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2019/01/01 Geocon West, Inc. Certificate of Liability Insurance
The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PERSTATUTE OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNEDAUTOSAUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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 endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12/26/2018 Cavignac &Associates 450 B Street,Suite 1800 San Diego CA 92101 Certificate Department 619-744-0574 619-234-8601 certificates@cavignac.com Travelers Property &Casualty Company of America 25674 GEOCINC-01 Travelers Property &Casualty Company of AmericaGeoconWest,Inc. 6960 Flanders Drive San Diego,CA 92121 Evanston Insurance Company 35378 1825920084 A X 1,000,000 X 1,000,000 X Cross Liab Incl 10,000 X Sev of Int Incl 1,000,000 2,000,000 X X X Y 6805H920955 1/1/2019 1/1/2020 2,000,000 Deductible 0 B 1,000,000 X XX Y BA3278P130 1/1/2019 1/1/2020 A UB9J123720 1/1/2019 1/1/2020 X 1,000,000 1,000,000 1,000,000 C Professional Liability MKLV7PL0003485 1/1/2019 1/1/2020 Each Claim Aggregate $2,000,000 $5,000,000 Re:Geocon Project #T2833-22-02 /CIP No.19-02 Murrieta Road Resurfacing,Newport Road to McCall Boulevard.Additional Insured coverage applies to General Liability and Automobile Liability for City of Menifee and its officers,employees,agents,and authorized volunteers per policy form.Auto Physical Damage:$500 Comprehensive &Collision Deductible.Professional Liability -Claims made form,defense costs included within limit.Professional Liability Coverage Deductible $100,000 per claim.If the insurance company elects to cancel or non-renew coverage for any reason other than nonpayment of premium they will provide 30 days notice of such cancellation or nonrenewal. 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8,-7)2(367)1)28',%2+)78,)430-'=40)%7)6)%(-8'%6)*900= +)2)6%0496437))2(367)1)28430-'=291&)6,% 3**-')4%' 8,-7)2(367)1)28',%2+)78,)430-'=40)%7)6)%(-8'%6)*900= ;%-:)63*86%27*)63*6-+,873*6)'3:)6=%+%-27838,)678397 8LMWIRHSVWIQIRXQSHMJMIWMRWYVERGITVSZMHIHYRHIVXLIJSPPS[MRK '311)6'-%0+)2)6%00-%&-0-8='3:)6%+)4%68 7',)(90) 2EQISJ4IVWSRSV3VKERM^EXMSR %R]TIVWSRSVSVKERM^EXMSRXLEX]SYLEZIEKVIIHMRE[VMXXIRGSRXVEGXSV EKVIIQIRXXS[EMZI]SYVVMKLXSJVIGSZIV]EKEMRWXFYXSRP]JSVTE]QIRXW [IQEOIFIGEYWISJ &SHMP]MRNYV]SVTVSTIVX]HEQEKIXLEXSGGYVWSV 4IVWSREPMRNYV]SVEHZIVXMWMRKMRNYV]GEYWIHF]ERSJJIRWI GSQQMXXIHEJXIV]SYLEZII\IGYXIHXLEXGSRXVEGXSVEKVIIQIRX -JRSIRXV]ETTIEVWEFSZIMRJSVQEXMSRVIUYMVIHXSGSQTPIXIXLMW IRHSVWIQIRX[MPPFIWLS[RMRXLI(IGPEVEXMSRWEWETTPMGEFPIXSXLMW IRHSVWIQIRX 8LI86%27*)63*6-+,873*6)'3:)6=%+%-27838,)678397'SRHMXMSR7IGXMSR -:'311)6'-%0+)2)6%00-%&-0-8='32(-8-327 MWEQIRHIHF]XLIEHHMXMSRSJ XLIJSPPS[MRK ;I[EMZIER]VMKLXSJVIGSZIV][IQE]LEZIEKEMRWXXLITIVWSRSV 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