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2018/02/18 L.C. Paving & Sealing, Inc. Certificate of Liability InsuranceACORN® AC� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 9/11/2018 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 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 HARTLEY CYLKE PACIFIC—#0574253 INSURANCE SERVICES, INC. PHONE (619)295-5155 FAX (619)291-0912 (A/C, No, Extl: (AC,No): E-MAIL ADDRESS: ana@ hcpacinsurance.com 2747 UNIVERSITY AVENUE CitY of Menift a INSURER(S) AFFORDING COVERAGE NAIC# SAN DIEGO CA 92104-4068 City Clerk INSURERA:UNITED SPECIALTY INSURANCE CO. INSURED+ p 'y 0 ry L.C. Paving & Sealing, Inc. SEP S d 2018 INSURERB:Nationwide Insurance Co. 23787 INSURERC:TOPA INSURANCE COMPANY 330 Rancheros Drive #208 INSURERD:STARNET INSURANCE COMPANY INSURER E ' San Marcos CA 92069 Received INSURER F: COVERAGES CERTIFICATE NUMBER:CL1891154707 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 TR TYPE OF INSURANCE i N DL'SUBRj POLICY NUMBER MMIDDNYYY), (MM/DDNYYYI I LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [ X OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 X ATNSF1811545 2/18/2018 2/18/2019 PERSONAL & ADV INJURY $ 1,000,000 NGENI AGGREGATE LIMIT APPLIES PER: POLICY PRO F— `� PRO LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT �(E3 accident Is 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ALL OWNED � SCHEDULED AUTOS AUTOS ,I—_�I 1 NON -OWNED HIRED AUTOS i� AUTOS ACP7893877894 COMP DED: $250 2/18/2018 2/16/2019 BODILY INJURY (Per accident) $ I PROPERTY DAMAGE (r accident) $ COLL DED: $500 rPe Medical payments $ 5,000 C UMBRELLA LIAB -- EXCESS LIAB ! X X !OCCUR �' CLAIMS -MADE I XL0020024201 2/18/2018 2/18/2019 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED RETENTIONS $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A BNUWC0138038 9/12/2018 9/12/2019 PER OTH- X �_LSTATUTE I ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 B COMMERCIAL PROPERTY ACP7893877894 2/18/2018 2/18/2019 BPP:$15,700 DED: $500 � INLAND MARINE LEASED/RENTED EQUIP $500 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS / 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 ACORD 25 (2014101) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) F9/11/2018 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 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 JANA CLARK NAME: HARTLEY CYLKE PACIFIC—#0574253 PHONE (619)295-5155 FAX (619)291-0912 _(A/C No Ext): (_A/C �: _ E-MAIL ana@hc acinsurance.com ADDRESS: p INSURANCE SERVICES, INC. 2747 UNIVERSITY AVENUE INSURER(S) 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:STARNET INSURANCE COMPANY 330 Rancheros Drive #208 INSURER E : INSURER F: San Marcos CA 92069 COVERAGES CERTIFICATE NUMBER:CL1891154707 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 I TYPE OF INSURANCE ADDLISUBRI ! POLICY NUMBER POLICY EFF POLICY EXP MMIDD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE �E OCCUR j EACH OCCURRENCE DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 $ 50,000 1 MED EXP (Any one person) $ 5,000 X ATNSF1811545 2/18/2018 2/18/2019 I PERSONAL & ADV INJURY $ 1, 000,000 GENI AGGREGATE LIMIT APPLIES PER: X El' POLICY JE� j I LOC GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 OTHER: I $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X ACP7893B77894 2/18/2018 2/18/2019 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) j $ BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS COMP DED: $250 PROPERTY DAMAGE (Per accident) $ Medical payments $ 5,000 ICOLL DED: $500 C X X UMBRELLA LIAB EXCESS LIAB X I OCCUR CLAIMS -MADE ! XL0020024201 2/18/2018 2/18/2019 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 IDED 1 11 RETENTION $ WORKERS AND EMPLOYE RS' LIABILITY ZANY PROPRIETOR/PARTNER/EXECUTIVE Y Ni D i OFFICER/MEMBER EXCLUDED? (Mandatory in NH) ! If yes, describe under DESCRIPTION OF OPERATIONS below N / A i BNUWC0138038 9/12/2018 9/12/2019 XMPENSATION ISTATUTE EERHEORH E.L. EACH ACCIDENT $ 1,000,0 00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1 000 000 B !COMMERCIAL PROPERTY ACP7893877894 ( 2/18/2018 2/18/2019 BPP:$15.700 DED: $500 j INLAND MARINE i LEASED/RENTED EQUIP $500 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS / 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 ICHAEL HARTLEY/KARI ACORD 25 (2014/01) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 9/11/2018 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 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 JANA CLARK NAME: HARTLEY CYLKE PACIFIC—#0574253 _ PHONE (619)295-5155 IFAx (619)291-0912 _(A/C No Ext): (A/C, No); E-MAIL ADDRESS: ana@hcp acinsurance.com INSURANCE SERVICES, INC. 2747 UNIVERSITY AVENUE _ INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:UNITED SPECIALTY INSURANCE CO. SAN DIEGO CA 92104-4068 INSURED INSURER B :Nationwide Insurance Co. 123787 INSURERC:TOPA INSURANCE COMPANY L.C. Paving & Sealing, Inc. 330 Rancheros Drive #208 INSURERD:STARNET INSURANCE COMPANY INSURER E : INSURERF: San Marcos CA 92069 COVERAGES CERTIFICATE NUMBER:CL1891154707 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 I TYPE OF INSURANCE DLiS 'ADUBR � I POLICY EFF POLICY EXP POLICY NUMBER MMIDD/YYYY MM/DDNYYY , LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X � OCCUR I DAMAGE ( RENTED ,PREMISES Ea occurrence $ 50,000 $ 5,000 X ATNSF1811545 2/18/2018 2/18/2019 MED EXP (Any one person) $ 1,000,000 PERSONAL & ADV INJURY GENT AGGREGATE LIMIT APPLIES PER: $ 2,000,000 GENERAL AGGREGATE X PRO- POLICY PRO I ILOC JECT PRODUCTS $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY (Per person) $ B ALL OWNED SCHEDULED (AUTOS AUTOS ACP7893877894 2/18/2018 2/18/2019 BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS COIF DED: $250 PROPERTY DAMAGE _(Per accident) $ COLL DED: $500 Medical payments $ 5,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE I $ 4,000,000 C X EXCESS LIAB CLAIMS -MADE XL0020024201 j 2/18/2018 2/18/2019 AGGREGATE DED RETENTIONS $ WORKERS COMPENSATIONPER X STATUTE ERH AND EMPLOYERS' LIABILITY Y/ N i I E.L. EACH ACCIDENT $ 1,000,000 D ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? in NH) N / A BNUWC0138038 9/12/2018 9/12/2019 (Mandatory E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICYLIMIT $ 1,000,000 B COMMERCIAL PROPERTY ACP7893877894 1 2/18/2018 2/18/2019 BPP:$15,700 DED: $500 INLAND MARINE I LEASED/RENTED EQUIP $500 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS / 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 t,tK I It -ILA I t HULUtK UANC:tLLA I IUN 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 MICHAEL HARTLEY/KARI ACORD 25 (2014/01) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACC)R& CERTIFICATE OF LIABILITY INSURANCE �.� FDATE(MMID DNYYY) 9/11/2018 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 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 HARTLEY CYLKE PACIFIC-#0574253 PHONE (619)295-5155 FAx (619)291-0912 _(A/C No Ext): A/C No E-MAIL ana@hc acinsurance.com ADDRESS: p INSURANCE SERVICES, INC. _ INSURER(S) AFFORDING COVERAGE NAIC# 2747 UNIVERSITY AVENUE INSURERA:UNITED SPECIALTY INSURANCE CO. SAN DIEGO CA 92104-4068 INSURED INSURER B :Nationwide Insurance Co. 23787 wsURERC:TOPA INSURANCE COMPANY L.C. Paving & Sealing, Inc. 330 Rancheros Drive #208 INSURERD:STARNET INSURANCE COMPANY _INSURER E : San Marcos CA 92069 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1891154707 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 ADDL SUBR'. POLICY NUMBER POLICY EFF POLICY EXP MM/DD/YYYY MM/DD/YYYY 1 LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X I OCCUR GENT AGGREGATE LIMIT APPLIES PER: X 1 POLICY _ JECOT I - LOC OTHER X ATNSF1811545 2/18/2018 EACH OCCURRENCE DAMAGEPREMISESS(RENTED Ea occurrence 2/18/2019 1 MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG I $ 1,000,000 $ 50,000 $ 5,000 $ 1,000,000 $ 2,000,000 $ 2,000,000 $ B AUTOMOBILE i X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS I NON -OWNED I HIRED AUTOS I AUTOS -1 X 11COLL ACP7893877894 COMP DED: $250 DED: $500 2/18/2018 'COMBINED SINGLE LIMIT Ea accident ! BODILY INJURY (Per person) 2/18/2019 BODILYINJURY (Per accident) PROPERTY DAMAGE (Per accident) Medical a menls $ 1,000,000 $ $ $ $ 5,000 C UMBRELLA LIAB OCCUR X EXCESS LIAB CLAIMS -MADE XL0020024201 2/18/2018 12/18/203.9 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED RETENTION$ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE (MOFFICER/MEMBER EXCLUDED? andatory in NH) yes, describe under DESCRIPTION OF OPERATIONS below N / A BNUWC0138038 i X I PER OTH- STATUTE ER E.L. EACH ACCIDENT 9/12/2018 9/12/2019 E.L. DISEASE - EA EMPLOYE E.L. DISEASE - POLICY LIMIT . $ 1,000,000 $ 1,000,000 $ 1,000,000 B I COMMERCIAL PROPERTY INLAND MARINE I I ACP7893877894 2/18/2018 2/18/2019 I BPP: $15,700 DED: $500 LEASED/RENTED EQUIP $500, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / 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 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 ACORD 25 (2014101) NS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ,4CO�Ro® CERTIFICATE OF LIABILITY INSURANCE ATE D9/11/2018 ) 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 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 JANA CLARK NAME: HARTLEY CYLKE PACIFIC—#0574253 PHONE (619)295-5155 FAx (619)291-0912 _(A/C No,_Ext): _ (A/C No): ADDRESS:Jana@ hcpacinsurance.com INSURANCE SERVICES, INC. INSURER(S) AFFORDING COVERAGE NAIC# 2747 UNIVERSITY AVENUE wsURERA:UNITED SPECIALTY INSURANCE CO. SAN DIEGO CA 92104-4068 INSURED INSURERB:Nationwide Insurance Co. 123787 INSURERC:TOPA INSURANCE COMPANY L.C. Paving & Sealing, Inc. 330 Rancheros Drive #208 INSURERD:STARNET INSURANCE COMPANY INSURER E : INSURERF: San Marcos CA 92069 COVERAGES CERTIFICATE NUMBER:CL1891154707 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' ADDLiSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY ! MM/DDNYYY 1 LIMITS A X COMMERCIAL GENERAL LIABILITY II, CLAIMS -MADE I,OCCUR EACH OCCURRENCE DAMAGES(RENTED PREMISES Ea occurrence) $ 1,000,000 $ 50,000 $ 5,000 X ATNSF1811545 2/18/2018 2/18/2019 I MED EXP (Any one person) $ 1,000,000 PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS -COMP/OP AGG �— GEN'LAGGREGATE LIMIT APPLIES PER: X POLICY ^' PRO- LOC ; JECT OTHER: $ 2,000,000 $ 2,000,000 $ j AUTOMOBILE LIABILITY B X ANY AUTO ALL OWNED i'' SCHEDULED AUTOS AUTOS NNONNOSWNED �I HIRED AUTOS j X ACP7893877894 COt� DED: $250 COLL DED: $500 !COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) 2/18/2018 2/18/203.9 BODILY INJURY (Per accident) PROPERTY DAMAGE � (Per accident) Medical payments $ 1 000 000 $ $ $ $ 5,000 C UMBRELLA LIAB X OCCUR X EXCESS LIAB j CLAIMS -MADE XL0020024201 EACH OCCURRENCE AGGREGATE 2/18/2018 1 2/18/2019 $ 4,000,000 $ 4,000,000 DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY iANY PROPRIETOR/PARTNER/EXECUTIVE Y OFFICER/MEMBER EXCLUDED? D i (Mandatory in NH) �� If yes, describe under DESCRIPTION OF OPERATIONS below N / A BNUWC0138038 I 9/12/2018 9/12/2019 STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 B "COMMERCIAL PROPERTY ACP7893877894 2/18/2018 2/18/2019 1 BPP:$15,700 DED: $500 INLAND MARINE LEASED/RENTED EQUIP $500 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addltlonal 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 No. 18-06 & Newport Road and Menifee Road Street Improvements project l:tK I It-IL:A 1 t HULUtK UANUtLLA I IUN 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 HARTLEY/KARI ACORD 25 (2014/01) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACOROP CERTIFICATE OF LIABILITY INSURANCE DATE /11 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 JANA CLARK NAME: HARTLEY CYLKE PACIFIC-#0574253 _PHONNo. Ext): (619)295-5155 ! Nod: (619)291-0912 INSURANCE SERVICES, INC. E-MAIL jana@hcpac.Lnsurance.com ADDRESS: p 2747 UNIVERSITY AVENUE INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:UNITED SPECIALTY INSURANCE CO. SAN DIEGO CA 92104-4068 INSURED INSURERB:Nationwide Insurance Co. I23787 L.C. Paving & Sealing, Inc. INSURERC:TOPA INSURANCE COMPANY 330 Rancheros Drive #208 INSURERD:STARNET INSURANCE COMPANY INSURER E : INSURERF: San Marcos CA 92069 COVERAGES CERTIFICATE NUMBER:CL1891154707 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 � IL,SUBRI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X I OCCUR EACH OCCURRENCE DAMAGE TO RENTED I PREMISES Ea occurrence $ 1,000,000 $ 50,000 $ 5,000 X ATNSF1811545 2/18/2018 2/18/2019 MED EXP (Any one person) $ 1,000,000 PERSONAL & ADV INJURY GEN'L X AGGREGATE LIMIT APPLIES PER: �� PRO - POLICY, JECT 1 1 LOC $ 2,000,000 GENERAL AGGREGATE IPRODUCTS- COMP/OPAGG $ 2,000,000 Is OTHER: AUTOMOBILE LIABILITY B 14 X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS X ACP7893877694 ! COMP DED: $250 i COLL DED: $500 2 18/2018 / 2/18/2019 COMBINED O BINEDtSINGLE LIMIT BODILY INJURY (Per person) S 1,000,000 $ BODILY ) $ PROPERTY DAMAGE Per accident) $ Medical payments S 5,000 uI UMBRELLA LIAB X OCCUR I EACH OCCURRENCE I $ 4,000,000 C X EXCESSLIAB CLAIMS -MADE I XL0020024201 2/18/2018 2/18/203.9 AGGREGATE $ 4,000,000 DED RETENTION$ ($ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE F_. OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A BNUWC0138038 9/12/2018 j 9/12/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 B COMMERCIAL PROPERTY i ACP7893877894 2/18/2018 2/18/2019 BPP:$15,700 DED: $500 INLAND MARINE 1 I LEASED/RENTED EQUIP $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / 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: Sun City Blvd. ADA Improvements - CIP 18-04 I, cm I Ir it -A I r- r1VLUCK L:ANL;tLLA I IUN 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 ICHAEL HARTLEY/KARI ACORD 25 (2014/01) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD