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2018/08/16 Road Works, Inc. Certficiate of Liability InsuranceA R�� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY 7/30/20 9 ) 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 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 NAME: Andy Manale Manale Insurance Services PHO1'.0N o (323) 581-4846 F�AXC No): c323>5e1-4e44 817 W. Beverly Blvd. ADDRES$:certificates@manaleins.com INSURERS AFFORDING COVERAGE NAIC 9 Suite 107 INSURER A: Financial Pacific Insurance Co. 31453 Montebello CA 90640 INSURED INSURER B : INSURER C : Road Works, Inc. INSURER D : INSURER E: 303 Short Street INSURER F: Pomona CA 91768 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. IINSR LTR 7ypE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE T OCCUR A A U P Ea nccLrrence $ 100,000 MED EXP(Any one person) $ 5,000 X 60477177 8/16/2018 8/16/2019 PERSONAL & ADV INJURY $ 1,000,000 GENIAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Employee Benefits $ OTHER: AUTOMOBILE LIABILITY M IN t L LI I Ea acrid tk $ 1,000,000 BODILY INJURY (Per person) $ `a' X ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS 60477177 8/16/2018 8/16/2019 BODILY INJURY (Per accident) $ PROPERTY DAAAAG I Per S[CFtlLYII $ NON -OWNED HIREDAUTOS AUTOS Uninsured motorist combined single $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE 60477177 8/16/2018 8/16/2019 X DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN P R H- TAT TE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A E L DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ A Business Personal Property 60:77177 8/16/2016 8/16/2019 Limit $654,600 Inland Marine 60477177 8/16/2018 8/16/2019 Limit $97,544 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of Menifee, its officers, agents, and employees are named additional insured with respects to General Liability CERTIFICATE HOLDER CANCELLATION City of Menifee 29844 Haun Road Menifee, CA 92586 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 Manale/VH ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) INS025 (201401) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 60477177 CG 20 10R 12 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (WITH LIMITED COMPLETED OPERATIONS COVERAGE) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESSOWNERS COVERAGE FORM SCHEDULE NAME OF PERSON OR ORGANIZATION Any person or organization to whom or to which the named insured is obligated by a virtue of a written contract to provide insurance that is afforded by this policy. Where required by contract, the officers, officials, employees, directors, subsidiaries, partners, successors, parents, divisions, architects, surveyors and engineers are included as additional insureds. All other entities, including but not limited to agents, volunteers, servants, members and partnerships are included as additional insureds, if required by contract, only when acting within the course and scope of their duties controlled and supervised by the primary (first) additional insured. If an Owner Controlled Insurance Program is involved, the coverage applies to off - site operations only. If the purpose of this endorsement is for bid purposes only, then no coverage applies. WHO IS AN INSURED: (Section II) This section is amended to include as an insured the person or organization within the scope of the qualifying language above, but only to the extent that the person or organization is held liable for your acts or omissions in the course of "your work" for that person or organization by or for you. The "products - completed operations hazard" portion of the policy coverage as respects the additional insured does not apply to any work involving or related to properties intended for residential or habitational occupancy (other than apartments). This clause does not affect the "products - completed operations" coverage provided to the named insured(s). WAIVER OF SUBROGATION: We waive any right of recovery, when required by written contract, that we may have against the person or organization within the scope of the qualifying language above because of payments we make for injury. LOCATION OF JOB: The job location must be within the State of domicile of the named insured, or within any contiguous State thereto. DESCRIPTION OF WORK: The type of work performed must be that as described under classifications in the CGL Coverage Part Declarations. PRIMARY CLAUSE: When this endorsement applies and when required by written contract, such insurance as is afforded by the general liability policy is primary insurance and other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. EXCLUSION This insurance provided to the additional insured does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering or failure to render any professional services, including: 1. The preparing, approving, or failing to prepare or approve, maps, designs, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. Endorsement EFFECTIVE DATE: SEE DEC Endorsement EXPIRATION DATE: SEE DEC CG 2010R 12 11 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission DATE (MM/DD/YYYY) Aca;rrn CERTIFICATE OF LIABILITY INSURANCE Acct#: 2530463 7/30/2019 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(ies) must 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 NTA T Willis of Greater Kansas City Inc. PHONE — Fax 5700 W 112th Street, Ste. 100 fA/C, No. E-1). 844-290-4908 WC. MCI. Overland Park, KS 66211 p�ESS: BBSlcerts@locktonaffinity.com INSURED Barrett Business Services, Inc. L/C/F ROAD WORKS, INC. 303 SHORT ST POMONA, CA 91768 E: F: INSURERS AFFORDING COVERAGE I NAIC # Ace American Insurance Co. 1 22667 COVERAGES CERTIFICATE Nt1MRER- RFVisinN NIfMRFR- 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. L � TYPE OF INSURANCE = VD POLICY NUMBER MMIDDlid1rdY EFF M IDD EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE J l OCCUR DAMAGE TO RENTzff-- Al (€a .a $ MED EXP [Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ JECOT n LOG PRODUCTS - COMP/OP AGG $ $ ETHER: AUTOMOBILE LIABILITY COMBINED SINGLE !Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccidenl $ HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE AED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y/N OFFICERIMEMB€R EXCLUDED? N / A C65212584 12/1/2018 12/1/2019 X MUTE FRH- E.LEACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 (Mandatory In Nil) If yyea descrlbeunder DESL�RIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Policy State = CA CERTIFICATE HOLDER CANCELLATION CITY OF MENIFEE 29844 Haun Road Menifee, CA 92586 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. A&_ ©1988-2014 ACORD CORPORA AGUKU 25 (1014/U1) I ne AGUKU name ana logo are registered marKS OT AGUKU