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2016/11/15 NPG, Inc AKA: Nelson Paving & Grading, Goldstar Asphalt Products Certificate of Liability InsuranceOP ID: DB ,A C_ "K" CERTIFICATE OF LIABILITY INSURANCE DATE 12/31/2016Y) 12/31 /2016 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 Crosby Insurance, Inc 8181 E. Kaiser Blvd CONTACT - NAME: John Sheffield a/c, o E,t : 714-221-5255 ac No): 714-221-5210 Anaheim Hills, CA 92808 John Sheffield nooRess: jsheffield@crosbyinsurance.com PRODUCER CUSTOMER ID #: NPGCO-J INSURER(S) AFFORDING COVERAGE NAIC # INSURED NPG, Inc. aka: Nelson Paving & Grading, Goldstar Asphalt Products P.O. Box 1515 INSURER A:lronshore Specialty Ins Co INSURER B : General Ins Co of America INsuRERc: Liberty Ins Underwriters INSURER D:ICW Group Perris, CA 92572 INSURER E: Great American Insurance Goup INSURER F : GUVtKAUtb CERTIFICATE NIIMRFR- 0c1/_Q1r%K1 Iv_ Ieerzce. 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 SUB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_1 OCCUR AGS0058703 11/15/2016 11/15/2017 'AMA E TO RENTED PREMISES Ea occurrence $ 50,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRO LOCI POLICY 1XI PRODUCTS - COMP/OP AGG $ 2,000,0010 $ B AUTOMOBILE LIABILITY ANY AUTO 24-CC-206754-0 11/15/2016 11/15/2017 COMBINED SINGLE LIMIT (12accident) $ 1,000,00 X BODILY INJURY (Per person) $ ALL OWNED AUTOS INCL PHYSICAL DAMAGE BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS X PROPERTY DAMAGE (PER ACCIDENT) $ X Comprehensive $ $1,000 de NON-OWNEDAUTOS Hired Phys Dam $50,000 MAXIMUM LIMIT X Collision $ $1,000 de UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 X AGGREGATE $ 5,000,00 C EXCESS LIAB CLAIMS -MADE 100002437207 11/15/2016 11/15/2017 DEDUCTIBLE $ RETENTION $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY �, / N ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDE( N/A WVE502882802 01/01/2017 01/01/2018 WC STATU- 0TH- X TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT It 1,000,00 DESCRIPTION OF OPERATIONS below E EQUIPMENT RENTED 11/15/2016 11/15/2017 Limit 500,00 FROM OTHERS _T1IMP0333772-04 Ded 1,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is require *If cancelled for non-payment of prmeium, only 10 days notice will be given. ?..omd) pcnsation coverage only. Certificates and ** ** Additional Insured cridot�aortxn� previa; Sly SEE ATTACHED CITYMEN City of Menifee City Clerk Office 29714 Huan 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 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). The additional premium for this endorsement shall be otherwise due. Person or Organization ANY PERSON OR ORGANIZATION FOR WHOM THIS WAIVER IS REQUIRED. 3 % of the total California Workers' Compensation premium Schedule Job Description ALL CALIFORNIA OPERATIONS This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 01/01/2017 Policy No. WVE 5028828 02 Endorsement No. Insured NPG INC Premium $ INCL. Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. 8-00) INSURED