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2018/06/15 Copp Contracting, Inc. Certificate of Liability Insurance (3)11 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY)G126'2014 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 Compass Direct insurance Services, Inc. NAIL 1 C Jeremy Steer 13681 Newport Ave., Ste 8 #622 PHONE rnx ..Ha— X* 714-665-8800 j (A+r. No); 71.7-665-98U1 Tustin, CA 2780 _ INSURERS AFFORDING COVERAGE NAIC # www.cdisi.com License #01-116100 INSURER A: Great American Assurance Company 26344 INSURED INSURERB: Everest National Insurance Company 10120 Copp Contracting, Inc. 6751 Stanton Ave INSURERC: Wesco Insurance Com2any 25011 Buena Park CA 90621 JNSURER0: Travelers Casualty Company 41769 INSURER E: AGCS Marine Insurance Company 22837 COVERAGES CFRTIFICATF NIIMI F-P' da-494nr7 RFVISIAN NIIMRFR- 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. ILTR NSR ADDL UBR TYPE OF INSURANCE S POLICY NUMBER POLICY EFF Pw OI r�fy-yyy LIMITS A r COMMERCIAL GENERAL LIABILITY �/ �/ GLP2869852 1111/2018 11/1/2019 EACH OCCURRENCE $I,O00000 J OCCUR CLAIMS -MADE FA_ PREMISES. Ea occurrence $ 50 000 ✓ MED EXP (Anyone person) $ Excluded Owner's/Cont. Pro r PERSONAL & ADV INJURY $1 000 000 $5 000 Ded $2 500 BI Ded GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 7/1EI° C] LOC PRODUCTS - COMP/OP AGG $ 2 OO 000 Em to ee Benlflts $1 00,000 OTHER: C AUTOMOBILE LIABILITY ✓ ✓ �WPP1588321 01 11/1/2018 11/1/2019 Eaagclde�tSlN[3L LIM $1000000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ r HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY D AGE Par accldetd) $ $ r Com rColl De 1 000 1 D UMBRELLA LIAB N OCCUR ✓ ,/ ZUP-81M8816A-18-NF 11/1/2018 11/1/2019 EACH OCCURRENCE $4000000 AGGREGATE $ 4 000 000 ✓ EXCESS LIAB CLAIMS -MADE DEO I I RETENTION $ $ B I WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBEREXCLUE NIA ✓ 7600015069181 6115/2018 6/15/2019 STOAT LITE .ER E.L. EACH ACCIDENT ^' $ 1 000�000 - E.L DISEASE - EA EMPLOYEE $ QD_%(]jM (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E-L. DISEASE - POLICY LIMIT $ 1 000 000 E SML93079179 11/1/2018 11/1/2019 $65,000/ $153,900 ,BPPiBuilding E Equipment Leased Rented or Borrowe SML93079179 11/1/2018 11/1/2019 $100,000 Deductible $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS I 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 (_FRTIFIrATF HOI nFR f'AIiclrl I ATIr)N ClIt Menifee Cityy Of Menifee Road Menifee u Road SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. l 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 48351067 1 18/19 GL AU WC UMB I Nina Lautensch.lager 1 4/26/2019 11:26:38 AM (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 Name of Additional Insured Person(s) or Organ ization(s): Any person or organization that "you" and such person or organiza- tion have agreed in writing in a contract ❑r agreement that such Person or organization be added as an additional insured on "your" policy, but only for "your work" performed during this policy period. Schedule Location and Description of Completed Operations: 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) 48351067 1 1B/19 GL AU WC UMB I Nina Lautenschlaget 1 4/26/2019 11:26:38 AM (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) 98351067 1 18/19 GL AD WC OMB I Nina Lautenschlager 1 4/26/2019 11:26:38 AM (PDT) I Page 5 of 10 Great American Assurance Company GLP2869852 CG 24 04 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: Any person or organization for wham or on whose behalf "you" are performing operations when "you" and such person or organization have agreed in writing in a contract or agreement to waive any right of recovery "we" may have against such person or organization, 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) 48351067 1 10/19 GL AU WC UMB I Nina Lautenschlager 14/26/2019 11:26:38 AM (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 Organ ization(s): Blanket as required by written contract I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 1 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 48351067 1 18/19 GL AU WC OMB I Nina Lautenschlager 14/26/2019 11:26:38 AM (PDT) I Page 9 of 10 Page 1 of 1 0