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2011/01/25 Becker Engineering Certificate of Liability Insurance (4)OP ID: JB "�� `J CERTIFICATE OF LIABILITY INSURANCE DAT10113D/YYYY) 10/13/11 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 805-495-4634 Associated Insurance Services, $ 5 4-0781 We Hampshire , C 913 City Of � A e n ��6 e Westlake Village, CA 91361 V 1 1V1 I i Jennifer Kight OCT1 7 O11 9 NCONTACT AME: PHONE FAX Ext : A/C No -M IL ADDRIESS: PRODUCER CUSTOMER ID1:BECKE-1 INSURERS AFFORDING COVERAGE NAIC # INSURED Becker Engineering Walter Karl Becker P O Box 890365 Received INSURER A:CentU Surety Company -INSURER B:Hartford Underwriters Ins Co 10456 INSURERC: Temecula, CA92589 INSURER D : INSURER E : INSURER F : — — — — -- rcr=VialutV IVUIVItSCK: 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 I ADD118UT POLICY EFF POLICY EXP LTR I TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X CCP682972 01/25/11 01/25/12 EACH OCCURRENCE S 1,000,000 X KhNTED PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 6,000 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 171 PEC�RO M LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ B UMBRELLA LIAB EXCESS LIAR OCCUR N / A 57WECDE7880 11/01/11 11/01/12 EACH OCCURRENCE $ FCLAIMS-MADE AGGREGATE $ DEDUCTIBLE RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in If yes, describe under DESCRIPTION OF OPERATIONS below $ WC STATU- OTH- X T Y IT S I I ER $ E.L. EACHACCI $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is named as additional insured. 10 day notice of cancellation may apply for non-payment of premium. r WIWA i r_ nut_ur-r•c CANCELLATION CITYMEN City of Menifee Public Works Dept 29714 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. 1 AUTHORIZED REPRES T IVE Jennifer Kight 1, n ©198 200,p ACORD ORPORATION. ri hts reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks ACORD CGL 1816 0106 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - PRIMARY AND NON-CONTRIBUTORY COVERAGE This endorsement modifies insurance provided under the following: CONTRACTORS LIMITED CLAIMS MADE GENERAL LIABILITY COVERAGE FORM CONTRACTORS LIMITED CLAIMS MADE AND REPORTED GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): I Location(s) Of Covered Operations r A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location 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. It is agreed that the insurance provided for the benefit of the above additional insured(s) shall be primary and non-contributory, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. CGL 1816 0106 Includes copyrighted material of Insurance Services Office, Inc. with its Page 1 of 1 ❑ permission. © ISO Properties, Inc., 2004