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2017/09/16 Bucknam Infrastructure Group, Inc. Certificate of Liability Insurance06/05/2018 (888) 780-5381 (877) 737-8498 Certificate@hanover.com Citizens Ins Co of America Hanover American Ins CoBUCKNAM INFRASTRUCTURE GROUP OBC A399956 03 09/16/2017 09/16/2018 1,000,000 1,000,000 10,000 1,000,000 2,000,000 2,000,000 OBC A399956 03 09/16/2017 09/16/2018 OBC A399956 03 09/16/2017 09/16/2018 WZC A399946 03 09/16/2017 09/16/2018 1,000,000 9,000,000 9,000,000 1,000,000 1,000,000 1,000,000 The City of Menifee, its officers, agents and employees named are an Additional Insured on General Liability pursuant to the terms and conditions of form: 391-1586 (General Liability Supplementary Endorsement). CITY OF MENIFEE ATTN: ACCOUNTS PAYABLE 29714 HAUN ROAD MENIFEE, CA, 92586 A A A B WILLIS OF ILLINOIS, INC. 233 S WACKER DR,SUITE 2000 CHICAGO, IL 60606 INC 3548 SEAGATE WAY SUITE 230 OCEANSIDE CA 92056 31534 36064 X X Y N X X X X X Y N Y N N X X SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. 27+(5 3HUDFFLGHQW (DDFFLGHQW   N / A SUBR WVD ADDL INSD 7+,6,672&(57,)<7+$77+(32/,&,(62),1685$1&(/,67('%(/2:+$9(%((1,668('727+(,1685('1$0('$%29()257+(32/,&<3(5,2' ,1',&$7('127:,7+67$1',1*$1<5(48,5(0(177(5025&21',7,212)$1<&2175$&72527+(5'2&80(17:,7+5(63(&772:+,&+7+,6 &(57,),&$7(0$< %( ,668(' 25 0$< 3(57$,1 7+( ,1685$1&( $))25'(' %< 7+( 32/,&,(6 '(6&5,%(' +(5(,1 ,6 68%-(&7 72 $// 7+( 7(506 (;&/86,216$1'&21',7,2162)68&+32/,&,(6/,0,766+2:10$<+$9(%((15('8&('%<3$,'&/$,06    3523(57<'$0$*( %2',/<,1-85< 3HUDFFLGHQW %2',/<,1-85< 3HUSHUVRQ &20%,1('6,1*/(/,0,7 $872621/< $8726$872621/< 1212:1(' 6&+('8/('2:1(' $1<$872 AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 2)),&(50(0%(5(;&/8'('" (Mandatory in NH) '(6&5,37,212)23(5$7,216EHORZ ,I\HVGHVFULEHXQGHU $1<35235,(7253$571(5(;(&87,9(    (/',6($6(32/,&</,0,7 (/',6($6(($(03/2<(( (/($&+$&&,'(17 (527+67$787(3(5 LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB ($&+2&&855(1&( $**5(*$7(  2&&85 &/$,060$'( '(' 5(7(17,21  352'8&76&20323$** *(1(5$/$**5(*$7( 3(5621$/ $'9,1-85< 0('(;3 $Q\RQHSHUVRQ ($&+2&&855(1&( '$0$*(725(17('35(0,6(6 (DRFFXUUHQFH COMMERCIAL GENERAL LIABILITY &/$,060$'( 2&&85 *(1 /$**5(*$7(/,0,7$33/,(63(5 32/,&<352-(&7 /2& CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD +,5(' $872621/< Willis of Illinois, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA Bucknam Infrastructure Group, Inc. 3548 Seagate Way, Suite 230 Oceanside, CA 92056 Retroactive Date: Full Prior Acts Deductible: $5,000 per claim City of Menifee Attn: Accounts Payable 29714 Haun Road Menifee, CA 92586 06/05/2018 1-877-945-7378 1-888-467-2378 certificates@willis.com Continental Casualty Company 20443 W6426828 A Professional Liability Per Claim:MCH288359767 09/16/2017 09/16/2018 Aggregate: 73680216273541SR ID:BATCH: $2,000,000 $2,000,000 Page 1 of 1 !"#$ %%&’( )*+ !"#$ $ %%&’ ! % " &’( !"#$ $ )*+, &-,!!% ./ ’! "!"0 !’ # "% ’,1%2 3 2, ,##2 !!’,"% ,# "4 "#%#!!5!, %2$!’!#$ " "$!’ ),+2 &00%! )-+ !!"0 #! 6 #%!2 !"! " !!% "1!1$( )*+%2!##%7#12 %!&8! ),+*%%11!! !" &"2 !6 12"!"0 !’##$ " !!% )-+##%! #!21! ! 6 12&"!"0& !’# ).+*%% 1 1! ! 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