2019/04/01 Becker Pipeline Co Certificate of Liability Insurance}'►`� is CERTIFICATE OF LIABILITY INSURANCE
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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
CONTACT Aaron Marin
RAMP:
PHONE r-Ax
C n (909) 476-0600 All NO (909)976-0601
The Empire Company t;EVY C`�@�i=�
(_) AN E
E-MAIL ADDRESSamarin@empire-co.com
10201 Trademark St, Ste D
P.O. Box 5400
1
INSURERS AFFORDING COVERAGE
NAIC #
INSURERA:Colon Insurance Com an
39993
Rancho Cucamonga CA 91729
Y
INSURED r' r f1 .y `r y. D
INSURER B: California Auto Insurance Company
38342
INSURERC:James River Insurance Company
12203
Becker Pipeline Co. yl(1iH14 yy L
INSURER D: Everest National Insurance CompanX
1 10120
1060 Northgate St, Ste B
INSURER E:
INSURER F:
Riverside CA 92507
COVERAGES CERTIFICATE NUMBER:19/20 Master 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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
➢➢L
S R
POLICY NUMBER
MMLI➢lYYY
1MhVVDNYYYJ
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
CLAIMS -MADE �X OCCUR
A G occurrence
$ 100,000
MED EXP (Any oneperson)
$ 5,000
X
103GL0006251-05
9/20/2019
9/20/2020
PERSONAL & ADV INJURY
$ 1,000,000
GENIAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
X POLICY 0PRO ❑
JECT LOC
PRODUCTS - COMP/OPAGG
$ 2,000,000
$
OTHER,
AUTOMOBILE LIABILITY
COM91NEO SINGLE OMIT
Es accidoLl
$ 1,000,000
BODILY INJURY (Per person)
$
B
X ANYAUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
RA040000047525
10/20/2019
10/20/2020
BODILY INJURY (Per accident)
$
HIRED AUTOS NON -OWNED
AUTOS
PROPERTY DAMAGE
Pe aCCi nl
$
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 2,000,000
X
AGGREGATE
$ 2,000,000
C
EXCESS LAB
CLAIMS -MADE
DED I I RETENTION $
$
00095718-0
9/20/2019
9/20/2020
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY Y/N
X 'E 7 T F.R
EL EACH ACCIDENT
$ 1,000,000
D
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? El
(Mandatory in NH)
N/A
7600017603191
4/1/2019
4/1/2020
E.L DISEASE - EA EMPLOYEE
$ 1,000 000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The City of Menifee, its officers, employees and agents are named as Additional Insured where required by
written contract per attached forms. (U462-0116)
CERTIFICATE HOLDER CANCELLATION
City of Menifee
29844 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.
AUTHORIZED REPRESENTATIVE
Kelly Ledbetter/KELLY �I¢eewt_
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01)
INS025 (201401)
The ACORD name and logo are registered marks of ACORD