2016/07/09 Gary F. Hoyt Landscape Arch, Inc. Certificate of Liability Insurance07-05-2016 6:33 PM Fax Nino Abad 01
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AC ORLD�
��. CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYYYY)
7/5/2016
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
Cavignac & Associates
450 B Street, Suite 1800
San Diego CA 92101
CONTACT Certificate Department
PHONE 619 744 0574 FAX 619 234 8601
A/C No
EMAIL . certificates@cavignac.com
cavi
@ 9
INSURER(S) AFFORDING COVERAGE
NAIC k
INSURERA:Travelers Property & Casualty Compa
25674
INSURED GARYFHO-01
INSURER B :
INSURER C :
Gary F Hoyt Landscape Arch Inc
Mr. Gary Hoyt
12888 Francine Terrace
INSURER D
INSURER E :
Poway CA 92064
INSURER F
COVERAGES CERTIFICATE NUMBER: 1666808959 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
W VD
POLICY NUMBER
POLICY EFF
MMIDDIYYYY)
POLICY EXP
IMM/DD/YYYYI
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE �X OCCUR
Contractual Liab
Y
6802727L490
7/9/2016
7/9/2017
EACH OCCURRENCE
$1.000.000
Ely
PREMISES Ea.c'urrence
$1:000,000
X
MED EXP (Any one person)
$10:000
X
Separation of In
PERSONAL & ADV INJURY
$11000:000
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY PELT LOC
OTHER:
GENERAL AGGREGATE
$2.000.000
PRODUCTS - COMPjOP AGG
$2,000,000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
AUTOWNED SCHEDULED
AUTS
NON -OWNED
HIRED AUTOS X AUTOS
INCL IN GL
Y
6802727L490
7/9/2016
7/9/2017
Ea accident
$ Included
BODILY INJURY (Per person)
$
BODILY INJURY (Peraccident)
$
X
Per accident
$
X
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DIED I I RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNERIEXECUTIVE F-1
OFFICER/IdEIABER EXCLUDED?
(Mandatory in NH)
Ifyes, describe under
DESCRIPTION OF OPERATIONS below
NIA
UB673SY949
7/9/2016
7/9/2017
PER OTH-
X STATUTE ER
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1.000.000
E.L. DISEASE -POLICY LIMIT
$1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: Newport Road West Widening/CIP No. 15-04. Additional Insured coverage applies to General and Automobile Liability for City of Menifee
per policy form.
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.
REPRESENTATIVE
@ 1988-2014 ACORD CORPORATION. All rights reserved.
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