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2013/04/08 Dekra-Lite Industries, Inc. Certificate of Liability Insurance1 ® .. " a 1/ �`� o CERTIFICATE OF LIABILITY INSURA.NCE� r 'rtu- DATE (MMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO R1614tt 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 E' l8$tI)Xjo, INSURER(S), AUTHORIZED JT� 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 endorsement(s). PRODUCER Spectrum Risk Management 74 Discovery CONTACT NAME: Account Manager Irvine, CA 92618 PHONE (AIC. No. Ext)' A/C No): 949-756-5740 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Golden Eaqle Insurance rati n 10836 www.spectrumrisk.com OC77485 INSURED Dekra-Lite Industries, Inc. INSURER B : 3102 W. Alton Ave. INSURER C INSURER D : Santa Ana CA 92704 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 15990567 REV!Si()N 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 I TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MM/DDYYY /Y POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY P/ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑✓ OCCUR No Deductibles ,/ CBP8903147 4/8/2013 4/8/2014 EACH OCCURRENCE S 1,000,000 PREMISESO(Ea RENTED S 500,000 MED EXP (Any one person) S 10,000 PERSONAL BADVINJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 17 POLICY 7/ PRO LOC PRODUCTS - COMP/OP AGG S 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS No Llability Deductible BA8903247 4/8/2013 4/8/2014 (CEOacic dentSINGLE LIMIT S 1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accident S ,/ s s A UMBRELLA LIAB EXCESS LIAB N OCCUR CLAIMS -MADE CU8903347 4/8/2013 4/8/2014 EACH OCCURRENCE S 2,000,000 AGGREGATE $ 2,000,000 DED RETENTION S NIL Prod/Comp O s Aggreq fe 2,000,000 S S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPR.IETOR/PARTNEPJEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A WC STATU- Ojp- TORY LIMITS E.L. `=^.CH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT I S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Menifee and its officers, employees, agents, and authorized volunteers shall be covered as additionalinsureds per forms attached to the policy when required by written contract, agreement or permit. CERTIFICATE HOLDER CANCELLATION Cltyy of Menifee City Manager 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 q— Alfonso Galvez © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CERT NO.: 15990567 Lea sands 4/9/2013 8:43:10 AM Page 1 of 2 Policy Number: CBP8903147 -- _- ---- Coverage Is Provided in PEERLESS INSURANCE COMPANY - A STOCK COMPANY � Horned Ensured: Agent: Dekra-Lite Industries, Inc. I SPECTRUM RISK MANAGEMENT & INS; Agent Code: •4-295959 Agent Phone: (949)-756-5730 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 Section 11 -- 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". SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION WHEN YOU AND SUCH PERSON OR ORGANIZATION HAVE AGREED IN WRITING IN A CONTRACT, AGREEMENT OR PERMIT THAT SUCH PERSON OR ORGANIZATION BE ADDED AS AN ADD'L INSURED ON YOUR POLICY TO PROVIDE: INSURANCE SUCH AS IS AFFORDED UNDER THIS COVERAGE PART' Location And Description Of Completed Operations: ANY LOCATION AT WHICH YOU PERFONIED WORK DESCRIBED IN WRITING IN THE CONTRACT, AGREEMENT OR PERMIT FUR A PERSON OR ORGANIZATION THAT HAS BEEN QUALIFIED AS AN ADDITIONAL. INSURED IN THIS ENDORSEMENT.. Information required to complete this Schedule, if not shown above, will be shown in the Declarations-. (rISQ Properties, Inc , 2004 CG 20 37 (07104) 10/05/2010 1398318 NN173635 28L19 F'(adlvlpsOG -'0126 tr CERT NO.: 15990567 Lea Sands 9/9/2013 8:43:10 AM Page 2 of 2 GCAFPPN 0000-1222 Page 15