2017/08/16 Road Works, Inc. Certificate of Liability Insurance (5)1308
FINANCIAL PACIFIC INSURANCE COMPANY POLICY NUMBER: 60477177
PO BOX 73909, CEDAR RAPIDS, IA 52407
ACCOUNT NUMBER.3000294813 (2) COMMERCIAL AUTO
DIRECT BILL —
SSUE DATE 0 8— 0 3— 2 017 D M D REPLACEMENT OF 1308 604771
NAMETDROAD WORKS INC
INSUREDINLAND EQUIPMENT MARINE LLC
AND
a ADDRESS 303 SHORT ST
POMONA CA 91768-3301
v POLICY FROM: 0 8 --16 — 2 01 7
12:01 R_M. Standard time
COMMERCIAL AUTO COVERAGE PART
DECLARATIONS RENEWAL EXTENSION
iENCY & CODE 440379
MANALE INSURANCE SERVICES
817 W BEVERLY BLVD STE 107
I MONTEBELLO CA
TO: 08-16-2018
90640
F' .1 1.1:
M will provide the insurance described in this policy in return for the premium and compliance with all applicable po Icy provisions .
insurance, we will renew this policy if you pay the required renewal premium for each successive policy period, subject to our premiums, rules and forms then in effect.
You must pay us priorto the end of the current policy period or else this policy will terminate after any statutorily required notices are mailed to you. An insufficient funds
check is not considered payment.
BUSINESS DESCRIPTION: CONTRACTOR
FORM OF BUSINESS: _ tndividual _ . Joint Venture _ Partnership X Corporation — Other
ITEM TWO SCHEDULE OF COVERAGE AND COVERED AUTOS
This policy provides only those coverage where a charge is shown in the PREMIUM column below. Each of these coverages will apply only to those "autos" shown as
COVERED AUTOS below. PREMIUM
COVERAGES COVERED AUTO SYMBOLS LIMIT OF INSURANCE
COVERED AUTO LIABILITY 01
UNINSURED MOTORISTS—BT ONLY07
(INCLUDING UNDERINSURED
MOTORISTS)
COMPREHENSIVE 07
COLLISION 07
MISC. SCHEDULED COVERAGES
Premium Charge Forms Advance Premium
SEE UW7002
Other Forms SEE UW7002
PREMIUM FOR THIS COVERAGE PART $ 8,941
Endorsement Adjustment Premium $
This Declarations Page supersedes and replaces any preceding
declarations page bearing the same policy number for this policy
CA 70 41 03 93
$1,000,000
$1,000,000
SEE SUPPLEMENTAL DECLARATIONS
SEE SUPPLEMENTAL DECLARATIONS
SEE SUPPLEMENTAL DECLARATIONS
V4
Charge Forms
BY
4,288
396
927
2,844
486
COMMERCIAL AUTO COVERAGE PART
SCHEDULE OF COVERED AUTOS YOU OWN
Coverage is provided where a premium and a
limit of liability are shown for the coverage.
UNIT NO. YEAR MAKE MODEL
001 1999 ISUZU TRUCK
COVERAGES: LIABILITY PIPIFPB APIPIAFPB MED. PAY.
LIMIT ( 1 )
DEDUCTIBLE
PREMIUM1,282
LOSS
PAYEE
UNIT NO. YEAR MAKE
002 2002 GMC
COVERAGES: LIABILITY
LIMIT (1 )
DEDUCTIBLE
PREMIUM 1,503
LOSS
PAYEE
UNIT NO. YEAR MAKE
COVERAGES:
LIABILITY
LIMIT
(1 )
DEDUCTIBLE
PREMIUM
1,503
LOSS
PAYEE
UNIT NO. YEAR MAKE
COVERAGES: LIABILITY
LIMIT
DEDUCTIBLE
PREMIUM
SS
1308 08-16-2017
POLICY NUMBER: 60477177
ITEM THREE
=HICLE ID NO. COST NEW (R DIUS CLASS TERRITORY
MLE4GTJ7C138XJ600648 175,000 0050 21189 04 103
UM UIM COLLISION (5) TOWING CARGO
(1} (1) COMP (3)
175,000SA 175,000SA
1,000 1,000
132 INC 441 1,395
TOTAL
GARAGING LOCATION PREMIUM
POMONA CA 91768 3,250
77rAOD:EL VEHICLE I➢ NO. COST NEW (INRAMOLES) IUS CLASS TERRITORY
RIES TRC 1GDK7C1C12J506928 175,000 0050 31189 04 103
PYPFPPB APIPIAFP6 MED. PAY. UM UEM
COLLISION (5) TOWING CARGO
(1) (1) COMP(3)
175,000SA 175,000SA
1,000 1,000
132 INC 409 1,295
TOTAL
GARAGING LOCATION PREMIUM
POMONA CA 91768 3,33S
MODEL
PIPIFPB APIPIAFPB MED. PAY
MODEL
PIPIFPB APIPIAFPB MED. PAY.
_HICLE ID NO. COST NEW RADIUS CLASS TERRITORY
(IN MILES)
1GDM7H1M1RJ502287 35,000 0050 31189 04 103
t1M UIM COLLISION (5) TOWING CARGO
(1) (1) COMP (3)
1,000 1,000
132 INC 77 154
GARAGING LOCATION
POMONA
VEHICLE ID NO.
UM UIM
TOTAL
PREMIUM
CA 91768 1,866
COST NEW (I14AD10 5) CLASS TERRITORY
MIL
COLLISION (5) TOWING CARGO
TOTAL
LO
PAYEE
GARAGING LOCATION
PREMIUM
FOOTNOTES:
(4) ACTUAL CASH VALUE OR COST OF REPAIR, WHICHEVER IS LESS MINUS S25
EACH COVERED AUTO FOR LOSS CAUSED BY MISCHIEF OR
ABBREVIATIONS:
AFPB=ADDED FIRST PARTY BENEFITS
PERSONAL INJURY PROTECTION
(A) GUEST PIP
(B) PEDESTRIAN PIP
DEDUCTIBLE FOR
VANDALISM
(5) ACTUAL CASH VALUE OR COST OF REPAIR, WHiCHf=VER IS LESS MINUS THE
APIP=ADDED
COMP -COMPREHENSIVE
FPB=FIRST PARTY BENEFITS
(1) LIMIT STATED IN "ITEM TWO" ON DECLARATIONS PAGE
DEDUCIBLE SHOWN FOR EACH COVERED AUTO
THEFT &WIND; LSP=LIMITED SPECIFIED
PIP -PERSONAL INJURY PROTECTION
(2) LIMIT STATED IN EACH APPLICABLE ENDORSEMENT
{6) F=FIRE; F&T=FIRE & THEFT; FTVV=FIRE,
SA=STATED AMOUNT BASIS
p) ACTUAL CASH VALUE OR COST OF REPAIR,
CAUSE OF LOSS
SCL=SPECIFIED CAUSES OF LOSS
WHICHEVER IS LESS MINUS DEDUCTIBLE SHOWN FOR
(7) PER DISABLEMENT
UIM=UNDERINSURED MOTORISTS
EACH COVERED AUTO BUT NO DEDUCTIBLE APPLIES TO
(8) THEFT INCLUDED
UM -UNINSURED MOTORISTS
LOSS CAUSED HY FIRE OR LIGHTNING
(9) WAIVER OF COLLISION DEDUCTIBLE
CA 70 39 02 16