2019/02/05 Allied Traffic and Equipment Rentals, Inc. Certificate of Liability InsuranceCERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
09/10/2019
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 policypes) 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 endorsament(s).
PRODUCER CONTACT
NAME; Carol Knox, Debbie S. Taylor or Debbie Waller
KGIB, INC. fAIG. No. PHONE , (714) 744-3300 FAX c No,: (714) 744-6537
KNOX GENERAL INSURANCE BROKERS A MAIL - carolipkgibinc.com, debbie@ibinc.com or dwaller@kgibinc.com
226 SOUTH GLASSELL STREET INSURPcR S AFFORDING COVERAGE NAIC 0
ORANGE CA 92866 INSURER A: CM VANTAGE SPECIALTY INSURANCE CO. 15872
INSURED INSURER B : EMPLOYERS MUTUAL CASUALTY CO. 21415
ALLIED TRAFFIC AND EQUIPMENT RENTALS, INC. INSURER C : STATE COMPENSATION INSURANCE FUND 35076
41806 IVY ST INSURER D : CERTAIN UNDERWRITERS AT LLOYD'S
INSURERE: "" THIS CERTIFICATE IS UPDATING THE
MURRIETA CA 92562-8842 INSURER F : GENERAL & EXCESS LIABILITY POLICIES
COVERAGES CPFtTIFIr_GTF NIIMRFR• 01=11I01n At NII IRADCD.
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.
i 7R TYPE OF INSURANCE -AINSD {74L,SU6n POLICY NUMBERt PMIDDY� MM/DDT LIMITS
PO
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
PREMISE Ea occ e e
$ 300,000
CLAIMS -MADE FRI OCCUR
MED EXP (Any one arson)
$ EXCLUDED
A
X
CMVPLI001002702
09/11/2019
09/11/2020
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY PRO- ❑
JECT LOC
PRODUCTS - COMP/OP AGG
$ 2,000.000
$
OTHER:
AUTOMOBILE
LIABILITY
MBI E SiN T
ea ecridenk
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
B
IAUTOS
OWNED SCHEDULED
AUTOS ONLY AUTOS
4E13309
02/05/2019
02/05/2020
BODILY INJURY (Per accident)
$
X
HIRED NON -OWNED
ONLY AUTOS ONLY
rx
PROPERTY D E$
Pc accldenl
A
X
UMBRELLA LIAB M
EXCESS LIAR
OCCUR
CLAIMS -MADE
CMVEXL0011741-02
09/11/2019
09/11/2020
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
DED RETENTION $
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y 1 N
OFFICER/MEMBER ANY /EXCLUDED?ECUTIVE
(Mandatory in NH)
If yes, describe under
NIA
923077919 05/01/2019
05/01/2020
�� STAT TE R
E. L. EACH ACCIDENT
$ 1,000,000
E.LDISEASE- EAEMPLOYE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000.000
DESCRIPTION OF OPERATIONS below
PROFESSIONAL LIABILITY
$1,000,000 PER ANY
ONE CLAIM
D
S-BW0268618 02/05/2019
02/05/2020
INCLDS ALL COST
EXPENSES
DESCRIPTION OF OPERATIONS I 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.
1.Ef. li/11Vl,.CLLA I IUN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF MENIFEE ACCORDANCE WITH THE POLICY PROVISIONS.
ENGINEERING DEPARTMENT RECEIVED AUTHORIZED REPRESENTATIVE
29714 HAUN ROAD �—
MENIFEE CA 92586
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
POLICY #CMVPLI0010027-02
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AMENDMENT - ADDITIONAL INSURED -
DESIGNATED ENTITY
SCHEDULE
Additional Insured:
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
POLICY #CMVPLI0010027-02
Deductible: $5,000
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 fimits specifed.
- 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