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2012/04/01 Bureau Veritas North America, Inc. Certificate of Liability Insurance
City of Menifee JAN 0 7 2013 ACOJz", �___- CERTIFICATE OF LIABILITY INSU E.F692121/2012 (MM/DD/YY1 Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS ICATE 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 Aon Risk Services Northeast, Inc. 199 water Street CONTACT NAME: PRONE 866-283-7122 FAX 847-953-5390 (AIC. No. Ext): (AIC. No.): New York NY 10038-3551 USA E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Bureau Veritas North America, Inc. 10620 Treena Street, Suite 200 San Diego CA 92131 USA INSURER A National Union Fire Ins Co of Pittsburgh 19445 INSURERB: Granite state Insurance Company 23809 INSURERC: Commerce & Industry Ins Co 19410 INSURERD: Insurance Company of the State of PA 19429 INSURER E: AXA Insurance Company i3302K::::] INSURER F: COVERAGES CERTIFICATE NUMBER: 570048527121 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 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 LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD MMIDD LIMITS A GENERAL LIABILITY GL 4 1 4 1 1 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE To PRENTED- REMISES Ea occurrence)$1,000,000 CLAIMS -MADE ❑X OCCUR MED EXP (Any one person) $2 5 , 000 PERSONAL & ADV INJURY $1,000,000 N GENERAL AGGREGATE $2,000,000 N GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2 , 000 , 000 co POLICY X PRO X LOC OO ECT r A AUTOMOBILE LIABILITY CA 3377177 04/01/2012 04/01/2013 COMBINED SINGLE LIMIT $1, 000 , 000 AOS Ea accident) B X ANY AUTO CA 3377178 04/01/2012 04/01/2013 BODILY INJURY (Per person) Z ALL OWNED SCHEDULED MA BODILY INJURY (Per accident) y AUTOS AUTOS HIRED AUTOS NON -OWNED PROPERTY DAMAGE V AUTOS Per accident t: d C X UMBRELLALIAB X OCCUR BE15434257 04/01/2012 04/01/2013 EACH OCCURRENCE $5,000,060 U EXCESS LWB CLAIMS -MADE SIR applies per policy terns & condi ions AGGREGATE $5,000,000 DED I X RETENTION $10, 000 D WORKERS ORKE SCOMPENSAIONAND YIN WCO25842303 04/01/2012 04/01/2013 X TCRS* LIABILITY AS STATLIMIs ERH ANY PROPRIETOR / PARTNER / EXECUTIVE E.L. EACH ACCIDENT $1,000,000 A OFFICER/MEMBEREXCLUDED? NIA WCO25842304 04/Ol/2012 04/Ol/2013 (Mandatory in NH) CA E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1, 000 , 000 E Archit&Eng Prof Pc5001884(13) 01/01/201301/01/2014 Each Claim $1,000,000 SIR applies per policy ter s & condi{ions Aggregate $1,000,000 .416 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: Civil Plan Check. city of Menifee is included as Additional Insured with respect to General Liability and Auto NFF 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. I✓ CERTIFICATE HOLDER CANCELLATION j 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 Menifee AUTHORIZED REPRESENTATIVE 29714 Haun Road Menifee CA 92586 USA �JSLO�L i�GJGditt�!'CD c/ /iLGf�'D� c/ 7lG ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD