2013/11/01 Adame Landscape, Inc. Certificate of Liability Insurance (5)CERTIFICATE OF LIABILITY INSURANCE
DATE(MWDDNYYY)
1/13/2014
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
R. David Bulen Insurance
P.O. Box 115
CONTACT
NAME: Laura Bramer
PHONE FAX (951 674-0675 (951)674-2375
(A/C. Ex ) (A/C. No):
i
l
ADDRESS: aurab@bulen. com
PRODUCER 90019857
CUSTOMER ID 1
Lake Elsinore CA 92531-0115
INSURERS AFFOflDING COVERAGE
NAIC#
INSURED -
INSURER A :GOlden Eagle Ins. CO
10836
INSURER B :
Adzme Landscape, Inc.
41863 Juniper St. JAN 17 2014
INSURER C :
INSURER D :
_
INSURER E :
Murrieta CA 92562,
rnv�o w nee.
INSURER F
----------._._ ...-------____-- nCvialuIV IVumCSCF(:
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 ADD L SUBR
LTR TYPE OF INSURANCE WVD POLICY NUMBER M�DDNYYY MMIDDNYYY LIMITS
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CURRENCE
$ 1,000,000
rDAMAGE
TO RENTED
Ea occurrence
$ 500,000
A CLAIMS -MADE � OCCUR
X
X
BP8935410
11/1/2013
11/1/2014
(Anyoneperson)
$ 10,000
L & ADV INJURY $ 1,000,000
_
-
GE N'LL AGGREGATE LIMIT APPLES PER:
I
I
I
GENERAL AGGREGATE Is 2,000,000
PRODUCTS 2 000 000
X PRO-
- COMP/OP AGG $ , ,
- - -
POLICY IECT LOC
I
j
$
AUTOMOBILE LIABILITY
! COMBINED SINGLE LIMIT
$ 1, 000, 000
X ANY AUTO
(Ea accident) I
A ALL OWNED AUTOS
X
X
A8935710 11/1/2014 BODILY INJURY (Per person) $
SCHEDULED AUTOS
I
hl/1/2013
BODILY INJURY (Per accident) $
--
X HIRED AUTOS
—
I PROPERTY DAMAGE $
(Per accident)
x I NON -OWNED AUTOS
7 $
UMBRELLA LIAB
I Uninsured motoristcombined $ 100, 000
EACH OCCURRENCE
EXCESS LIAB CLAIMS_MAD�i i
- ---------�— - --i
I
i
_
I i�
I AGGREGATE $
4 DEDUCTIBLE
i
I
I
I - _ ----------
l
RETENTION $
-
I $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
WC STATU- I OTH-j
i !TOR= t IMIIS I Ems!
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
N/A
i E.L. EACH ACCIDENT
CIDIs
(Mandatory In NH)
If yes, describe under
E.L. DISEASE • EA EMPLOYE $
DESCRIPTION OF OPERATIONS below
A Equipment Floater
E.L. DISEASE - POLICY LIMIT $
BP8935410 jii/1/2014
hi/1/2013 $287,600/$500deductible Sched Equip
1
1 $so,o)0/$500deductible Rented/Lease
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required)
City of Menifee, its officers, employees, representatives and authorized volunteers, (excl Professional Liability),
are included as Additional Insured per attached GECG970 1/11. RE: Cherry Hills Blvd., Street Median, All landscape
operations performed by or on behalf of the named insured. *30-day notice of cancellation, except for 10-day notice of
cancellation for nonpayment of premium.
/'CI'9TI C1I-.wTr IIA, ems, —,-
City of Menifee
29714 Haun Rd.
Sun City, 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
Alvarado/SONDRA cat. GI Z-
Armmn me onnornni
v I teas-ZUUV AGUHU L;UHPORATION. All rights reserved.
INS025 (20090s) The ACORD name and logo are registered marks cf ACORD
Policy Number:CBP8935410
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL LIABILITY GOLD ENDORSEMENT - CONTRACTORS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SECTION I — COVERAGES
COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY
2. Exclusions
Item 2.9. 2) is replaced with the following:
2•g• 2) a watercraft you do not own that is:
a) less than 50 feet long; and
b) Not being used to carry persons or property for a charge.
Item 2.g. 6) is added:
6) An aircraft in which you have no ownership interest and that you have chartered with crew.
The last paragraph of 2. Exclusions is replaced with the following:
Exclusions c. through n. do not apply to damage by fire, explosion, sprinkler leakage, or lightning to premises
while rented to you, temporarily occupied by you with the permission of the owner, or managed by you under
a written agreement with the owner. A separate limit of insurance applies to this coverage as described in
Section III — Limits of Insurance.
SECTION I — COVERAGES
COVERAGE C. MEDICAL PAYMENTS
If Medical Payments Coverage is provided under this policy, the following is changed:
3. Limits
The medical expense limit provided by this policy shall be the greater of:
a. $10,000; or
b. The amount shown in the declarations.
Coverage C. Medical Payments is primary and not contributing with any other insurance, even if that other
insurance is also primary.
The following is added.
COVERAGE D. PRODUCT RECALL NOTIFICATION EXPENSES
Insuring Agreement
We will pay "product recall notification expenses" incurred by you for the withdrawal of your products,
provided that:
a. Such withdrawal is required because of a determination by you during the policy period, that the use or
consumption of your products could result in "bodily injury" or "property damage'; and
b. The "product recall notification expenses" are incurred and reported to us during the policy period.
The most we will pay for "product recall notification expenses" during the policy period is $100,000.
SUPPLEMENTARY PAYMENTS — COVERAGES A AND B
Item b. and d. are replaced with:
b. The cost of bail bonds required because of accidents or traffic law violations arising out of the use of any
vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds.
d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense
of the claim or "suit' including actual loss of earnings up to $500 a day because of time off from work.
Includes copyrighted material of Insurance Services Offices Inc., with its permission.
GECG 970 (01/11)
Page 1 of 4
SECTION If — WHO IS AN INSURED
Item 4. is replaced with:
4. Any subsidiaries, companies, corporations, firms, or organizations you acquire or form during the policy
period over which you maintain a controlling interest of greater than 50% of the stock or assets, will qualify as
a Named Insured if:
a) you have the responsibility of placing insurance for such entity; and
b) coverage for the entity is not otherwise more specifically provided; and
c) the entity is incorporated or organized under the laws of the United States of America.
However; coverage under this provision does not apply to "bodily injury" or "property damage" that
occurred before you acquired or formed the entity, or "personal injury" or "advertising injury" arising out of
an offense committed before you acquired or formed the entity.
Coverage under this provision is afforded only until the end of the policy period, or the twelve (12) month
anniversary of the policy inception date whichever is earlier.
SECTION Ili — LIMITS OF INSURANCE
Paragraph 2. is amended to include:
The General Aggregate Limit of Insurance applies separately to each "location" owned by you, rented to you, or
occupied by you with the permission of the owner.
Paragraph 6. is replaced with the following:
6. Subject to 5. above, the Fire Damage Limit is the most we will pay under Coverage A for damages because of
"property damage" to premises while rented to you, temporarily occupied by you with permission of the owner,
or managed by you under a written agreement with the owner, arising out of any one fire, explosion or
sprinkler leakage incident.
The Fire Damage Limit provided by this policy shall be the greater of:
a. $500,000 or
b. The amount shown in the Declarations.
SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS
Item 2. a. is replaced with:
2. Duties In The Event of Occurrence, Offense, Claim or Suit
a. You must promptly notify us. Your duty to promptly notify us is effective when any of your executive
officers, partners, members, or legal representatives is aware of the `occurrence", offense, claim, or "suit'.
Knowledge of an `occurrence", offense, claim or "suit' by other employee(s) does not imply you also have
such knowledge. To the extent possible, notice to us should include:
1) How, when and where the "occurrence" or offense took place;
2) The names and addresses of any injured persons and witnesses; and
3) The nature and location of any injury or damage arising out of the `occurrence", offense, claim or
"suit'.
Item 4. b. 1) b) is replaced with:
b. Excess Insurance
1) b) That is Fire, Explosion or Sprinkler Leakage insurance for premises while rented to you,
temporarily occupied by you with permission of the owner, or managed by you under a written
agreement with the owner; or
Item 6. is amended to include:
6. Representations
d. If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not
deny coverage under this Coverage Part because of such failure. However, this provision does not affect
our right to collect additional premium or exercise our right of cancellation or non -renewal.
Includes copyrighted material of Insurance Services Offices Inc., with its permission.
GECG 970 (01/11) Page 2 of
Item 8. is replaced with:
8. Transfer of Rights Of Recovery Against Others To Us
a. If the insured has rights to recover all or part of any payment we have made under this Coverage Part,
those rights are transferred to us. The insured must do nothing after loss to impair them. At our request,
the insured will bring suit or transfer those rights to us and help us enforce them.
b. If required by a written "insured contract", we waive any right of recovery we may have against any
person or organization because of payments we make for injury or damage arising out of your ongoing
operations or "your work" done under that written "insured contract" for that person or organization and
included in the "products -completed operations hazard".
Item 10. and Item 11. are added:
10. Cancellation Condition
If we cancel this policy for any reason other than nonpayment of premium we will mail or deliver written notice
of cancellation to the first Named Insured at least 60 days prior to the effective date of cancellation.
11. Liberalization
If we adopt a change in our forms or rules which would broaden your coverage without an extra charge, the
broader coverage will apply to this policy. This extension is effective upon the approval of such broader
coverage in your state.
SECTION V — DEFINITIONS
The following definitions are added or changed:
9. "Insured contract"
a. Is changed to:
a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that
indemnifies any person or organization for damage by fire, explosion or sprinkler leakage to premises
while rented to you, or temporarily occupied by you with permission of the owner, or managed by you
under a written agreement with the owner is not an "insured contract".
23. and 24. are added:
23. "Location" means premises involving the same or connecting lots, or premises whose connection is
interrupted only by a street, roadway, waterway or right-of-way of a railroad.
24. "Product recall notification expenses" means the reasonable additional expenses (including, but not
limited to, cost of correspondence, newspaper and magazine advertising, radio or television
announcements and transportation cost), necessarily incurred in arranging for the return of products, but
excluding costs of the replacement products and the cash value of the damaged products.
The following Provisions are also added to this Coverage Part:
A. ADDITIONAL INSUREDS — BY CONTRACT, AGREEMENT OR PERMIT
1. Paragraph 2. under SECTION II — WHO IS AN INSURED is amended to include as an insured any
person or organization when you and such person or organization have agreed in writing in a contract,
agreement or permit that such person or organization be added as an additional insured on your policy to
provide insurance such as is afforded under this Coverage Part. Such person or organization is not
entitled to any notices that we are required to send to the Named Insured and is an additional insured
only with respect to liability arising out of:
a. Your ongoing operations performed for that person or organization; or
b. Premises or facilities owned or used by you.
With respect to provision 1.a. above, a person's or organization's status as an insured under this
endorsement ends when your operations for that person or organization are completed.
With respect to provision 1.b. above, a person's or organization's status as an insured under this
endorsement ends when their contract or agreement with you for such premises or facilities ends.
Includes copyrighted material of Insurance Services Offices Inc., with its permission.
GECG 970 (01/11) Page 3 of
2. This endorsement provision A. does not apply:
a. Unless the written contract or agreement has been executed, or permit has been issued, prior to the
"bodily injury", "property damage" or "personal and advertising injury";
b. To "bodily injury" or "property damage" occurring after:
(1) All work, including materials, parts or equipment furnished in connection with such work, in the
project (other than service, maintenance or repairs) to be performed by or on behalf of the
additional insured(s) at the site 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;
c. To the rendering of or failure to render any professional services including, but not limited to, any
professional architectural, engineering or surveying services such as:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions,
reports, surveys, field orders, change orders or drawings and specifications; and
(2) Supervisory, inspection, architectural or engineering activities;
d. To "bodily injury", "property damage" or "personal and advertising injury" arising out of any act, error
or omission that results from the additional insured's sole negligence or wrongdoing;
e. To any person or organization specifically designated an additional insured for ongoing operations by
a separate ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS endorsement
issued by us and made a part of this policy
B. PRIMARY NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION
Condition 4. Other Insurance of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is
amended as follows:
a. The following is added to paragraph a. Primary Insurance:
If an additional insured's policy has an Other Insurance provision making its policy excess, and you have
agreed in a written "construction contract" to provide the additional insured coverage on a primary and
noncontributory basis, this policy shall be primary and we will not seek contribution from the additional
insured's policy for damages we cover.
For the purposes of this endorsement, "construction contract" means a written contract or written
agreement other than a premises lease, facilities rental contract or agreement, an equipment rental or
lease agreement, or a permit issued by a state, county, municipality or other governmental authority.
b. The following is added to paragraph b. Excess Insurance:
(3) Except as specified in paragraph a., above, any other insurance in which a parry who is an additional
insured hereunder is designated as a Named Insured.
Regardless of the terms of any written agreement between you and an additional insured, this insurance
is excess over any other insurance whether primary, excess, contingent or on any other basis for which
the additional insured has been added as an additional insured.
Includes copyrighted material of Insurance Services Offices Inc., with its permission.
GECG 97f? (131111) Page 4 of