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2018/12/15 Haitbrink Asphalt Paving, Inc. Certificate of Liability InsurancecaRo� CERTIFICATE OF LIABILITY INSURANCE J DATE (MMIDDIYYYY) 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 NCONT AMEA°T 6320 Canoga Avenue, 12th Floor PRONE FAx Woodland Hills, CA 91367 N Ertl, 818-598-8900 Arc No 1: 818.598-8910 o Yuen www.venbrook.com CA Lic No. OD80832 INsuRERA: Executive Risk Ind INSURED INSURER B : Federal Insurance Haitbrink Asphalt Paving, Inc. P.O. Box 2379 INSURERC: Navigators S ecia Corona CA 92878 INSURER D INSURER E COVERAGES CERTIFICATE NUMBER: 50229174 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS _TR I TYPE OF INSURANCE A �,/ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F/7 OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY J PECOT- LOC B I AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY HAUTOS ONLY C UM13RELLALIAB N OCCUR EXCESS LIAB CLAIMS -MADE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N A NYPROPRISTOR7 PAR TN EWEXECUTVE OFFICERIMEMBEREXCLUDED? ❑Y NIA rMandatary In NHl 54309863 1 12/15/2018I6/15/2020 Deductible: $5000 12/15/2018 16/15/2020 i LA18EXCZ00VLVIC 1 12/15/2018 6/15/2020 D1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requir *10 day notice of cancellation for non-payment of premium, 30 days for all other. CERTIFICATE HOLDER City of Menifee Enggineering Department 28714 Haun Road Menifee CA 92586 ACORD 25 (2016/03) CANCELLATI REVISION NUMBER- ED NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS D HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRENCE $ 1,000.000 PREMISES Ea occurrence) $ 100,000 MED EXP (Any one n) $ 5,000 PERSONAL BADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 2,000.000 S Ea sBE ccl6. IN LE LIMIT $ 1,000.000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per aecid9Dt1 EACH OCCURRENCE $ 1 000 000 AGGREGATE S1,000.000 5 J SEATVTE ER E L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 0 E.L. DISEASE - POLICY LIMIT _L1 5 1,000 000 ed) 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 Adrianna Padilla ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 50229174 1 18-20 GL/AL/EX/CP CPL;19-20 WC I Adrienne Padilla 1 7/29/2019 3:30:05 PM (PDT) I Page 1 of 1