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2011/04/01 Bureau Veritas North America, Inc. Certificate of Liability Insurance
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ,1ti,5/20„ 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-;IN&URER(S),2.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 Aon Risk Services Northeast, Inc. Parsippany N7 Office CONTACT NAME: PHONE (866) 283-7122 FAX (847) 953-5390 (AIC. No. Ext): (AIC. No.): E-MAIL ADDRESS: 10 Lanidex Center West P.O. BOX 608 INSURER(S) AFFORDING COVERAGE NAIC # Parsippany N7 07054-0608 USA INSURED Bureau Veritas North America, Inc. 11590 W. Bernardo Court, #100 San Diego CA 92127 USA INSURER A: New Hampshire Ins Co 23841 INSURERB: National Union Fire Ins Co of Pittsburgh 19445 INSURER C: Commerce & Industry Ins Co 19410 INSURERD: Granite State Insurance Company 23809 INSURERE: Lexington Insurance Company 19437 INSURER F: GUVtKAUt!N LaKI ll'IGAIIM NL1MKtcK_ b/LJU44h:J1)1iSh RFVISIr7N NItMRFR' 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. Limits shown are as requested TR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDID CY EFF POLICY MM/DD P LIMITS C GENERAL LIABILITY GL 4 1 4 4 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TOR NTED PREMISES Ea occurrence $1,000,000 CLAIMS -MADE x1 OCCUR MED EXP (Any one person) $25 , 000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2 , 000 , 000 POLICY X PRO- X LOC B AUTOMOBILE LIABILITY CA 3377177 04/01/2011 04/01/2012 COMBINED SINGLE LIMIT Ea accident $1,000,000 ADS BODILY INJURY ( Per person) D ANY AUTO CA 3377178 04/01/2011 04/01/2012 ALL OWNED SCHEDULED MA BODILY INJURY (Per accident) AUTOS AUTOS PROPERTY DAMAGE Per accident HIRED AUTOS NON -OWNED 'I AUTOS C X UMBRELLA LIAR X OCCUR BE55053428 04/01/2011 04/01/2012 EACH OCCURRENCE $5,000,000 SIR applies per policy terns & conditions AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION S10, 000 A WORKERS COMPENSATION AND WCO25842303 04/01/2011 04/01/2012 X I WC STATI- OTH- TORY LIMITS ER EMPLOYERS' LIABILITY YIN ADS E.L. EACH ACCIDENT $1,000,000 A' ANY PROPRIETOR/ PARTNER; EXECUTIVE I N/A wc025842304 04/01/2011 04/01/2012 OFFICER/MEMBEREXCLUDED7 (Mandatory in NH) CA E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L- DISFASE-POLICY LIMIT $1,000,000 - E Archit&Eng Prof 12/15/2011 01/01/2013 Each Claim $1,000,000: �026030221 Aggregate $1,000,0001 i DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) L Project: Civil Plan Check. City of Menifee is included as Additional Insured with respect to General Liability and Auto '- Liability policies where required by written contract. A Waiver of Subrogation is granted in favor of Additional Insured on the workers' Compensation policy where required by written contract. The insurance provided shall be primary and any other insurance maintained by the Additional insured is excess and Non -Contributory. See attached Endt. CG20100704, 87950 (10/05), 74434 (10/99) and WC040361. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Meni fee 29714 Haun Road AUTHORIZED REPRESENTATIVE Menifee CA 92586 USA e.XXa�z is%�:u�c c/rfititctD �G�, cJ�za ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD