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2016/06/15 Copp Contracting, Inc. Certificate of Liability Insurance1 ® ACORDO CERTIFICATE OF LIABILITY INSURAN _, DATE,(MMIDD/YYYY) . 10/18/2016 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 COVERAGI�,AFFORDED, BY, THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUl�IC'la. INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 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 *6�e�ns/(orsement.:.;A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER compass Direct Insurance Services, Inc. p 13681 Newport Ave., Ste 8 #622 Tustin, CA 92780 CONTACT NAME: JeremySeltzer PHONED 714-665-9800 aIX No): 714-665-9801 ADDRESS: erem cdisi.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Wesco Insurance Company 25011 www.cdisi.com License #OH 16100 INSURED Copp Contracting, Inc. 6751 Stanton Ave INSURERB: Everest National Insurance Company 10120 INSURERC: INSURER D: Buena Park CA 90621 INSURER E : INSURER F : rrrfPRArGS rFRTIGICATF NIIMRFR• 19dzA7aa 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. INSR LTR OF INSURANCE ADDLSUBRTYPE INSD WVD POLICY NUMBER MM/DDNYYY EXP MMIDD/YYYY LIMITS A V COMMERCIAL GENERAL LIABILITY CLAIMS -MADE �✓ OCCUR Owner's/Cont. Pro / / WPP105128305 11/1/2016 11/1/2017 EACH OCCURRENCE s 1,000,000 PREMISES E.RENTED T� occurrence) S 100,000 ✓ MED EXP (Any one person) $ 5,000 ✓ XCU / Deductible $1,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ✓� ECT D LOC OTHER: GENERAL AGGREGATE s 2,000,000 PRODUCTS -COMP/OPAGG I S 2,000,000 Employee Benifits s 1,000,000 A AUTOMOBILE LIABILITY ✓ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED ✓ AUTOS ONLY ✓ AUTOS ONLY ✓ Comp/Coll De $1 000 ✓ ✓ WPP105128305 11/1/2016 11/1/2017 MBINED (CEO accid..') SINGLELIMIT s 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accident S s UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE $ DED I I RETENTIONS S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE❑ OFFICER/M EMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A ✓ 7600015069161 3/15/201C 6/15/2017 ✓ STATUTE OERH E.L. EACH ACCIDENT s 1,000,000 E.L. DISEASE - EA EMPLOYEE S 1,000,000 E.L. DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Re: PMP 16-03 Patio Homes Neighborhood Street Resurfacing Project City of Menifee, the Agency, its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers are named as additional insured as per attached endorsements, with respects to the operations of the insured as per contract. GtK I It -ILA I L F1ULULK liHlY IiCLLH I IVIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityy of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 29714 Haun Rd ACCORDANCE WITH THE POLICY PROVISIONS. Menifee CA 92586 AUTHORIZED REPRESENTATIVE Jeremy Seltzer ©1988-2015 ACORD CORPORATION. All rights reserves. Copp Contracting, Inc. WPP1051283 05 THIS ENDORSEMENT CHANGES THE POLICY. COMMERCIAL GENERA 2L�IA0BILIT 07 4 PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR CO ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization(s): City of Menifee, the Agency, its elected officials, officers, employees, agents, representatives, consultants, contract employees and Volunteers Locations Of Covered Operation rance as is afforded by this policy It is agreed that such insu for the benefit of the additionalIiinsure insurance all by the be mary insurance, and any ti additional insured(s) shall be excess and noncontributory as respects any claim, loss or liability allegedly arising out of the operations of the named insured, provided loss oevler that this insurance will not apply to any which is determined to be solely the result of the additional insured's negligence or solely the additional insured's re. Information re uired to cod lete this Schedule, if not shown above, will be shown in the Declarations. Section II —Who Is An Insured is amended to B. With respect to the insurance afforded to these A. g additional insureds, the following additional exclu- include as an additional insured the person(s) or ut only sions apply: organization(s) shown in the Schedule, "propertyb I to "bodily injury" or with respect to liability for "bodily injury,,., injury T �� insurance ng after: damage" or "personal and advertising P P y materials, parts or equip - caused, in whole or in part, by: 1. All work, including dent furnished in connection with such work, 1. Your acts or omissions; or on the project (other than service, o(ntenance behalf of 2. The acts or omissions of those acting on your or repairs) to be performed by or on behalf; the additional insured(s) at the location of the in the performance of your ongoing operations for covered operations has been completed; or the additional insured(s) at the location(s) desig- 2 That portion of "your work" out of which the nated above. injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 32935766 1 16/17 GL AU WC I Laura Yardeen 1 10/1B/2016 3:09:30 PM (PDT) I Page 2 of 9 WPP1051283 05 Copp Contracting, Inc. COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Location And Description Of Completed Operations City of Menifee, the Agency, its elected officials, It is agreed that such insurance as is afforded by this officers, employees, agents, representatives, policy for the benefit of the additional insured shown consultants, contract employees and Volunteers shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and noncontributory as respects any claim, loss or liability allegedly arising out of the operations of the named insured, provided however that this insurance will not apply to any claim loss or liability which is de- termined to be solely the result of the additional in- sured's negligence or solely the additional insured's responsibility. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sche- dule of this endorsement performed for that addi- tional insured and included in the "products - completed operations hazard". Page 1 of 1 CG 20 37 07 04 © ISO Properties, Inc., 2004 32435766 1 16/17 GL AU WC I Laura Yardeen 1 10/18/2016 3:09:30 PM (PDT) I Page 3 of 9 WPP1051283 05 Copp Contracting, Inc. COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: City of Menifee, the Agency, its elected officials, officers, employees, agents, representatives, consultants, contract employees and Volunteers I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 32435766 1 16/17 GL AU WC I Laura Yardeen 1 10/16/2016 3:09:30 PM (PDT) I Page 4 of 9 Page 1 of 1 ❑ WPP1051283 05 Copp Contracting, Inc. COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): This endorsement applies only to your projects away from premises owned by or rented to you for which you have certificates of insurance on file at your office. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by 'occur- damages or under Coverage C for medical rences" under Section I — Coverage A, and for all expenses shall reduce the Designated Con - medical expenses caused by accidents under struction Project General Aggregate Limit for Section I — Coverage C, which can be attributed that designated construction project. Such only to ongoing operations at a single designated payments shall not reduce the General Ag- construction project shown in the Schedule gregate Limit shown in the Declarations nor above: shall they reduce any other Designated Con- t. A separate Designated Construction Project struction Project General Aggregate Limit for General Aggregate Limit applies to each des- any other designated construction project ignated construction project, and that limit is shown in the Schedule above. equal to the amount of the General Aggregate 4. The limits shown in the Declarations for Each Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, ex- General Aggregate Limit shown in the Decla- cept damages because of "bodily injury" or rations, such limits will be subject to the appli- "property damage" included in the "products- cable Designated Construction Project Gen - completed operations hazard", and for medi- eral Aggregate Limit. cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 ❑ 32435766 1 16/17 GL AU WC I Laura Yardeen 1 10/18/2016 3:09:30 PM (PDT) I Page 5 of 9 B. For all sums which the insured becomes legally C. obligated to pay as damages caused by "occur- rences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be attri- buted only to ongoing operations at a single des- ignated construction project shown in the Sche- dule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical D. expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 © Insurance Services Office, Inc., 2008 32435766 116/17 GL AU WC I Laura Yardeen 110/18/2016 3:09:30 PM (PDT) I Page 6 of 9 CG 25 03 05 09 ❑ WPP1051283 05 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 11/1/2016 Countersigned By: �; r Named Insured: Copp Contracting, Inc. Authorized Representative) SCHEDULE Name of Person(s) or Organ ization(s): City of Menifee, the Agency„its elected officials, officers, employees, agents, representatives, consultants, contract employees and Volunteers (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section it of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑ 32435766 1 16/17 GL AU WC I Laura Yardeen 1 10/18/2016 3:09:30 PM (PDT) I Page 7 of 9 WPP1051283 05 COMMERCIAL AUTO CA 04 44 03 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Copp Contracting, Inc. Endorsement Effective Date: 11/1/2016 SCHEDULE Name(s) Of Person(s) Or Organization(s): City of Menifee, the Agency, its elected officials, officers, employees, agents, representatives, consultants, contract employees and Volunteers I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Oth- ers To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "ac- cident" or the 'loss" under a contract with that person or organization. CA 04 44 03 10 © Insurance Services Office, Inc., 2009 32435766 1 16/17 GL AU WC I Laura Yardeen 1 10/18/2016 3:09:30 PM (PDT) I Page 8 of 9 Page 1 of 1 ❑ WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION City of Menifee, the Agency, its elected officials, officers, employees, agents, representatives, consultants, contract employees and Volunteers BLANKET WAIVER OF SUBROGATION This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 6/15/2016 Policy No. 7600015069161 Insured: Copp Contracting, Inc. Insurance Company: Everest National Insurance Company Countersigned By: - 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual - 1999. Endorsement No. 001 Premium $ fNCL. 32435766 1 16/17 GL AU WC I Laura Yardeen 1 10/18/2016 3:09:30 PM (PDT) I Page 9 of 9