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2018/08/28 Dudek Certificate of Liability InsuranceSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 5/20/2019 Hall &Company A/E Insurance Services 19660 10th Ave NE Poulsbo WA 98370 Allison Barga Licesnse #0K93926 360-626-2007 360-626-2007 abarga@hallandcompany.com Zurich American Insurance Company 16535 25 Steadfast Insurance Company 26387Dudek 605 3rd Street Encinitas CA 92024 2077032269 A X 1,000,000 X 100,000 X OCP/XCU/BFPD 10,000 X Cross Liability 1,000,000 2,000,000 X GLO014631102 8/28/2018 8/28/2019 2,000,000 A 1,000,000 X X X BAP014632902 8/28/2018 8/28/2019 A X X 1,000,000AUC0146407028/28/2018 8/28/2019 1,000,000 X 0 A X N WC014633002 8/28/2018 8/28/2019 1,000,000 1,000,000 1,000,000 B Professional Liab Claims Made Contractors Pollution Liab:Occur PEC014631402 8/28/2018 8/28/2019 $1,000,000 Per Claim $2,000,000 Aggregate Re:Annual On Call Professional Services The City of Menifee,its councilmembers,officers,agents,and employees are an Additional Insured on the Commercial General Liability and Auto Liability when required by written contract or agreement regarding activities by or on behalf of the Named Insured.The Commercial General Liability insurance is primary insurance and any other insurance maintained by the Additional Insured shall be excess only and non-contributing with this insurance.A waiver of subrogation applies to the Commercial General Liability,Auto Liability,Umbrella /Excess Liability and Workers Compensation /Employers Liability in favor of the Additional Insured. City of Menifee 29714 Haun Road Menifee CA 92586 GLO014631102 08/28/2018 08/28/2019 08/28/2018 N/A BAP014632902 08/28/2018 08/28/2019 08/28/2018 N/A N/A N/A GLO014631102 08/28/201808/28/2018 08/28/2019 WC014633002 U-CA-103-A CW (10/16) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Blanket Notification To Others Of Cancellation THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy No. BAP 0146329-02 Effective Date: 08/28/2018 This endorsement modifies insurance provided under the: Auto Dealers Coverage Form Business Auto Coverage Form Motor Carrier Coverage Form A. If we cancel this Coverage Part by written notice to the first Named Insured for any reason other than nonpayment of premium, we will deliver electronic notification that such Coverage Part has been cancelled to each person or organization shown in a Schedule provided to us by the First Named Insured. Such Schedule: 1. Must be initially provided to us within 15 days: a. After the beginning of the policy period shown in the Declarations; or b. After this endorsement has been added to policy; 2. Must contain the names and e-mail addresses of only the persons or organizations requiring notification that such Coverage Part has been cancelled; 3. Must be in an electronic format that is acceptable to us; and 4. Must be accurate. Such Schedule may be updated and provided to us by the First Named Insured during the policy period. Such updated Schedule must comply with Paragraphs 2., 3. and 4. above. B. Our delivery of the electronic notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured. Delivery of the notification as described in Paragraph A. of this endorsement will be completed as soon as practicable after the effective date of cancellation to the first Named Insured. C. Proof of e-mailing the electronic notification will be sufficient proof that we have complied with Paragraphs A. and B. of this endorsement. D. Our delivery of electronic notification described in Paragraphs A. and B. of this endorsement is intended as a courtesy only. Our failure to provide such delivery of electronic notification will not: 1. Extend the Coverage Part cancellation date; 2. Negate the cancellation; or 3. Provide any additional insurance that would not have been provided in the absence of this endorsement. E. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the Schedule provided to us as described in Paragraphs A. and B. of this endorsement. All other terms, conditions, provisions and exclusions of this policy remain the same. Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add’l. Prem Return Prem. GLO 0146311-02 08/28/2018 08/28/2019 08/28/2018 64955000 INCL Blanket Notification to Others of Cancellation or Non-Renewal U-GL-1521-A CW (10/12) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. If we cancel or non-renew this Coverage Part by written notice to the first Named Insured, we will mail or deliver notification that such Coverage Part has been cancelled or non-renewed to each person or organization shown in a list provided to us by the first Named Insured if you are required by written contact or written agreement to provide such notification. However, such notification will not be mailed or delivered if a conditional notice of renewal has been sent to the first Named Insured. Such list: 1. Must be provided to us prior to cancellation or non-renewal; 2. Must contain the names and addresses of only the persons or organizations requiring notification that such Coverage Part has been cancelled or non-renewed; and 3. Must be in an electronic format that is acceptable to us. B. Our notification as described in Paragraph A. of this endorsement will be based on the most recent list in our records as of the date the notice of cancellation or non-renewal is mailed or delivered to the first Named Insured. We will mail or deliver such notification to each person or organization shown in the list: 1. Within seven days of the effective date of the notice of cancellation, if we cancel for non-payment of premium; or 2. At least 30 days prior to the effective date of: a. Cancellation, if cancelled for any reason other than nonpayment of premium; or b. Non-renewal, but not including conditional notice of renewal. C. Our mailing or delivery of notification described in Paragraphs A. and B. of this endorsement is intended as a courtesy only. Our failure to provide such mailing or delivery will not: 1. Extend the Coverage Part cancellation or non-renewal date; 2. Negate the cancellation or non-renewal; or 3. Provide any additional insurance that would not have been provided in the absence of this endorsement. D. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the list provided to us as described in Paragraphs A. and B. of this endorsement. All other terms and conditions of this policy remain unchanged. U-WC-100-A CW (10/16) Includes copyrighted material of National Council on Compensation Insurance, Inc. used with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY U-WC-100-A CW (10/16) NOTIFICATION TO OTHERS OF CANCELLATION ENDORSEMENT This endorsement is used to add the following to Part Six of the policy. PART SIX – CONDITIONS F. Notification To Others Of Cancellation 1. If we cancel this policy by written notice to you for any reason other than nonpayment of premium, we will deliver electronic notification to each person or organization shown in a Schedule provided to us by you. Such Schedule: a. Must be initially provided to us within 15 days: After the beginning of the policy period shown in the Declarations; or After this endorsement has been added to policy; b. Must contain the names and e-mail addresses of only the persons or organizations requiring notification that this policy has been cancelled; c. Must be in an electronic format that is acceptable to us; and d. Must be accurate. Such Schedule may be updated and provided to us by you during the policy period. Such updated Schedule must comply with Paragraphs b. c. and d. above. 2. Our delivery of the electronic notification as described in Paragraph 1. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to you. Delivery of the notification as described in Paragraph 1. of this endorsement will be completed as soon as practicable after the effective date of cancellation to you. 3. Proof of e-mailing the electronic notification will be sufficient proof that we have complied with Paragraphs 1. and 2. of this endorsement. 4. Our delivery of electronic notification described in Paragraphs 1. and 2. of this endorsement is intended as a courtesy only. Our failure to provide such delivery of electronic notification will not: a. Extend the policy cancellation date; b. Negate the cancellation; or c. Provide any additional insurance that would not have been provided in the absence of this endorsement. 5. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the Schedule provided to us as described in Paragraphs 1. and 2. of this endorsement. All other terms and conditions of this policy remain unchanged. This endorsement changes the policy to which it is attached and is 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 Policy No. Endorsement No. Insured Premium $ Insurance Company Policy No.Eff. Date of Pol.Exp. Date of Pol.Eff. Date of End.Producer Add'l Prem.Return Prem. Named Insured and Mailing Address:Producer: PEC 0146314-02 08/28/2018 08/28/2019 08/28/2018 64955000 DUDEK 605 3RD ST ENCINITAS, CA 92024-3513 MICHAEL J. HALL & COMPANY 19660 10TH AVE NE POULSBO, WA 98370-7554 ---------- ---------- Blanket Notification to Others of Cancellation THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Agribusiness Pollution Liability Insurance Policy - Claims Made and Reported Coverage Commercial Umbrella Liability Policy Commercial Umbrella Liability Policy – Claims Made and Reported Coverage Contractor’s Pollution Liability Insurance Policy Contractor’s Pollution Liability Insurance Policy - Claims Made and Reported Coverage Environmental Cleanup and Liability Insurance Policy - Claims Made and Reported Coverage Environmental Impairment Liability Insurance Policy - Claims Made and Reported Coverage Environmental Services Package Policy Excess Environmental Insurance Policy - Claims Made and Reported Coverage Follow Form Excess Liability Policy Follow Form Excess Liability Policy – Claims Made and Reported Coverage Healthcare Pollution Liability Insurance Policy - Claims Made and Reported Coverage Lender Environmental Collateral Protection and Liability Insurance Outstanding Loan Balance -Claims Made and Reported Coverage Lender Environmental Collateral Protection and Liability Insurance Policy – Claims Made and Reported Coverage Professional Consultant’s Liability Insurance Policy - Claims Made and Reported Coverage Professional Environmental Consultant’s Liability Insurance Policy Professional Environmental Consultant’s Liability Insurance Policy - Claims Made and Reported Coverage Public Entity Pollution Liability - Claims Made and Reported Coverage Real Estate Environmental Liability Insurance Policy - Claims Made and Reported Coverage Remediation Stop Loss Z Choice Pollution Liability Z Choice® Real Estate Environmental Liability - Claims Made and Reported Coverage Z Choice™ Pollution Liability - Claims Made and Reported Coverage Z Link® Commercial General and Pollution Liability A.If we cancel this policy by written notice to the first Named Insured for any reason other than nonpayment of premium,we will deliver electronic notification that such policy has been cancelled to each person or organization shown in a Schedule provided to us by the First Named Insured. Such Schedule: STF-ENVL-1632-A CW (11/10) Page 1 of 2 1.Must be initially provided to us within 15 days: a.After the beginning of the policy period shown in the Declarations; or b.After this endorsement has been added to policy; 2.Must contain the names and e-mail addresses of only the persons or organizations requiring notification that such Coverage Part has been cancelled; 3.Must be in an electronic format that is acceptable to us; and 4.Must be accurate. Such Schedule may be updated and provided to us by the First Named Insured during the policy period.Such updated Schedule must comply with Paragraphs 2. 3. and 4.above. B.Our delivery of the electronic notification as described in Paragraph A.of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured.Delivery of the notification as described in Paragraph A.of this endorsement will be completed as soon as practicable after the effective date of cancellation to the first Named Insured. C.Proof of emailing the electronic notification will be sufficient proof that we have complied with Paragraphs A.and B.of this endorsement. D.Our delivery of electronic notification described in Paragraphs A.and B.of this endorsement is intended as a courtesy only. Our failure to provide such delivery of electronic notification will not: 1.Extend the Coverage Part cancellation date; 2.Negate the cancellation; or 3.Provide any additional insurance that would not have been provided in the absence of this endorsement. E.We are not responsible for the accuracy,integrity,timeliness and validity of information contained in the Schedule provided to us as described in Paragraphs A. and B. of this endorsement. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. STF-ENVL-1632-A CW (11/10) Page 2 of 2