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2018/08/01 Haitbrink Asphalt Paving, Inc. Certificate of Liability InsuranceACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 12/14/2018 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 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). PRODUCER Venbrook Insurance Services CA Lic OD80832 6320 Canoga Avenue 12th Floor Woodland Hills, CA 91367 NAME:CONTACT HONE Ext 818-598-8900 A/c No: 818-598-8910 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Executive Risk Indemnity Inc 35181 www.venbrook.com CA Lic No. OD80832 INSURED Haitbrink Asphalt Paving, Inc. P.O. Box 2379 INSURERB: Federal Insurance Company 20281 INSURERC: Navigators Specialty Insurance Company 36056 INSURERD: Insurance Company of the West 27847 Corona CA 92878 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 45935358 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. LTR ILT TYPE OF INSURANCE ADDL SUER POLICYNUMBER POLICY MM/DD/YEFF YYY MMIDDYEXP LIMITS A �/ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR 11 54309863 Clty Of M Cif`7 Clerk DEC O 12/15/2018 j nifee oiR v 6/15/2020 EACHOCCURRENCE S1,000.000 PREMISES Ea occurrence $1 CO 000 MED EXP (Any one person) $5 000 PERSONAL & ADV INJURY $1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO ❑ LOC JECT OTHER: GENERALAGGREGATE 52,000,000 PRODUCTS - COMP/OP AGG $2 000.000 $ B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 54309862 Remfv. 2/15/2018 6/15/2020 EOa BI EDtSINGLELIMIT 51 000000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accident S S C HUM13RELLA LIAB EXCESS LIAB ,/ OCCUR CLAIMS -MADE LA18EXCZOOVLVIC 12/15/2018 6/15/2020 EACH OCCURRENCE S1,000, 000 AGGREGATE S1,000,000 DED I I RETENTIONS S D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA I WSD 5030914 02 8/1/2018 8/1/2019 ,/ SPEROTTATUTE ERH E.L. EACH ACCIDENT S1,000,000 E.L. DISEASE - EA EMPLOYEE S1,000,000 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) *10 day notice of cancellation for non-payment of premium, 30 days for all other. CERTIFICATE HOLDER CANCELLATION City of Menifee Engineering Department 28 g14 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 /] / /�rtr�uti�fT�t/ (WH) Adrianna Padilla (/� 91988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 45935358 1 18-20 GL/AL/EX/CP;18-19 WC/CPL I (WH) Adrianna Padilla 1 12/14/2018 1:10:07 PM (PST) I Page 1 of 1 Venbrook Insurance Services CA Lic OD80832 6320 Canoga Avenue 12th Floor Woodland Hills, CA 91367 City of Menifee Engineering Department 28714 Haun Road Menifee CA 92586 MAIL DOCUMENT Certificate of Insurance Delivery by ecertsonlineTm Sender: (WH) Adrianna Padilla Phone: 818-598-8900 Subject: Cert No. 45935358 - Certificate of Liability: Haltbrink Asphalt Paving, Inc. - Date: 12/14/2018 No. of Pages: 2 URL: www.venbrook.com THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTRY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT, OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBYNOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US IMEDIATELY BYTELEPHONE, AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE. Certificate of Insurance Delivered by ecertsonlineTm Insurance Visions, Inc. All rights reserved.