise stated below. (The information below is required only when this endorsement is issued subsequent to preparation of the policy). Policy Number: CIP351747 Named Insured: STC TRAFFIC, INC. Endorsement Effective date: AF 000 859 Included copyrighted material of ISO Properties, INC. Page 1 of 1 07/2012 with its permission POLICY NUMBER:CIP35 1747 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following COM M ERCIAL G EN ERAL LIABILITY COVERAGE PART PRODUCTS/COM PLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE City of Menifee 297 1 4 Haun Road Menifee CA 92586 Information required to complete this Schedule if notshown above will be shown inthe Declarations. The following is added to Paragraph 8. Transfer Of Rights 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. CG 24 04 0509 Insurance Services Office,Inc.,2008 Page 1 of 1 ENDORSEMENT This Endorsement Changes the Policy-Please Read it Carefully PRIMARYAND NON-CONTRIBUTING INSURANCE (Third-Party's Sole Negligence) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD LIABILITY COVERAGE PART BUSINESSOWNERS LIABILITY COVERAGE FORM The following is added to Section IV- Commercial General Liability Conditions, Paragraph 4: Section IV: Commercial General Liability Conditions 4. Other Insurance: d. Notwithstanding the provisions of sub-paragraphs a, b, and c of this paragraph 4,with respect to the Third Party shown below, it is understood and agreed that in the event of a claim or"suit" arising out of the Named Insured's sole negligence, this insurance shall be primary and any other insurance maintained by the additional insured named as the Third Party below shall be excess and non-contributory. The Third Party to whom this endorsement applies is: ANY PERSON OR ORGANIZATION WITH WHOM THE INSURED HAS AGREED BY WRITTEN CONTRACT TO PERFORM SERVICES AND PRIOR TO ANY LOSS THAT ARE WITHIN THE TERMS AND CONDITIONS OF THIS POLICY TO WHICH THIS FORM IS ATTACHED Absence of a specifically named Third Party above means that the provisions of this endorsement apply "as required by written contractual agreement with any Third Party for whom you are performing work." All other terms and conditions of this policy remain unchanged. This endorsement is effective on the inception date of the policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: CIP351747 Named Insured: STC TRAFFIC, INC. Endorsement Effective Date: Endorsement Serial No. AF 001 397 0712 Includes copyrighted material of Insurance Services Office, Inc. with its permission Copyright, Insurance Services Office, Inc.1994 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 57 WEC G19278 Endorsement Number: Effective Date: 01/01/19 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: STC TRAFFIC, INC. 5865 AVENIDA ENCINAS STE 142 B CARLSBAD CA 92008 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 from whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 11/22/18 Policy Expiration Date: 01/01/20