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2017/06/09 Inland Empire Construction, Inc. Certificate of Liability InsuranceCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 09/19/2017 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 pollcy(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). PRODUCER 909-824-0293 909-422-1414 ALC Insurance Services ' 1740 E Washington Street Suite C3 Colton CA 92324 CONTACT NAME: Alfonso Costas a"CC Ext: 909ONE -824-0293 FAX No:909-422-1414 E-MAIL - - ADDRESS: PRODUCER CUS ERI INSURER(S) AFFORDING COVERAGE NAIC,Y INSURED 909-473-9066 909-473-9040 Inland Empire Construction, Inc. 2456 Kern Street San Bernardino, CA 92407 INSURER A:Shield Commercial Insurance INSURER e: Mid Century Insurance Co. INSURER C : INSURER D : INsuRERE: INSURER F. GUVkKAGkJ VCICI Irll.Al C �4v aOva�n. 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 DDL UBR POLICY NUMBER POLICYEFF MMIDD/YYYY POLICY EXP MfdIDD1YYYY LIMITS. A GENERAL LIABILITY ✓ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ✓❑ OCCUR ✓ DSI-1258954-00 06/09/2017 06/09/2018 EACH OCCURRENCE $ DAMAGE TOP RENTED PREMISES Ea occurrence $ MED EXP Any one person) $ PERSONAL &ADV INJURY $1,000-000 OENERALAGGREGATE $ PRODUCTS - COMP/OP AGG $O 00 GEN'LAGGREGATELIMITAPPLIESPER PRO- LOC ✓ JECT POLICY D $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIREDAUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accidonl) $ BODILY INJURY (Per pereon) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ . - $ B UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE NIA A A09490878 06/09/2017 06/09/2018 EACH OCCURRENCE. $ AGGREGATE S DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE -OFFICER/MEMBEREXCLUDED? Y (Myandatory In NH) DESCRIPTION OF OPERATIONS below desce under $ TH- ✓ WC ST MIT PR S EL EACH ACCIDENT $ 1,000,0.00 E.L. DISEASE -EA EMPLOYE $1,000,000 E.L. DISEASE- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) Job Description: General Contractor Project: CIP Projects Certificate Holder is named as Additional Insured per company.form SCIS-BAICOM-1 (10/15/15) attached. 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. AUTHORIZED REPRESENTATIVE n iaRR.7nn9 ncnRn CORPORATION. All riahts reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: DSI 1258954 00 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE MEAD IT CA>ht YLJLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - BLANKET COMPLETED OPERATIONS COMMERCIAL WORK ONLY This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or organization(s): Location(s) Of Covered Operations Any Additional Insured Person or Organization Any location of Additional Insured Person or if completed operations coverage is required by Organization where work is performed by you written contract; but only for commercial work if completed operations coverage is required started or completed during the policy period. 'by insured contract "Residential work" is not covered. "Residential work" includes all residential housing, including but not limited to single family homes, apartments, condominiums, townhomes, dormitories, retirement and assisted living facilities. 1. Section II —. Who Is An Insured, paragraph 3 is amended to include, for Coverage A liability only, as an additional insured, the person, entity or organization designated in this endorsement for whom the Named Insured has performed operations only when the Named Insured has agreed with the person, entity or organization in an insured contract to name the person, entity or organization as an additional insured. 2. Such person, entity or organization is only an additional insured with respect to liability for bodily injury or property damage caused, in whole or in part, by your work at the location designated in this endorsement performed for the additional insured under the insured contract and included in the products -completed operations hazard. 3. The insured contract must be currently in effect or become effective during the policy period, be executed prior to the bodily injury or property damage first happening, and be between the Named Insured and the additional insured. 4. The applicable limit of our liability shall not be increased by the inclusion of the additional insured under the policy. 5. We shall have no duty to indemnify the additional insured for damages, claims or any other liabilities arising from actions, inactions, errors or omissions of the additional insured. SCIS-BAICOM-1 © SCIS All rights reserved Form Edition 10/15/15 Page 1 of 2 6. Our duty to contractually indemnify the additional insured under an insured contract shall be limited to that sum derived by applying the percentage of fault of the Named Insured as determined by the trier the trier -of -fact to the total damage sum allocated by the trier -of -fact to the additional insured. Under no circumstances shall we pay more than this proportionate contractual indemnity share. 7. Any contractual indemnity payments made on behalf of any additional insured under an insured contract shall reduce the applicable limits of insurance on a dollar for dollar basis. Any contractual indemnity payments are subject to the terms, conditions and limitations of the policy. 8. This endorsement does not create a duty on our part to defend the additional insured or to participate in, contribute to, or reimburse any person, organization or entity for any fees or expenses incurred in the defense of the additional insured. 9. The following additional provisions apply: Section IV - Conditions, Condition 2. INSURED'S DUTIES IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT of the policy is amended to include: An additional insured under this endorsement shall in addition to complying with all provisions of the policy: (1). Give written notice to us of an occurrence or an offense which may result in a claim or suit within thirty (30) days of notice to the additional insured. (2). Give written notice to us of a claim or suit brought against the additional insured within thirty (30) days of the additional insured being served with the claim or suit. (3). Give written notice to any other insurer who has or may have coverage under its policy or policies for a claim, suit or demand for defense or indemnity within thirty (30) days of the additional insured being served with the claim, suit or demand for defense or indemnity. Such notice must demand the full coverage available under the policy. The additional insured will not take any action to waive or limits such other coverage available to it. (4). Obtain and provide to us copies of each and every policy from each and every insurer identified pursuant to the preceding paragraph. 10. This endorsement is subject to all terms, conditions and exclusions of the policy, which remain unchanged. SCIS-BAICOM-1 Form Edition 10/15/15 Page 2 of 2 © SCIS All rights reserved