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2018/12/01 R I C Construction Co, Inc. Certificate of Liability Insurance (3)ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/30/2018 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 have ADDITIONAL INSURED provisions or 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 Patriot Risk & Insurance Services 2415 Campus Drive, Suite #200 Irvine, CA 92612 City of Menifee City Clerk CONTACT NAME: PHONE 949 486-7900 FAX, No: 949 486-7950 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAICtf INSURERA: Middlesex Insurance Company 23434 www.patrisk.com OK07568 INSURED R I C Construction Co. Inc. INSURER B : 10675 E Avenue, Suite #1 INSURERC: INSURERD: Hesperia CA 92345 Received INSURER E : INSURER F : COVFRAGFS CFRTIFICATF NIIMRFR' nGannaaa RFVlQlnAl AIIIMRGo- 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 NUMBER Y EFF POLICPOLICY MM/ D MM/DDI EXP LIMITS A �/ COMM ERCIAL GENERAL LIABILITY CLAIMS -MADE ✓ OCCUR ✓ �/ A0114746004 12/1/2018 12/1/2019 EACH OCCURRENCE $1000000 DAMAGE TO RENTED PREMISES Ea occurrence $ 500 000 MED EXP (Any one person) $ 5 000 PERSONAL & ADV INJURY $ 1 000 000 GEN'L HOTHER: AGGREGATE LIMIT APPLIES PER: POLICY Z PE� LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS $3 000 OOO Employee Benfits $1 000 000 A AUTOMOBILE LIABILITY ✓ ✓ A0114746001 12/1/2018 12/1/2019 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 ✓ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY ✓ AUTOS P BODILY INJURY eraccidenl ( ) $ HIRED NON -OWNED AUTOS ONLY ✓ AUTOS ONLY PROPERTY DAMAGE Per accident $ A �/ UMBRELLA LIAB �/ OCCUR A0114746006 12/1/2018 12/1/2019 EACH OCCURRENCE $5000000 AGGREGATE $ 5 000 000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? N / A ✓ A0114746005 12/1/2018 12/1/2019 f STATUTE 0RH E.L. EACH ACCIDENT $ 1 00O 000 E.L. DISEASE - EA EMPLOYEE $1-000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 000 000 A Leased/Rented & Contractors Eqpt A0114746003 12/1/2018 12/1/2019 Contractor's Equipment: $1,404,617 Leased/Rented Equipment: $50,000 Deductible: $2,500 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, employers, agents, representatives, consultants, contract employees and volunteers are named as additional insured with respects to General Liability on a primary and non-contributory basis per attached endorsement and named insured with respects to Auto Liability per attached endorsement. Waiver of Subrogations apply to General Liability, Auto Liability and Workers Compensation per attached endorsements. 30 days notice of cancellation, 10 days for non-payment of premium. CERTIFICATE HOLDER City of Menifee Attn: Gina Gonzalez, Project Manager Cityy Hall 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 w Dave Jacobson ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 5644638 1 18/19 GLAU/U14B/WC/IH I Annette Romero 1 11/30/2018 3:47:16 PM (PST) I Paoe 1 of 5 R I C Construction Co. Inc. POLICY NUMBER: A0114746004 CO(`>fi['>IJERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDD OO RSEMEW CGS (I COOES THE POLIC V. PLEASE READ ff CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 0413 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 Page 1 of 1 1,A44 A I I to/19 rLAII/11MA/Wr/TM I Anna,— P-- I 11/If) /901A 7.47.1A PM (—T1 I P.— � of S POLICY NUMBER: A0114746001 COMMERCIAL AUTO CA 76 01 0615 THIS EMBO 3SEMEMY CHAVISES THE POLICY. pLEASSE READ 0T CAREFULLY. H UQ o LLD? DDIIFE- SCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or arganization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated. Named Insured: R I C Construction Co. Inc. Endorsement Effective Date: 12/01/2018 SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization you are required to add as an additional insured under a written contract or agreement in effect prior to any accident, injury, loss or damage. Information required to complete this Schedule, if not shown above, will be shown In the Declarations. A. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in: (1) Paragraph A.I. of Section If - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms; or (2) Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. B. Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other auto insurance issued to the person or organization in the schedule under your policy provided that: (1) The person or organization is a Named Insured under such other Insurance; and (2) Prior to the accident" you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the person or organization. CA 76 01 0615 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. POLICY NUMBER: A0114746001 COMBPAERML AUTO CA 04 441013 MS EVADD ORSEMENT CHANGES THE P aOC V. PLEASE RED Off' CAREFULLY. NOAIVERI, OF 7RANSFERI OF RIGHTS OF RECOVERY GAIVIST OTHERS 70 US Q�/MIVER OF OU o ROGATM� This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: R I C Construction Co. Inc. Endorsement Effective Date: 12/01/2018 SCHEDULE Name(s) Of Person(s) Or Organization(s): Any person or organization you are required to add as an additional insured under a written contract or agreement In effect prior to any accident, Injury, loss or damage. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the 'loss" under a contract with that person or organization. CA 04 441013 © Insurance Services Office, Inc., 2011 Page 1 of 1 4Fdd F1A i 1A110 IT /IIMR /W(`/TM i -- , ii 1-7-1A .11 1 -- I — c WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Name Any person or organization from whom you are required to waive your right to recover under a written contract or agreement In effect prior to any loss or damage Address. 10675 E Ave Ste 1 Hesperia, CA 92345-5120 Description of Waiver: Any person or organization from whom you are required to aive your right to recover under a written contract or agreement in effect prior to any loss or damage JobID: City of Menifee and its elected officials, officers, employers, agents, representatives, consultants, contract employees and volunteers 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 12/01/2018 Insured R I C Construction Co. Inc. Insurance Company Middlesex Insurance Company WC 00 03 13 (Ed. 4-84) CO 1983 National Council on Compensation Insurance. Policy No. A0114746005 Endorsement No. Premium Countersigned by'`� Page 1 of 1 5644638 1 18/19 GLAU/UMB/WC/IM I Annette Romero 1 11/30/2018 3:47:16 PM (PST) I Page 5 of 5