2008/07/13 Buxton Company Certificate of Liability InsuranceACORU, CERTIFICATE
OF LIABILITY INSURANCE
Y'
0DATE 6/23/2009
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wortham Insurance & Risk Mgt
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1600 West Seventh Street
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Worth, TX 76102-2505
817 336-3030
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURER A: Valley Forge Insurance Company
20508
Buxton Company
INSURERB: Continental Casualty Company
20443
2651 S. Polaris Drive
INSURERc: Federal Insurance Company
20281
Fort Worth, TX 76137
INSURER D: National Fire Insurance Co of H
2O478
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MNI/DD/YY
POLICY EXPIRATION
DATE MM/DD/Y
LIMITS
A
GENERAL LIABILITY
2093358583
07/13/08
07/13/09
EACH OCCURRENCE
$1,000,000
MERCIAL GENERAL LIABILITY
DA11,AGE To RENTED occurrence)
s300 000
MED EXP (Any one person)
$5 000
CLAIMS MADE a OCCUR
4—C101M
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
s2,000,000
GEN-L AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMP/OP AGG
s2,000,000
POLICY PRO-
JECT LOC
D
AUTOMOBILE
LIABILITY
ANY AUTO
P1079708301
07/13/08
07/13/09
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIREDAUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY- EA ACCIDENT
$
OTHER THAN EA ACC
S
ANY AUTO
S
AUTO ONLY: AGG
B
EXCESS/UMBRELLA LIABILITY
P2093460191
07/13/08
07/13/09
EACH OCCURRENCE
$5 000 000
AGGREGATE
$5 00U 000
OCCUR CLAIMS MADE
$
DEDUCTIBLE
$
X RETENTION $ 10000
A
WORKERS COMPENSATION AND
WC2093007771
05/03/09
05/03/10
X WC STATIJ OTH-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
YES
E.L. DISEASE - POLICY LIMIT
$1,000,000
C
OTHER E & O
68017554
11/11/08
11/11/09
3,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
** Workers Comp Information **
Other States Coverage
Proprietors/Partners/Executive Officers/Members Excluded:
Tom Buxton, Chmn
(See Attached Descriptions)
L;LK I_II-IL;A_I E HULUEK CANCELLATION SEE BELOW & PAGE 2
City of Menifee
29714 Haun Road
Sun City, CA 92586
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVE
—rw"tcwrry 17 OTJ FFJ7U3/4t5/My/y4U IULJb 4DAUUKULUKYUKAIIUN1U00
DESCRIPTIONS (Continued from Page 1)
David Glover, CFO
David Rambie, Exec. V.P.
Todd Walls, Sen. V.P.
Harvey Yamagata, Sen. V.P.
Rich Hollander, President
Tim White, Exec VP
Blanket additional and insured Blanket waiver of subrogation coverage is subject to a written contract
between the Named Insured and certificate holder that requires such status on the General Liability and
Auto Liability. Blanket Waiver of subrogation will apply only to the extent provided by law per any
contractual provision on the Workers Compensation. 30 Day Notice of Cancellation except 10 Day Notice for
Cancellation for Non Pay. Umbrella is follow form to the underlying. Primary and Non Contributory coverage
applies to the General Liability.
AMS 25.3 (2001/08) 3 or 3 95103748/M97940