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2019/05/01 NV5, Inc. Certificate of Liability InsuranceThe ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PERSTATUTE OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNEDAUTOSAUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 4/14/2019 Cavignac &Associates 450 B Street,Suite 1800 San Diego CA 92101 Certificate Department 619-744-0574 619-234-8601 certificates@cavignac.com Valley Forge Insurance Company 20508 NV5INC0-01 Continental Casualty Co.20443NV5,Inc. 15092 Avenue of Science,Suite 200 San Diego,CA 92128 National Fire Ins.Hartford 20478 Berkley Insurance Company 32603 293666219 A X 1,000,000 X 1,000,000 X Cross Liab/SevIn 15,000 X $0 Deductible 1,000,000 2,000,000 X X X Y Y 6057040530 5/1/2019 5/1/2020 2,000,000 B 1,000,000 X Y Y 6057040575 5/1/2019 5/1/2020 C N Y WC6057040558 5/1/2019 5/1/2020 X 1,000,000 1,000,000 1,000,000 D Professional Liability AEC902912003 5/1/2019 5/1/2020 Each Claim Aggregate $10,000,000 $20,000,000 Re:CIP 13-04 Bradley Road Bridge Design.Additional Insured coverage applies to General and Automobile Liability for City of Menifee,and its officers, employees,agents,and authorized volunteers per policy form.Primary coverage applies to General and Automobile Liability per policy form.Waiver of subrogation applies to General and Automobile Liability and Workers Compensation per policy form.Prof.Liab.-Claims made,defense costs included within limit;Pollution Liability is included in policy form #ADI0510002.If the insurance company elects to cancel or non-renew coverage for any reason other than nonpayment of premium they will provide 30 days notice of such cancellation or nonrenewal. 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3DJH RI ,QVXUHG 1DPHNV5 Global, Inc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lobal, Inc. &RS\ULJKW&1$$OO5LJKWV5HVHUYHG,QFOXGHVFRS\ULJKWHGPDWHULDORI,QVXUDQFH6HUYLFHV2IILFH,QFZLWKLWVSHUPLVVLRQ This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART Information required to complete this Schedule, if not shown above, will be shown in the Declarations. It is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To The Insurer is amended by the addition of the following: Solely with respect to the person or organization shown in the Schedule above, the Insurer waives any right of recovery the Insurer may have against such person or organization because of payments the Insurer makes for injury or damage arising out of the Named Insured’s ongoing operations or your work done under a contract with that person or organization and included in the products-completed operations hazard. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. SCHEDULE Name Of Person Or Organization: Any person or organization against whom you have agreed to waive such right of recovery in a written contract or agreement. Policy No: 6057040530 &1$;; (G $'',7,21$/,1685('(1'256(0(17 ±&2175$&78$/2%/,*$7,21 ,W LV XQGHUVWRRG DQG DJUHHG WKDW WKLV HQGRUVHPHQW DPHQGV WKH %86,1(66 $872 &29(5$*()250 DV IROORZV 6&+('8/( 1DPH RI $GGLWLRQDO ,QVXUHG 3HUVRQ 2U 2UJDQL]DWLRQ AS REQUIRED BY CONTRACT 3DUDJUDSK $:KR ,V $Q ,QVXUHG RI 6HFWLRQ ,,±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±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±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olicy No: 6057040530; 6057040575CUE6076054554 Form No: CNA68021XX (02-2013) Endorsement Effective Date: 05/01/2019 © Copyright CNA All Rights Reserved. It is understood and agreed that: If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificateholders at least 30 days in advance of the date cancellation is effective. If notice is mailed, then proof of mailing to the last known mailing address of the Certificateholder on file with the Agent of Record will be sufficient to prove notice. Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon us or the Agent of Record. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. NOTICE OF CANCELLATION TO CERTIFICATEHOLDERS Policy No: 6057040558; 6057040561 Form No: CC68021A (02-2013) Endorsement Effective Date: 05/01/2019 © CNA All Rights Reserved. It is understood and agreed that: If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificateholders at least 30 days in advance of the date cancellation is effective. If notice is mailed, then proof of mailing to the last known mailing address of the Certificateholder on file with the Agent of Record will be sufficient to prove notice. Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon us or the Agent of Record. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. NOTICE OF CANCELLATION TO CERTIFICATEHOLDERS Policy No. WC6057040558 05/01/2019