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2018/11/01 Copp Contracting, Inc. Certificate of Liability Insurance4CQRo® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 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. 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). PRODUCER CDN ACT Cam ass direct Insurance Services, Inc. NAIN� Jeremy Seltzer 13681 Newport Ave., Ste 8 #622 Tustin, CA 92780 PHONE FAx 714-665-9800 c Nn_ 714-665-9801 www.cdisi.com INSURED Copp Contracting, Inc. 6751 Stanton Ave Buena Park CA 90621 License #OH16100 INSURER B : Everest National Insurance Company I 10120 INSURERC: Wesco Insurance Company 25011 INSURER D : Travelers Casualty Company 41769 INSURER E : AGCS Marine Insurance Comoanv 22837 COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE N DLISU 0 POLICY NUMBER MW� CY EFF D/YYYY POLICY EXP MWDDNYYY LIMITS A COMMERCIALGENERAL LIABILITY GLP2869852 11/1/2018 11/1/2019 EACH OCCURRENCE $1000000 CLAIMS -MADE 7 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 50 000 J MED EXP (Any one person) $ Excluded Owner's/Cont_ Pro J $5,000 Ded $2,500 BI Ded PERSONAL&ADV INJURY $ 1,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY ✓❑ JEST LOC $2,000000 PRODUCTS - COMP/OP AGG Em to ee Benifits $1.000 000 OTHER: C AUTOMOBILE LIABILITY ANY AUTO WPP1588321 01 11/1/2018 11/1/2019 OV/ EaMBBBIIN DSdentLINGLELIMIT $1.000000 _ $ BODILY INJURY (Per person) SCHEDULED AN AUTOS ONLY AUTOS PHIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ _ $ BODILY INJURY (Per accident) PROPERTY DAMAGE PB t $ J Cam Coll Oei 000 D UMBRELLALIAB ,/ OCCUR ZUP-81M8816A-18-NF 11/1/2018 11/1/2019 EACH OCCURRENCE $4000000 AGGREGATE $4.000 000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ i B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUC N / A 7600015069191 6/15/2019 6/15/2020 f STATUTE EORH $ 1 000 000 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 000 000 E BPP/Building SML93079179 I 11/1/2018 11/1/2019 $65,000/ $153,900 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Re: City of Menifee Miralago and Lake Pointe Communities Street Resurfacing PMP 19-01 City of Menifee and its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers are hereby added as additional insures but only as respects work done by, for, or on behalf of the named insures GtK I IFIGA I L t1ULULK aT menuep CANGLLLA I IUN City Clerk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CEtyy Hall ACCORDANCE WITH THE POLICY PROVISIONS. 29844 f taun Rd. jUN ' 7 2M Menifee CA 92586 AUTHORIZED REPRESENTATIVE Received Jeremy Seltzer ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 49256332 1 18/19 GL AU WC UMB I Nina Lautenschlager 1 6/12/2019 2:02:04 PM (PDT) I Page 1 of 10 Great American Assurance Company GLP2869852 Copp Contracting, Inc. CG 20 37 (Ed 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 Organ ization(s): Location and Description of Completed Operations: City ofMenifee Per Certificate(s) of Insurance City Hall "Your work" performed during this policy period. Additional Premium: Included 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 damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that Additional Insured and included in the "products -completed operations hazard." Copyright, ISO Properties, Inc, 2004 CG 20 37 (Ed. 07/04) PRO (Page 1 of 1) 49256332 1 18/19 GL AU WC UMH I Nina Lautenschlager 1 6/12/2019 2:02:04 PM (PDT) I Page 3 of 10 3. Any payments made under Coverage A. for damages or under Coverage C. for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. B. For all sums which the Insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents under COVERAGE C. (SECTION 1), which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. any payments made under Coverage A. for damages or under Coverage C. for medical 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 Designated Construction Project General Aggregate Limit. C. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of LIMITS OF INSURANCE (SECTION III) not otherwise modified by this endorsement shall continue to apply as stipulated. Copyright, Insurance Services Office, Inc., 1996 CG 25 03 (Ed. 03/97) PRO (Page 2 of 2) 49256332 1 18/19 GL AU WC DMH I Nina Lautenschlager 1 6/12/2019 2:02:04 PM (PDT) I Page 5 of 10 Great American Assurance Company CG 24 04 GLP2869852 Copp Contracting, Inc. (Ed. 05 09) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 City Hall 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. Copyright, ISO Properties, Inc. 2008 CG 24 04 (Ed. 05/09) PRO (Page 1 of 1) 49256332 1 18/19 GL AU WC UMB I Nina Lautenschlager 1 6/12/2019 2:02:04 PM (PDT) I Page 7 of 10 W PP 1588321 01 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: 11/1/2018 SCHEDULE Name(s) Of Person(s) Or Organization(s): City of Menifee City Hall 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 49256332 1 18/19 GL AU WC GMB I Nina Lautenschlager 1 6/12/2019 2:02:04 PM (PDT) I Page 9 of 10 Page 1 of 1 13 c n� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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. 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). PRODUCER p CONTACT Compass Direct Insurance Services, Inc. NAME: Jeremy Seltzer 13681 Newport Ave., Ste 8 #622 PHONE FAX TUstln, CA 92780 714-665-9800 No): 714-665 9801 e- MAIL _ .. JV1MM/.cdisi.com INSURED Copp Contracting, Inc. 6751 Stanton Ave Buena Park CA 90621 License #01116100 I INSURER(S) AFFORDING COVERAGE I NAIC# I COVFRAGFR CERTIFICATE NUMBER d07FG37'1 RFVISION NIIMRFR- 10120 25011 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 1 TYPE OF INSURANCE ADOL�SUB POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP M/DD/YYYY LIMITS A d COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FA OCCUR Owner's/Cont. Pro GLP2869852 11/1/2018 11/1/2019 EACH OCCURRENCE $1.000000 PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) s Excluded $5,000 Ded $2,500 BI Ded PERSONAL & ADV INJURY $ 1,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JE � LOG GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 Employee Benifits $1,000.000 C IAUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED +� AUTOS ONLY AUTOS ONLY comp/call D �i M WPP158832101 11/1/2018 11/1/2019$B;N✓t SINGLE LIMIT $1000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per accident $ $ D UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE ZUP-81M8816A-18-NF 11/1/2018 11/1/2019 EACH OCCURRENCE 14,000,000 AGGREGATE $4,000,000 DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 7600015069191 6/15/2019 6/15/2020 STATUTE EORH E.L. EACH ACCIDENT $ 1 000.000 E.L. DISEASE - EA EMPLOYEE $ 1 E-L_ DISEASE - POLICY LIMIT $ 1.000 000 E BPP/Building I SML93079179 11/1/2018 11/1/2019 $65,000/ $153,900 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Re: CIP 19-08, Encanto Drive Neighborhoods Street Resurfacing Project City of Menifee City of Menifee and its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers are hereby added as additional insures but only as respects work done by, for, or on behalf of the named insures (,:tKIIVI(,�AIt MULUtK vrcY WI IVItVIIIIL-t! L;ANC;tLLAIIUN City Clerk Cityy of Menifee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE AC't o M eni e `` II THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Menifee CA 92586 Lie) 4 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Jeremy Seltzer ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 49256333 118/19 GL AU WC UMB I Nina Lautenschlager 1 6/12/2019 2:02:04 PM (PDT) I Page 1 of 10 Great American Assurance Company GLP2869852 Copp Contracting, Inc. CG 20 37 (Ed 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 Organ ization(s): Location and Description of Completed Operations: City ofMenifee Per Certificate(s) of Insurance "Your work" performed during this policy period. Additional Premium: Included 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 damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that Additional Insured and included in the "products —completed operations hazard." Copyright, ISO Properties, Inc., 2004 CG 20 37 (Ed. 07/04) PRO (Page 1 of 1) 49256333 1 18/19 GL AU WC UMB I Nina Lautenschlager 1 6/12/2019 2:02:04 PM (PDT) I Page 3 of 10 Any payments made under Coverage A. for damages or under Coverage C. for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. B. For all sums which the Insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents under COVERAGE C. (SECTION 1), which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: t. any payments made under Coverage A. for damages or under Coverage C. for medical 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 Designated Construction Project General Aggregate Limit. C. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of LIMITS OF INSURANCE (SECTION III) not otherwise modified by this endorsement shall continue to apply as stipulated. Copyright, Insurance Services Office, Inc., 1996 CG 25 03 (Ed. 03/97) PRO (Page 2 of 2) 49256333 1 16/19 GL AU WC UMB I Nina Lautenschlager 1 6/12/2019 2:02:04 PM (PDT) I Page 5 of 10 Great American Assurance Company CG 24 04 GLP2869852 Copp Contracting, Inc. (Ed. 05 09) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 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. Copyright, ISO Properties, Inc.. 2008 CG 24 04 (Ed. 05/09) PRO (Page 1 of 1) 49256333 1 16/19 GL AU WC DMB I Nina Lautenschlager 1 6/12/2019 2:02:04 PM (PDT) I Page 7 of 10 WPP1588321 01 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: 11/1/2018 SCHEDULE Name(s) Of Person(s) Or Organization(s): City of Menifee 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 49256333 118/19 GL AU WC UMB I Nina Lautenschlager 16/12/2019 2:02:04 PM (PDT) I Page 9 of 10 Page 1 of 1 13