2019/08/01 L & S Construction, Inc. Certficiate of Liability InsuranceL&SCONS-01 SMARI
DATE (MM/DDIYYYY)
CERTIFICATE OF LIABILIW INSURANCE 7124/2019
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 License # 0757776 CONTACT
NAME,
Newport Beach, CA - HUB International Insurance Services Inc. F
4695 MacArthur Court, Suite 600 �fpn (9 4 9) 6 2 3 - 3 9 8 0 jkXc..m0.-(949) 891-0407
Newport Beach, CA 92660
INSURED
L & S Construction, Inc.
674 North Batavia Street
Orange, CA 92868
INSURER F
R!
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.
TYPE OF INSURANCE I—
POLICY NUMBER AAWNCYrAll I (Mumuctn'T =M
MMERCIAL GENERAL LIABILITY
Icol
�X
CLAIMS -MADE F)71:, OCCUR
X
03181
811/2019 811/2020
�% AGGREGATE LIMIT APPLIES Pim
X. POLICY X 3jRe� 17 LOC
Per Ptaj Gen Agg per contrad
x
OTHEFt
AUTOMOBILE LIABILITY
1
X ANY AUTO
54303180
8/1/2019 8/1/2020
OWNED [SCHEDULED
AUTOS ONLY AUTOS
HIRED NON WNED
�J
UT(50
AUTOS ONLY A S ONLY
LIMITS
UMBRELLA LIAB I
_d OCCUR EACH OCCURRENCE S
EXCESS LIA CLAIMS-MADE1 S
DED I I RETENTIONS S
B WORKERS COMPENSATION
AND EMPLOYERVILIABILITY X Mm I-EIR11-
ANY PROPRIFFQRJPARTNEfVEXEGUTIVE YIN 154303182 8/1/2019 8/1/2020 ! 1000,000
FjLICER1,11E.M1.1 U NIA E.L. EACH ACCIDENT Is
EXCL DEW L DISEASE - EA EMIPL A. 1,000,000
AYE9
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: Encroachment Permit for L & S Construction, Inc. Job #934. Watt Communities at Mosaic, LLC. Project Address: Tract 28206, Garbani Road and Palomar
Road, Menifee, CA. glai
City of Menifee is included as Additional Insured where required by an executed written contract as respects General Liability per attached endorsements.
City of Menifee
29714 Haun Road
Menifee, CA 92586
"ity ot meni'i
C1 ! .
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
oua�gzlzz_
ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: L&SCONS-01
BMARIN
LOC #:
AC"REY
11114.� ADDITIONAL REMARKS SCHEDULE
AGENCY License # 5777 NAMED INSURED
61 L & S Co n struction. I n c.
4ewport Beach, CA - HUB International Insurance Services Inc. ___,674 North Batavia Street
POLICY NUMBER Orange, CA 92868
;EE PAGE 1
CARRIER NAIC CODE
SEEPAGE1 I
:SEE P 1
EFFECTFVE DATE:
Page 1 of 1
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance
Cancellation:
* Should the policy(ies) be cancelled before the expiration date, Hub International Insurance Services Inc. (Hub), independent of any
rights which may be afforded within the policies to the certificate holder named below, will provide to such certificate holder notice
of such cancellation within thirty (30) days of the cancellation date, except in the event the cancellation is due to non-payment of
premium, in which case Hub will provide to such certificate holder notice of such cancellation within ten (10) days of the cancellation
date. I
ACORD 101 (2008/01) @ 2008 ACORD CORPORATION. All rights -reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: 54303181
COMMERCIAL GENERAL LIABILITY
CG 20 37 04 13
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
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s) - J
WHERE REQUIRED BY WRITTEN CONTRACT, BUT ONLY
WHERE THE CONTRACT SPECIFIES COVERAGE FOR
COMPLETED OPERATIONS.
Location And Description Of Completed Operations
ALL LOCATIONS WHERE REQUIRED BY WRITTEN CONTRACT.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section 11 — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) 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 "prod ucts-completed operations
hazard".
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
2. If coverage provided to the additional insured
is required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III — Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable
Limits of Insurance shown in the Declarations.
CG 20 37 04 13 @ Insurance Services Office, Inc., 2012 Page 1 of 1
POLICY NUMBER: 54303181
COMMERCIAL GENERAL LIABILITY
CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) I I
Or Organization(s) Location(s) Of Covered Operations
WHERE REQUIRED BY WRITTEN CONTRACT. ALL LOCATIONS WHERE REQUIRED BY WRITTEN CONTRACT. I
Information required to complete this Schedule, if not shown above. will be shown in the DPrI2rqtinn.q
A. Section 11 — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but 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 for
the additional insured(s) at the location(s)
designated above.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury" or
11 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
other than another contractor or subcontractor
engaged in performing operations for a
principal as a part of the same project.
CG 20 10 04 13 @ Insurance Services Office, Inc., 2012 Page 1 of 2
C. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III — Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
Page 2 of 2 @ Insurance Services Office, Inc., 2012 CG 20 10 04 13