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2019/01/01 Jeff Carpenter, Inc. Certificate of Liability InsuranceAC�RO� JEFFCAR-02 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 5117/2019 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 Armstrong/Robitaille/Riegle Business and Insurance Solutions 830 Roosevelt, Suite 200 Irvine, CA 92620 INSURED Jeff Carpenter, Inc. 1380 Old Oleander Avenue Perris, CA 92571 I idic r o, EXtI: (949) 381-7700 1 (W8. No): (949) 487-6151 INSURER E : United Specialty Insurance Co. 12537 West American Insurance Company 44393 RSUI Indemnity Company .22314 Everest National Insurance Co 10120 COVERAGES CERTIFICATE NUMSFR: Rr-VIslnM IIJl IuFtr—t7- 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. ILTR NSR TYPE OF INSURANCE ADD INSD SUBR POLICY NUMBER PMQDryYYYJ FF POLDI pYEXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I. X OCCUR X ATNSF1984557 5/18/2019 5/18/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 50,000 MED EXP (Any oneperson) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 B AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED Y AUTOS ONLAUTOS HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY IBAW2056385264 2/28/2019 2/28/2020 COMBINED SINGLE LIMIT 1,000,000 X BODILY INJURY Perperson) $ BODILY INJURY Per accident X ROPER DAMAGE Por accint C+ X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE NHA247205 5/18/2019 5/18/2020 EACH OCCURRENCE 8,000,000 AGGREGATE $ 8,000,000 DED I X I RETENTION $ 0 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN FGERIMEMBER EXCLUDED? A anFIdatoryy In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA '7600004179191 1/1/2019 1/1/2020 X PER OITH- E.L. EACH ACCIDENT 1,000,000 E L. DISEASE - EA EMPLOYEE 1,000,000 $ >=4. DISEASE - P011CYLIMIT $ 1,000,000 I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE: Job# BH-03E,H,P Terra Bella Tract# 28206-2 Menifee, Ca. The City Of Menifee is named as an Additional Insured. Coverage provided is primary and non-contributory as required by written contract per the attached forms. The City Of Menifee 39714 Haun Rd. Menifee, CA 92586 I ACORD 25 (2016/03) CANCELLATION 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 ©1988-2015 ACORD CORPORATION All rights reserved. The ACORD name and logo are registered marks of ACORD UNITED SPECIALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 069 02 (04/18) WRAP- UP EXCLUSION (Limited off -site exception) This Exclusion modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to SECTION 1 - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions and SECTION 1 — COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, Paragraph 2. Exclusions of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM; This insurance does not apply to "bodily Injury", "property damage", or "personal and advertising injury" arising out of any project which is insured, in whole or in part, under a Consolidated Insurance Program commonly known as an Owner Controlled Insurance Program, a Contractor Controlled Insurance Program, a Wrap -Up Insurance Program or any other type of insurance program designed to provide liability coverage for parties involved in the development, design, construction, erection, supervision or management of a specific project or projects. This exclusion applies whether or not the Consolidated Insurance Program: 1. Provides coverage identical to that provided by this policy: 2. Has limits adequate to cover all claims; 3. Remains in effect. However, this exclusion does not apply to work performed by you or on your behalf for a project that is insured under a Consolidated Insurance Program if the work is performed away from the premises insured under the Consolidated Insurance Program and that no coverage for this work is found in the Consolidated Insurance Program. This exception to the exclusion does not apply to "bodily injury" or "property damage" which is included in the "products -completed operations hazard". Nothing in this endorsement shall be construed as to grant any products -completed operations coverage. All other terms, conditions and exclusions under the policy are applicable to this Endorsement and remain unchanged. VEN 069 02 (04/18) Page 1 of 1 Policy Number: ATNSF1984557 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or or- ganization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an addi- tional insured on your policy. Such person or or- ganization is an additional insured only with re- spect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are com- pleted. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the render- ing of, or the failure to render, any professional architectural, engineering or surveying ser- vices, including: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sureds) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontrac- tor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER:ATNSF1984557 COMMERCIAL GENERAL LIABILITY CG 2037 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) Location and Description of Completed Op - or Organlzation(s): I erations: When required by written contract As per written contract Excluding new tract work except for work done from "curb to curb" Curb to Curb means All infrastructure Includ- ing utilities and concrete up to the individual property lines, pubic right away and public utility easement. This does not include any work done on the Individual lots. E Information required to complete this Schedule, if not shown above, will be shown in the Declara- tions. Section If — Who Is An Insured is amender) to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insurer) and included in the "products -completed operations hazard". CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 M UNITED SPECIALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 051 00 (01/15) PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Any coverage provided to an Additional Insured shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: 1) a written contract or written agreement specifically requires that this insurance apply on a primary and non-contributory basis; or 2) prior to a loss, you request in writing and we agree that this insurance shall apply on a primary and non-contributory basis. All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. VEN 051 00 (01/15) Page 1 of 1