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2017/09/12 L.C. Paving & Sealing, Inc. Certificate of Liability Insurance (4)/ ® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 2/20/2018 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 HARTLEY CYLKE PACIFIC-#0574253 INSURANCE SERVICES, INC. 2747 UNIVERSITY AVENUE SAN DIEGO CA 92104-4068 CONTACT JANA CLARK NAME: PHONE . (619)295-5155 A!C No; (619)291-0912 E-MAIL ADDRESS: j p ana@hc acinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:UNITED SPECIALTY INSURANCE CO. INSURED L.C. Paving & Sealing, Inc. 330 Rancheros Drive #208 San Marcos CA 92069 - INSURERB:Nationwide Insurance Co. 23787 INSURERC:TOPA INSURANCE COMPANY INSURERD:MIDWEST EMPLOYERS CASUALTY CO, INSURER E : INSURERF: COVERAGES CERTIFICATE NUMBER:CL1822050685 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 MM/DDNYYY POLICY EXP MMIDDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X❑QCCUR DAMAGE TO PREMISES EaoccTurrence $ 50,000 MED EXP (Anyone person) $ 5,000 X 17271050B 2/18/2018 2/18/2019 PERSONAL & ADV INJURY $ 1,000,000 GENI AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS $POLICY❑PRO 2,000,000 - X JECT❑LOC $ OTHER: AUTOMOBILE LIABILITY (CEO, accident MBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS ACP7893877894 COMP DED: $500 2/18/2018 2/18/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident $ Medical payments $ 5, 000 COLL DED: $00 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 X AGGREGATE $ 4,000,000 C EXCESS LIAR CLAIMS -MADE DED I I RETENTION$ $ XL660837202 1 2/18/2018 2/18/2019 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN X STATUTE ORH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYE $ 1,000,000 OFFICERIML (Mandatory In ER H)EXCLUDED? (Mandatory In NH)If BNUWC0139038 9/12/2017 9/12/2018 E.L. DISEASE- POLICY LIMIT S 1 000 000 yes, describe underDESCRIPTION OF OPERATIONS below 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, 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: PW 17-02 ON CALL CONCRETE MAINTENANCE SERVICES I.CK I It -ILA 1 r- 11ULUCK I w.. 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 y ACORD 25 (2014/01) INS 025 (201401) U 19BB-ZU14 AUUKU UUFCNUKA I IUN. An rignts reservea. The ACORD name and logo are registered marks of ACORD A� " CERTIFICATE OF LIABILITY INSURANCE DATE M/DD/YYYY) (M 2/20/2018 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 HARTLEY CYLKE PACIFIC-#0574253 INSURANCE SERVICES, INC. 2747 UNIVERSITY AVENUE SAN DIEGO CA 92104-4068 CONTACT JANA CLARK NAME: PHCN o t: (619)295-5155 pC No: (619)291-0912 E-MAIL jana@hcpacinsurance.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA:UNITED SPECIALTY INSURANCE CO. INSURED L.C. Paving & Sealing, Inc. 330 Rancheros Drive #208 San Marcos CA 92069 INSURERB:Nationwide Insurance Co. 23787 INSURERC:TOPA INSURANCE COMPANY INSURERDMIDWEST EMPLOYERS CASUALTY CO, INSURER E INSURERF: COVERAGES , CFRTIFICATE NUMBER:CL18220506E5 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 AD L SUBR POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE OCCUR PRAEMSES GE ToEaoccu ence RENTED $ 50,000 MED EXP (Any one person) $ 5,000 X 17271050B 2/18/2018 2/18/203-9 -PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PRO ❑ LOC JECT $ OTHER: AUTOMOBILE LIABILITY Ea a..,d.n,SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS ACP7893877894 COMP DED: $250 2/18/2018 2/18/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ Medical payments $ 5, 000 LOLL DED: $500 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 X AGGREGATE $ 4,000,000 C EXCESS LIAR CLAIMS -MADE DED I I RETENTION$ $ XL660837202 2/18/2018 2/1B/2019 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY IN ANY PROPRIETOR/PARTNERIEXECUTIVE Y❑ X I STATUTE 'ER' E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - FAEDAPLOYE $ 1, 000, 000 D OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA BNUWC0130038 9/12/2017 9/12/2018 E.L. DISEASE -POLICY LIMIT S 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below 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 I.AN%,CLLA 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 CHAEL HARTLEY/KARI ACORD 25 (2014/01) 1NS025 (201401) V 998S-ZU94 AUUKU UUKI UKA I IUN. All rignTs reserveo. The ACORD name and logo are registered marks of ACORD / ® A � ECERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 2/20/2018 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 HARTLEY CYLKE PACIFIC-#0574253 INSURANCE SERVICES, INC. 2747 UNIVERSITY AVENUE SAN DIEGO CA 92104-4068 CONTACT JANA CLARK NAME: PHCN o E t (619) 295-5155 a�C No: (619)291-0912 E-MAIL ADDRESS: p ana@hc acinsurance.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:UNITED SPECIALTY INSURANCE CO. INSURED L.C. Paving & Sealing, Inc. 330 Rancheros Drive #208 San Marcos CA 92069 INSURERB:Nationwide Insurance Co. 23787 INSURERC:TOPA INSURANCE COMPANY INSURERD:MIDWEST EMPLOYERS CASUALTY CO, INSURER E : INSURERF: COVERAGES , CERTIFICATE NUMBER:CL1822050685 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 iNqn SUBR vivo POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X❑ OCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP (Anyone person) $ 5,000 X 17271050B 2/18/2018 2/18/2019 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 X PRO LOC POLICY ❑ JECT $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS X ACP7893877894 COMP DED: $250 2/18/2018 2/18/2019 BODILY INJURY (Peraccident) $ Pe�accitlantDAMAGE $ Medical payments $ 5,000 COLL DED: $500 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 X AGGREGATE $ 4,000,000 C EXCESS LIAR CLAIMS -MADE DED I I RETENTION$ $ XL660837202 2/18/2018 2/18/2019 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE H X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 )EXCLUDED? ❑ OFFICED (Mandatory (Mandatory -in NH) -in N / A BNUWC0138038- 9/12/2017- 9/12/2018 E.L. DISEASE -POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below B COMMERCIAL PROPERTY ACP7893877894 2/18/2018 2/18/2019 BPP:$15.700 DED: $500 INLAND MARINE LEASEDIRENTED 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 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