2011/11/01 Adame Landscape, Inc. Certificate of Liability Insurance (3)ACORa' CERTIFICATE OF LIABILITY INSURANCE
�.�
D/DD
10/28/2011
/2s11
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 ..
Landscape Contractors (Lic#0755906)
Insurance Services, Inc. City ®$ Menife:' '
1835 N. Fine Avenue
Fresno CA 93727 t 9�f!h
CONTACT NAME: Elizabeth Ng O, CISR
PHONE (559) 650-3555 FA/C No; (559)650-3558
ADDRE .engo@lcisinc. com
INSURERS AFFORDINGCOVERAGE
NAIC#
INSURERA:ARCH Insurance Company
11150
INSURED
Adame Landscape, Inc. Qp e
41863 Juniper St.���tl`��
Murrieta CA 92562
INSURER B :
INSURERC:
INSURERD:
INSURER E
INSURERF:
COVERAGES
CERTIFICATE NUMBER:11/12 ADAME
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 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
LTR
TYPE OF INSURANCE
ADDL
INSR
SUER
WVD
POLICY NUMBER
POLICY EFF
MMIDDIYYW
POLICY EXP
MM/DD/YYYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 1XI OCCUR
1,CPKG0201100
11/1/2011
11/1/2012
DAMAGE TO RENTED
PREMISES Ea occurrence
S 100,000
MEDEY,P(Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
X
$1000 PD DED
GENERAL AGGREGATE
S 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
S 2,000,000
X POLICY PRO LOC
-
$
AUTOMOBILE
LIABILITY
Co BcdeDtSINGLELIMIT
$ 1,000,000
BODILY INJURY (Per person)
S
A
X
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
LCPKG0201100
11/1/2011
11/1/2012
BODILY INJURY (Per accident)
S
X
PROPERTY DAMAGE
Per accident
$
NON -OWNED
HIRED AUTOS N AUTOS
Underinsured motorist
$ 1,000,000
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
I_TDED
RETENTION S
S
WORKERS COMPENSATION
WC STATU- ITH-
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
N / A
E.L. EACH ACCIDENT
S
E.L. DISEASE - EA EMPLOYE
S
(Mandatoryin NH)
If ,cs, describa under
E.L. DISEASE -POLICY LIMIT
$
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
RE: Cherry Hills Sun City Shopping Center
Blanket Additional insured per attached OOGLO434000108
City of Menifee named as additional insured.
City of Menifee
29740 Haun Rd
Sun City, CA 92586
CANCELLATION
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
ACORD 25 (2010105)
INS025 (201005) 01
E Ngo, CISR/RBUSTO —
@ 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and loao are reaistered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT
CAREFULLY.
BLANKET ADDITIONAL INSURED PROTECTION ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
1. SECTION II - WHO IS AN INSURED is amended to include as an insured any
organization or person required to be named as an additional insured pursuant to a
written contract or agreement.
The insurance provided by this endorsement is subject to the following:
a. This insurance does not apply to any person or organization not specifically
approved by us as an additional insured.
b. Any insurance afforded an additional insured under this endorsement shall not
begin before the date that the person or organization is approved by us as an
additional insured.
c. The Limits of Insurance under this insurance, which are listed in the Declarations
of this policy, shall not be increased, regardless of the number of additional
insureds, or the limits specified in the contract or agreement.
d. Any coverage that is not provided under an additional insured's liability insurance
policy for your acts, errors, or omissions is also not provided under this insurance.
e. With respects to the additional insured, this insurance does not apply to: 1.
"Property Damage" to "your product" arising out of it or any part of it. 2. "Property
Damage" to "your work" arising out of it or any part of it and included in the
"products -completed operations hazard". 3. Liability for "Property Damage" or
"Bodily Injury" for acts, errors, omissions of an additional insured.
f. If required under written contract, this insurance will apply to an additional insured
as primary insurance and other insurance which may be available to such
additional insured shall apply on an excess basis.
g. If required by a written contract, we waive our right to recovery against any
additional insured because of payments we make for injury or damage arising out
of :your ongoing operations, or "your work" done under a contract with that
additional insured and included in the "products completed operations hazard".
All other terms and conditions of this Policy remain unchanged.
Endorsement Number: N/A
Policy Number: LCPKG0201100
Named Insured: Adame Landscape, Inc.
This endorsement is effective on the inception date of this policy unless otherwise stated herein.
Endorsement Effective Date: 11/01/2011
00 GL0434 00 01 08 Includes copyrighted material of Insurance Services Office, Inc Page 1 of 1
.with its permission