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2019/02/18 L.C. Paving & Sealing, Inc. Certificate of Liability InsuranceCERTIFICATE OF LIABILITY INSURANCE DAT() 16/2019 / 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 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 GONTACT JANA CLARK NAME PHONE (619)295-5155 FAXC (619)291-0912 iAlg- Na AINo HARTLEY CYLKE PACIFIC-#0574253 INSURANCE SERVICES, INC. E-MAiL ADDRESS: jana@hcpacinsurance.com 2747 UNIVERSITY AVENUE INSURER S AFFORDING COVERAGE NAIC # INSURER A:UNITED SPECIALTY INSURANCE CO. SAN DIEGO CA 92104-4068 INSURED INSURER B: Nationwide Insurance Co. 23787 INSURERc:TOPA INSURANCE COMPANY L.C. Paving & Sealing, Inc. INSURERD:CLEAR SPRING PROPERTY & CASUALTY CO 620 Alpine Way INSURER E : INSURER F: Escondido CA 92029 COVERAGES CERTIFICATE NUMBER:CL1991660767 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ITR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDD/Y YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE I� OCCUR PREMISS Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 X ATNSF1924018 2/18/2019 2/18/2020 PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO LOC JECT PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SING E IMFT IFa acddont) $ 1,000,000 X BODILY INJURY (Per person) $ B ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS ACP7803877894 2/18/2019 2/18/2020 BODILY INJURY (Per accident) $ HIREDAUTOS NON -OWNED AUTOS P1 COMP DED: $250 PROPERTY DAMAGE Per accident $ Med!Cal payments $ 5,000 I COLL DED: $500 UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 4,000,000 X AGGREGATE $ 4,000,000 C EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ XL0020024202 2/18/2019 2/18/2020 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X OTH- 7 7 7 EL, EACH ACCIDENT $ 1,000,000 D ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N I A CSWK0000002670 9/12/2019 9/12/2020 EL. DISEASE- EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B COMMERCIAL PROPERTY ACP7803877894 2/18/2019 2/18/2020 BPP:$16,200 DED: $500 INLAND MARINE 1 LEASED/RENTED EQUIPMENT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Menifee and its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers are hearby added as additional insured but only as respects work done by, for, or on behalf of the named insured. *10 day notice of cancellation for non-payment of premium shall apply. RE: PW 17-02 ON CALL CONCRETE MAINTENANCE SERVICES CERTIFICATE HOLDER CANCELLATION CFCNANC lFEE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 29714 Haun Rd. ACCORDANCE WITH THE POLICY PROVISIONS. SEP 2 3 2019 Menifee, CA 92586 AUTHORIZED REPRESENTATIVE RECEIVEDIMICHAEL RR,, HARTLEY/KARI T✓ © 1988-2014 ACORD CORPORATION. All rights roserVed. ACORD 25 (2014/01) INS025 (201401) The ACORD name and logo are registered marks of ACORD AC Roy CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY 19 ) 9 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). PRODUCER N ME. JANA CLARK JPHIOAlCNNv Ext: (619)295-5155tFAC NG [ (619)291-0912 HARTLEY CYLKE PACIFIC-#0574253 E-MAIL jana@hcpacinsurance.com ADDRESS: INSURANCE SERVICES, INC. 2747 UNIVERSITY AVENUE INSURERS AFFORDING COVERAGE NAIC # INSURERA:UNITED SPECIALTY INSURANCE CO. SAN DIEGO CA 92104-4068 INSURED INSURER B: Nationwide Insurance Co. 23787 INSURERC:TOPA INSURANCE COMPANY L.C. Paving & Sealing, Inc. INSURERD:CLEAR SPRING PROPERTY & CASUALTY CO 620 Alpine Way INSURER E : INSURERF! Escondido CA 92029 COVERAGES CERTIFICATE NUMBER:CLI991660767 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 iR TYPE OF INSURANCE DL • BR POLICYNUMBER POLICYEFF MM/DDIYYVV POLICYEXP MMfDONYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE OCCUR PDAMAGEr e $ 50,000 MED EXP (Any one person) $ 5,000 X ATNSF1924018 2/18/2019 1 2/18/2020 PERSONAL & ADV INJURY $ 1,000,000 'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $ 2,000,000 ECLOC ❑T F 2,000,000POLICY $ OTHER: AUTOMOBILE LIABILITY OMBI N E D S IN LE LIMI aCodent $ 1,000,000 BODILY INJURY (Per person) $ B %{ ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS X ACP7803877894 2/18/2019 2/18/2020 BODILY INJURY (Per accident) $ NON -OWNED HIREDAUTOS AUTOS cotes DED: $250 PROPERTY DAMAGE Per=Iden $ Medical payments $ 5,000 COLL DED: $500 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 C X EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ XL0020024202 2/18/2019 2/18/2020 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN XP R OTH- T ER E.L EACH ACCIDENT $ 1,000 000 ANY PROPRIETOWPARTNER/EXECUTIVE D OFFICER/MEMBER EXCLUDED? ElN (Mandatory in NH) / A CSWK0000002670 9/12/2019 9/12/2020 E.L DISEASE- FA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below I E. L. DISEASE- POLICY LIMIT $ 1,000,000 B COMMERCIAL PROPERTY ACP7803877894 2/18/2019 2/18/2020 BPP:$16,200 DED: $500 INLAND MARINE LEASED/RENTED EQUIPMENT $500 , 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of Menifee and its elected officials, officers, employees, agents, representatives, consultants, contract employees and voluteers are hearby added as additional insured but only as respects work done by, for, or on behalf of the named insured. *10 day notice of cancellation for non-payment of premium shall apply. RE: CIP No. 15-05, Holland Road Missing Sidewalk CERTIFICATE HOLDER CANCELLATION City of Menifee 29714 Haun Rd. 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 HARTLEY/KARI ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS026 (201401) o® CERTIFICATE OF LIABILITY INSURANCE DATE 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). PRODUCER GONTACT NAME: JANA CLARY PHONE kl (619)295-5155 FAX No): (e19)291-0912 HARTLEY CYLKE PACIFIC—#0574253 ADDRL jana@h acinsurance.com DDREss: � INSURANCE SERVICES, INC. INSURER(S) AFFORDING COVERAGE NAIC 0 2747 UNIVERSITY AVENUE INSURERA:UNITED SPECIALTY INSURANCE CO. SAN DIEGO CA 92104-406B INSURED INSURER B! Nationwide Insurance Co. 23787 INSURERc:TOPA INSURANCE COMPANY L.C. Paving & Sealing, Inc. INSURERD:CLEAR SPRING PROPERTY & CASUALTY CO 620 Alpine Way INSURER E : INSURER F: Escondido CA 92029 COVERAGES CERTIFICATE NUMBER:CL1991660767 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. 1NSR LTR TYPE OF INSURANCE POLICY NUMBER MM/ POLICY D/YYYY MM/ IC/Y Y EXP YYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISE Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 X ATNSF1924018 2/18/2019 2/18/2020 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE S 2,000,000 X POLICY mot F1 LOC PRODUCTS - COMP/OPAGG S 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED 51NGLE LIMIT accident $ 1,000,000F BODILY INJURY (Per person) $ X ANYAUTO B ALL OWNED SCHEDULED AUTOS AUTOS ACP7803877894 2/18/2019 2/1B/2020 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS COMP DED: $250 Medical pa menls $ 5,000 COLL DED: $500 UMBRELLALIAB OCCUR EACH OCCURRENCE $ 9 000 000 X N AGGREGATE $ 4,000,000 C EXCESS LIAB CLAIMS -MADE DEC) RETENTION $ $ XL0020024202 2/18/2019 2/18/2020 WORKERS COMPENSATION X P OTH- TAT 7 ER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ 11000,000 OFFICER/MEMBER EXCLUDED? ❑NIA E.L. DISEASE - EA EMPLOYEE S 1,000,000 D (M andatory in NH) CSWK0000002670 9/12/2019 9/12/2020 If yes, describe under DESCRIPTION OF OPERATIONS be ow.. E.L. DISEASE - POLICY LIMIT $ 1,000,000 B COMMERCIAL PROPERTY ACP7803877894 2/18/2019 2/18/2020 BPP:$16,200 DED: $500 INLAND MARINE LEASED/RENTED EQUIPMENT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Menifee and its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers are hearby added as additional insured but only as respects work done by, for, or on behalf of the named insured. *10 day notice of cancellation for non-payment of premium shall apply. RE: Quail Valley Goetz Road Pedestrian Sidewalk Improvements Project CIP 16-10 CERTIFICATE HOLDER CANCELLATION City of Menifee 29714 Haun Rd. 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 CHAEL HARTLEY/KARI PION. All rights reserved ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) a0 CERTIFICATE OF LIABILITY INSURANCE F DATE(... 019 IYY) 1 9/16/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). PRODUCER NAME: JANA CLARK PH O Na Ext : (619) 295-5155 tAIC N7 (619)291-0912 HARTLEY CYLKE PACIFIC-#0574253 EMAIL ADDRESS: jana@hcpacinsurance.com INSURANCE SERVICES, INC. 2747 UNIVERSITY AVENUE INSURERS AFFORDING COVERAGE NAIC # INSURER A: UNITED SPECIALTY INSURANCE CO. SAN DIEGO CA 92104-4068 INSURED INSURER B: Nationwide Insurance Co. 23787 INSURERC:TOPA INSURANCE COMPANY L.C. Paving & Sealing, Inc. INSURER D: CLEAR SPRING PROPERTY & CASUALTY CO 620 Alpine Way INSURER E INSURERF: Escondido CA 92029 COVERAGES CERTIFICATE NUMBER:CL1991660767 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. TR TYPE OF INSURANCE I POLICY NUMBER MMI ID/YYYY YEXP MMIDDYYY LIMITS X COMMERCIAL GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE�X- OCCUR DAMAGE TO RENTED PREMI S Es occurrence $ 50,000 MED EXP (Any one person) $ 5,000 X ATNSF1924018 2/18/2019 2/18/2020 PERSONAL & ADV INJURY $ 1,000,000 GEMLAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 0 JEC El LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acJd n $ 1,000,000 X BODILY INJURY (Per person) $ B ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS X ACP7803877894 2/18/2019 2/18/2020 BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS coNP DED: $250 PROPERTY DAMAGE Par.1d.nl $ Medical payments $ 5,000 COLL DED: $500 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 X AGGREGATE $ 4,000,000 C EXCESS LIAB CLAIMS -MADE �-'0020024202 DEP I I RETENTION $ $ 2/18/2019 2/18/2020 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X I PER OTH- T T 7 EL. EACH ACCIDENT $ 11000,000 D ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA CSWK0000002670 9/12/2019 9/12/2020 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS belolgr EL DISEASE- POLICY LUv11T $ 1,000,000 B COMMERCIAL PROPERTY ACP7803877694 2/18/2019 2/18/2020 BPP:$16.200 DED: $500 INLAND MARINE LEASED/RENTED EQUIPMENT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace is required) City of Menifee and its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers are hearby added as additional insured but only as respects work done by, for, or on behalf of the named insured. *10 day notice of cancellation for non-payment of premium shall apply. RE: Sun City Blvd. ADA Improvements - CIP 18-04 CERTIFICATE HOLDER CANCELLATION 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 HARTLEY/KARI D 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) INS025 (201401) The ACORD name and logo are registered marks of ACORD A`� oP CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 9/16/2019 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 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 NAME: JANA CLARK HARTLEY CYLKE PACIFIC—#0574253 PHONE Ext (619) 295-5155 FAAXX Na (619)291-0912 INSURANCE SERVICES, INC. E-MAIL jana@hcpacinsurance.com ADOR£SM 2747 UNIVERSITY AVENUE INSURERS AFFORDING COVERAGE NAIC # SAN DIEGO CA 92104-4068 INSURERA:UNITED SPECIALTY INSURANCE CO. INSURED INSURER B: Nationwide Insurance Co. 23787 L.C. Paving & Sealing, Inc. INSURERC:TOPA INSURANCE COMPANY 620 Alpine Way INSURERD:CLEAR SPRING PROPERTY & CASUALTY CO INSURER E : Escondido CA 92029 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1991660767 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 CONTRACTOR 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. I LTR R TYPE OF INSURANCE INSD LWD POLICY NUMBER MM/DEVYYYY MMIDLVYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑X OCCUR PREMISES Ea occurrence S 50,000 MED EXP (Any one person) S 5,000 X ATNSF1924018 2/18/2019 2/18/2020 PERSONAL BADVINJURY $ 1,000,000 GENIAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 X POLICY PRAT El LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY OOM BI IN LIM Ea Occident $ 1,000,000 X BODILY INJURY (Per person) $ 13 ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS X ACP7803877894 2/18/2019 2/18/2020 BODILY INJURY (Per accident) $ PROPERTYDAh1AGE $ NON -OWNED HIRED AUTOS AUTOS COm DED: $250 Medical a mms $ 5,000 COLL DED: $500 UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 4,000,000 AGGREGATE $ 4 .000 000 C X EXCESS LIAB CLAIMS -MADE DED RETFJNTION $ $ XL0020024202 2/18/2019 2/18/2020 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE XPER TH- STATUTE ER E.L EACH ACCIDENT $ 1,000 000 D OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA CSWK0000002670 9/12/2019 9/12/2020 E.LDISEASE- EAEMPLOYEE $ 11000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE- POLICY LIMIT $ 1 000 i 000 B COMMERCIAL PROPERTY ACP7803877894 2/18/2019 2/18/2020 BPP:$16,200 DED: $500 INLAND MARINE LEASED/RENTED EQUIPMENT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) City of Menifee and its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers are hearby added as additional insured but only as respects work done by, for, or on behalf of the named insured. *10 day notice of cancellation for non-payment of premium shall apply. RE: CIP No. 18-06 & Newport Road and Menifee Road Street Improvements project CERTIFICATE HOLDER CANCELLATION 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 CHAEL HARTLEMARI 5 01998-2014 ACORD CORPORATION. All riahts reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) ACC)RV CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 9/16/2019 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 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 CONTACT NAME: JANA CLARK PHOIAIC.N u xt: (619) 295-5155 1 FAX AIC NO: (619)291-0912 HARTLEY CYLKE PACIFIC-#0574253 E-MAILs_jana@hcpacinsurance.com ADDRES INSURANCE SERVICES, INC. INSURERS AFFORDING COVERAGE NAIC N 2747 UNIVERSITY AVENUE INSURER A: UNITED SPECIALTY INSURANCE CO. SAN DIEGO CA 92104-4068 INSURED INSURER 13: Nationwide Insurance Co, 237B7 INSURERC:TOPA INSURANCE COMPANY L.C. Paving & Sealing, Inc. INSURERD:CLEAR SPRING PROPERTY & CASUALTY CO 620 Alpine Way INSURER E: INSURER F: Escondido CA 92029 COVERAGES CERTIFICATE NUMBER:CL1991660767 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 INSR LTR TYPE OF INSURANCE INSD V.VD POUCY NUMBER MMDONYYY ID MMDNYYY LIMITS X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE � OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 X ATNSF1924018 2/18/2019 2/18/2020 PERSONAL & ADV INJURY $ 1,000,000 GENIAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY F_1JECT 7 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY COM 81NED SINGLE LIMIT Ea accldonl $ 1,000,000 BODILY INJURY (Per person) $ B n ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS X ACP7803877894 2/18/2019 2/18/2020 BODILY INJURY (Per accident) $ PROP♦=RTY DAMAGE Per accldenl $ NON -OWNED HIRED AUTOS AUTOS COMP DED: $250 Medical payments $ 5,000 COLL DED: $500 LIAS X OCCUR EACH OCCURRENCE $ 4,000,000 JUMBRELLA X AGGREGATE $ 41000,000 C EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ XL0020024202 2/18/2019 2/18/2020 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N X I PEk OTH- T FR .ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,000,000 D OFFICER/MEMBER EXCLUDED? (Mandatary in NH) ❑ N /A CSWK0000002670 9/12/2019 9/12/2020 E L DISEASE- EA EMPLOYEE $ 11000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ 1,000,000 B COIRHERCIAL PROPERTY ACP7803877894 2/18/2019 2/18/2020 8PP:$16.200 DED: $500 INLAND MARINE LEASED/RENTED EQUIPMENT $500 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Menifee and its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers are hearby added as additional insured but only as respects work done by, for, or on behalf of the named insured. *10 day notice of cancellation for non-payment of premium shall apply. RE: CIP 18-04 - Sun City ADA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 29714 Haun Road ACCORDANCE WITH THE POLICY PROVISIONS. Menifee, CA 92586 AUTHORIZED REPRESENTATIVE ,q MICHAEL HARTLEY/KARI / ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) INS025 (201401) The ACORD name and logo are registered marks of ACORD