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2018/12/31 DSRM Cable Construction, Inc. Certificate of Liability Insurance (3)ACC>REP CERTIFICATE OF LIA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY All CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXl BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pol the terms and conditions of the policy, certain policies may require an enc certificate holder in lieu of such endorsement(s). PKUDUGER Robert Bell Insurance Brokers, Inc. 605 East Alvarado Street City of Menifee Suite 200 City Clerk Fallbrook CA 92028 INSURED JAN 0 7 2019 DSRM Cable Construction, Inc 4 San Raphael Place Received Phillips Ranch CA 91766 BILITY INSURANCE DATE(MM/DD/YYYY) 12/13/2018 D CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS END OR ALTER THE COVERAGE AFFORDED BY THE POLICIES :ONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED cy(ies) must he endorsed. If SUBROGATION IS WAIVED, subject to Drsement. A statement on this certificate does not confer rights to the CONTACT NAME: Elizabeth Michel, CISR PHONE t, (760)451-8556 203I FA C Nn: (760)451-8613 -D emichel@robertbellinsurance.com ADDRESS: INSURE S) AFFORDING COVERAGE NAIC # INSURERA:Ohio CasualtyInsurance Co 24074 1NSURERB:America Fire and Casualty Co 24066 INSURER C : INSURER D : INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER:2018 Master 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. ER JA .TR TYPE OF INSURANCE POLCY NUMBER POLICY EFF POLICY EXP MMI00IYYYY 717MfD0lYYYY X COMMERCIAL GENERAL LIABILITY A CLAIMS -MADE a] OCCUR X f I BKO55878322 1 12/31/2018 1 12/31/2019 GEN'LAGGREGATE LIMIT APPLIES PER: X ❑ PRO- ❑ POLICY JECT LOC OTHER: AUTOMOBILE LIABILITY B X ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS —5878322 12/31/2018 12/31/2019 NON -OWNED X HIRED AUTOS E AUTOS X *HA Phys Dmg X UMBRELLA LIAB X OCCUR B40ED EXCESS LIAB CLAIMS -MADE X RETENTION $ 10,000 ESA55878322 12/31/2018 12/31/2019 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ N I A (h4andatory In NH) If yes, describe under OF SCRIPTION OF OPERATIONS below A Installation Floater BK055878322 12/31/2018 12/31/2019 Rented, Leased Equipment DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder 1s an additional insured per the attached CG 88 10 04 13 and CG 85 83 04 13 CERTIFICATE HOLDER CANCELLATION LIMITS EACH OCCURRENCE $ 1,000,000 PREMISES Es Dccumenrs $ 500,000 MED EXP (Any one person) 5 15,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OPAGG $ 2,000,000 Ea accldenl SINGLENED I $ 1, 000, 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ "HA -ACV Less DedualwAn EACH OCCURRENCE $ 5 $1,000 5,000,000 AGGREGATE 5 5,000,000 PER OTH, STATUTE ER S E L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E.L. DISEASE- POLICY LIMIT Installation Lim Jobsite/Catastrophe Deductible S $250,000 $1, 000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 29714 Haun Rd ACCORDANCE WITH THE POLICY PROVISIONS. Menifee, CA 92586 AUTHORIZED REPRESENTATIVE Michael Bell/EM ©1988-2014 ACORD CORPORATION. All rights ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)