Loading...
2017/10/31 A A A Paving Co, Inc. Certificate of Liability InsuranceAAAPAVI-01 SGUILLEh A�ORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYI) 10/24/2018 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 License # OC36861 CONTACT __NAME: Inland Empire-Alliant Insurance Services, Inc. PHONE FAX 735 Carnegie Dr Ste 200 (AIC, No, Ext): (909) 886-9861 (AIC, No):(909) 886-_-__ - San Bernardino, CA 92408 City of Menifee . E-MAIL City Clerk INSURER(S) AFFORDING COVERAGE NAIC# INSURER A:Colony Insurance Company- 39993 INSURED O C T 2 9 2018 _INSURER s : Employers Mutual Casualty Company 21415 A A A Paving Co Inc INSURER C : Everest_National Insurance Company 10120 3330 North Locust Avenue INSURER_D_ : Rialto, CA 92377 Received INSURER E INSURER F : e'n1/C0Ar_CC !`CGTIC lf�ATC r.uua000. 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 NUMBER POLICY EFF POLICY EXP L I S i LIMITS A X _ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR X 103GL0020645-00 10/31/2017 01/01/2019 DAMAGE TO RENTED 100 OOO PREMISES (Ea occurrence) $ 5,000 MED EXP (Any one person) _ $ 1,000,000 PERSONAL& ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL_ AGGREGATE $ 2,000,000 POLICY X PO-JEC _ LOC PRODUCTS - COMP/OP AGG -------. - - _ . $ 2,000,000 - - _. - OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 .. (Ea accident)_ _- _ __ - - . $ - - X_ ANY AUTO 2X5-98-21 --- 19 10/31/2018 01/01/2019 BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS _. - BODILYINJURY(Peraccidenl)_ $ X HIRED X NON -OWNED PROPERTY AMAGE AUTOS ONLY AUTOS ONLY _(Per accident4 _ $ $ A UMBRELLA LIAB -X OCCUR EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS -MADE XS172700 10/31/2017 01/01/2019 _ 2,000,006 _.AGGREGATE $ DED RETENTION S $ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY Y I N _ --STATUTE _ _ ER- ANYPROPRIETOR/PARTNER/EXECUTIVE ---- 7600010498181 01/01/2018 01/01/2019 EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) - -E.L._ - - - -- E.L. DISEASE - EA EMPLOYEE - - $ 1,000,000 If yes, describe under D DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Operations pertaining to named insured for certholder. Certholder is add'I insd as respects gen'I liab per end't attached. City of Menifee 29714 Haun Rd. 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. AUTHny'0R,IZZE[D REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 103 GL 0020645-00 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 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) Or Organization(s): Location(s) Of Covered Operations All persons or organizations as required by written contract As designated in written contract with the Named with the Named Insured Insured Information required to complete this Schedule, if not shown above, will shown in the Declarations. 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, 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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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 in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 103 G L 0020645-00 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER NSURAHCE COMMON This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 103 GL 0020645-00 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COH o A Coil OO RS - COMPLETED OFF RMHS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations All persons or organizations as required by written As designated in written contract with the Named contract with the Named Insured Insured 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 organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1