2018/02/05 Allied Traffic and Equipment Rentals, Inc. Certificate of Liability Insurance.mac oR� CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
09/18/2018
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
CONTACT
NAME; Carol Knox, Debbie S. Taylor or Debbie Waller
KGIB, INC.
PHONE () 744-3300 714 FAX
A/c No): (714) 744-6537
KNOX GENERAL INSURANCE BROKERS
E-MAIL
carol
ADDRESS: @kgibinc.com, debbie@kgibinc.com or dwaller@kgibinc.com
226 SOUTH GLASSELL STREET
ORANGE
INSURERS AFFORDING COVERAGE
NAIC #
INSURERA: CM VANTAGE SPECIALTY INSURANCE CO.
15872
CA 92866
INSURED
INSURER B: EMPLOYERS MUTUAL CASUALTY CO.
21415
ALLIED TRAFFIC AND EQUIPMENT RENTALS, INC.
INSURERC: STATE COMPENSATION INS FUND
35076
41806 IVY ST
INSURER D : CERTAIN UNDERWRITERS AT LLOYD'S
INSRERF:URERE: ***** UPDATING GENERAL LIABILITY
MURRIETA CA 92562-8842
INsuCOVERAGE ONLY*****
-- — — MOVIAtUN NUNItStK:
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
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
TO WHICH THIS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
HEREIN IS SUBJECT
TO ALL THE TERMS,
INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE wvnPOLICY NUMBER MM/DD MMIDD/YYYY
LIMITS
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE �X OCCUR
EACH OCCURRENCE
DAMAGE TO RENTED
S 1,000,000
PREMISES Ea occurrence
S 300,000
A
MED EXP (Any one person)
$ EXCLUDED
X CMVPLI001002701 09/11/2018 09/11/2019
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X ❑ PRO-
GENERAL AGGREGATE
S 2,000,000
POLICY JECT LOC
PRODUCTS - COMP/OP AGG
s 2,000,000
OTHER:
S
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
ANY AUTO
BODILY INJURY (Per person)
$
B
OWNED SCHEDULED
X
BODILY INJURY (Per accident)
$
AUTOS ONLY AUTOS
4E13309
02/05/2018
02/05/2019
X
HIRED �/ NON -OWNED
AUTOS ONLY X AUTOS ONLY
PROPERTY DAMAGE
S
Per accident
S
X
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
S 1,000,000
HCLAIMS-MADE
B
EXCESS LIAB
4J13309
02/05/2018
02/05/2019
AGGREGATE
$
DED I X I RETENTIONS 10,000
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
PER _
X
$
�, / N
STATUTE ERH
C
ANY PROPRIETOR/PARTNER/EX0T
OFFICER/MEMBER EXCLUDED? ECUTIVE
N / A
9230779-2018
05/01/2018
05/01/2019
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
S 1,000,000
(Mandatory In
If yes, describe under
DESCRIPTION OF OPERATIONS below
I
E.L. DISEASE - POLICY LIMIT
S 1,000,000
PROFESSIONAL LIABILITY
$1,000,000 PER ANY
ONE CLAIM
D
S-TP 20180504
02/05/2018
02/05/2019
INCLUDES ALL
COST/EXP.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: CITY PERMIT
THE CITY OF MENIFEE IS NAMED AS ADDITIONAL INSURED PER FORM PLI 51 10 06/16 AS RESPECTS TO GENERAL LIABILITY.
rGDT1r1r A'rC un1 nnn
CITY OF MENIFEE
ENGINEERING DEPARTMENT
29714 HAUN ROAD
MENIFEE
CA 92586
� wn
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
v -l"O-LUTO ACOKU CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: CMV-PLI-0010027-01
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
u� _ :aDa +JEg,1T o , _DDMONAL INSURED -
DESM-1 -TED LE-ATITY
SCHEDULE
Additional insured:
Any person or organization who you are required to add as an additional insured on this policy under a
written contract or written agreement in effect prior to any loss or damage, but only to the extent required in
the wriften contract or written agreement, including any amounts or limits specified.
A. Information to complete the Schedule, if not shown above, will be shown in the Declarations.
The following is added to the Who Is An Insured Section of the Coverage Form:
B. The person(s) or organization(s) shown in the Schedule above is (are) an insured but only as
respects claims or "suits" for damages caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf.
C. The insurance afforded to such Additional Insured only applies to the extent permitted by law.
D. If insurance provided to the Additional Insured is required by a contract or agreement, the Insurance
afforded to them will not be broader than, nor the limits of insurance greater than, that which you are
required by the contract or agreement to provide for such Additional Insured.
All other terms and conditions of the policy remain unchanged.
PLI 51 10 06 16
Page 1 of 1 Copyright 2016, CM Vantage Specialty Insurance Company
Deductible: $5,000 POLICY NUMBER: CMV-PLI-0010027-01
Amount Applies: Per Claim
Amount Applies to: All Claims
Claims Expense: Included
- The following information completes the Schedule of PLI 51 10 06 16 - Additional Insured - Designated
Entity (Premises, Operations, Products and Completed Operations):
Any person or organization who you are required to add as an additional insured on this policy under a
written contract or written agreement in effect prior to any loss or damage, but only to the extent required in
the written contract or written agreement, including any amounts or limits specified.
- The following information completes the Schedule of PLI 52 40 06 16 - Additional Insured - Primary and
Noncontributory - Other Insurance Condition
Any person or organization who you are required to add as an additional insured on this policy under a
written contract or written agreement in effect prior to any loss or damage, but only to the extent required in
the written contract or written agreement, including any amounts or limits specified.
-The following information completes the Schedule of CG 24 04 05 09 - Waiver of Transfer of Rights of
Recovery Against Others to Us:
Any person or organization who you are required to add as an additional insured on this policy under a
written contract or written agreement in effect prior to any loss or damage, but only to the extent required in
the written contract or written agreement, including any amounts or limits specified.
- The following information completes the Schedule of PEL 82 80 06 16 - Exclusion - Unmanned Aircraft:
N/A
PLI 00 01 06 16 Copyright 2016, CM Vantage Specialty Insurance Company Page 3 of 3