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2014/12/01 Chrisp Company Certificate of Liability Insurance (3)ACc7R�® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 1 12/3/2014 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 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 endorsements . PRODUCER Arthur J. Gallagher & Co. Insurance Brokers of CA, Inc. LIC #0726293 3697 Mt. Diablo Blvd., Suite 300 CONTACT De NAME: Certificate Department PHONE . 925-late 925- 2 FAX N ; 925-953-6270 EMAIL . C nests a com q @ 19 INSURERS AFFORDING COVERAGE NAIC # Lafayette CA 94549 INSURERA:Old Republic General Insurance Corp24139 INSURED INSURERB:Natlonal Union Fire Ins Co Plttsbur 19445 Chrisp Company 43650 Osgood Road Fremont, CA 94539 INSURERC: INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1714803711 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 INSD WVD POLICY NUMBER POLICY EFF MM/DD POLICY IXP MM/DD LIMBS A X COMMERCIAL GENERAL LIABILITY Y Y AlCG99131404 2/1/2014 12/1/2015 EACH OCCURRENCE $1,000,000 CLAIMS -MADE �X OCCUR DAMAGES( RENTED PREMISES Ea occurrence) $50,000 X MED EXP (Any one person) $5,000 BI/PD: $10,000 X DED/OCC PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO-- LOC PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY Y AlCA99131404 2/1/2014 12/1/2015 BNEDY Eaaccident I I NGLE I $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO AUTOS NED AUTOSULD BODILY INJURY (Per accident) $ NON-OWNED HIRED AUTOS FAUTOS X PROPERTY DAMAGE Per acc dent $ B X UMBRELLA LIAR X OCCUR BE049130709 2/1/2014 12/1/2015 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION$10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N Y AlCW99131404 12/1/2014 12/1/2015 X I PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTNE E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 (See attached suppl. page) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Chrisp Job #: 2M.4555 I RE: NEWPORT ROAD AND MENIFEE ROAD PROJECT, MENIFEE, CA. ADDITIONAL INSURED(S): City of Menifee, its respective elected and appointed officers, directors, officials, employees, agents and volunteers. CERTIFICATE HOLDER CANCELLATION CITY OF MENIFEE 29714 HAUN ROAD MENIFEE CA 92586 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 004225 POLICY NUMBER: AlCG99131404 COMMERCIAL GENERAL LIABILITY CG20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Where required by written contract. Location(s) Of Covered Operations Where required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A 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", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or '.property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations: whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All terms and conditions apply unless modified by this endorsement. Page 1 of 1 © Insurance Services Office, Inc_, 2012 CG 20 10 0413 004225 POLICY NUMBER: A1Cc;99131404 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ ITCAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Where required by written contract, but only when coverage for Completed Operations is specifically required by that contract. Location and Description Of Completed Operations Where required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. 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". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less_ This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations_ All terms and conditions apply unless modified by this endorsement. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 004225 OLD REPUBLIC GENERAL INSURANCE CORPORATION CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(s) Location(s) of Covered Operations Or Organization(s): As required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other insurance of a like kind available to the person or organization shown in the schedule above unless the other insurance is provided by a contractor other than the person or organization shown in the schedule above for the same operation and job location. If so, we will share with that other insurance by the method described in paragraph 4.c. of Section IV — Commercial General Liability Conditions. All other terms and conditions remain unchanged. Named Insured Chrisp Company Policy Number AlCG99131404 Endorsement No. Policy Period 12/1/14 to 12/1/15 Endorsement Effective Date: 12/1/2014 Producer's Name: Arthur J. Gallagher & Co. Insurance Brokers of CA, Inc. Producer Number: License #0726293 CG EN GN 0029 09 06 004225 POLICY NUMBER: AlCG99131404 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: WHERE REQUIRED BY WRITTEN CONTRACT 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 Page 1 of 1 004225 POLICY #:AlCA9 91314 04 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 ofthe 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: 12 / 01 / 2 014 Countersigned By: Authorized Representative) Named Insured: SCHEDULE Name of Person(s) or Organization(s): (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 II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc_, 1998 004225 POLICY NUMBER: A1CA99131404 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 Named Insured: CHRISP COMPANY Endorsement Effective Date: 12/01/2014 SCHEDULE Name(s) Of Person(s) Or Organization(s): Where required by written contract. 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. All terms and conditions of this policy apply unless modified by this endorsement. CA 04 44 03 10 © Insurance Services Office, Inc., 2009 Page 1 of 1 004225 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WHERE REQUIRED BY WRITTEN CONTRACT This endorsement changes the policy to which it is attached 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 12 / 01 / 14 Policy Na. AICW9 91314 0 4 Endorsement No. 000 Insured CHRISP COMPANY Premium $ Insurance Company OLD REPUBLIC GENERAL INSURANCE CORPORATION WC 00 0313 (Ed. 4-84) 01983 National Council on Compensation Insurance. 004225 CORD® AGENCY CUSTOMER ID: LOC #: AnnITIMIA1 PPUADWQ Cr1-IGI'1111 G AGENCY NAMED INSURED POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: DDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: Additional Information GENERAL LIABILITY: `Additional Insured if required by written contract per attached Form CG20100413 . Additional Insured if required by written contract per attached Form CG20370413 • Coverage is Primary/Non-Contributory if required by written contract per attached CGENGN0029 0906 • Waiver of Subrogation if required by written contract per attached Form CG2404 0509 AUTOMOBILE LIABILITY: • Additional Insured if required by written contract per attached Form CA2048 0299 • Waiver of Subrogation as required by written contract per attached Form CA04440310 WORKERS' COMPENSATION: . Covered States: California, Nevada, Oregon • Waiver of Subrogation if required by written contract per Form WC000313 0484 UMBRELLA LIABILITY: ` Underlying: General Liability, Automobile Liability and Employer's Liability Pang. of ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 004225