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2018/08/16 Road Works, Inc. Certificate of Liability InsuranceA`�►217� CERTIFICATE OF LIABILITY INSURANCE ° TE(M �2019 M/DDNYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 NAME: Andy Manale PHONE (323) 581-4846 Fvc No: (323)581-4844 Manale Insurance Services 817 W. Beverly Blvd. ADORE55:certificates@manaleins.com INSURE S AFFORDING COVERAGE NAIC N Suite 107 INSURER A: Financial Pacific Insurance Co. 31453 Montebello CA 90640 INSURED INSURER B : INSURER C : Road Works, Inc. INSURER D : INSURER E: 303 Short Street INSURERF: Pomona CA 91768 COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 U R POLICY NUMBER POLICY EFF MM/DD POLICY EXP MMIDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1, 000 , 000 A CLAIMS -MADE OCCUR D PREMISES Ea WPID A R occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 X 60477177 8/16/2018 8/16/2019 PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: I GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY ❑ JECT 17 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Employee Benefits $ OTHER' AUTOMOBILE LIABILITY IN Ea BD SINGLE LI I wd $ 1,000,000 BODILY INJURY (Per person) $ `a' X ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS 60477177 8/16/2016 8/16/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Paraocldanl $ NON -OWNED HIREDAUTOS AUTOS Uninsured matodel combined a to $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 2,000,000 A EXCESS LIAR CLAIMS -MADE 60477177 8/16/2018 8/16/2019 X DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N/A E.L DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ A Business Personal Property 60477177 8/16/2018 8/16/2019 Limit $654,600 Inland Marine 60477177 B/16/2018 8/16/2019 Limit $97,544 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of Menifee, its officers, agents, and employees are named additional insured with respects to General Liability CERTIFICATE HOLDER CANCELLATION City of Menifee 29844 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 Manale/VH (Judy J%u..txC/ ©1988-2014 ACORD CORPORATION- All rights reserved. ACORD 25 (2014/01) INS025 (201401) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 60477177 CG 20 10R 12 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (WITH LIMITED COMPLETED OPERATIONS COVERAGE) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESSOWNERS COVERAGE FORM SCHEDULE NAME OF PERSON OR ORGANIZATION Any person or organization to whom or to which the named insured is obligated by a virtue of a written contract to provide insurance that is afforded by this policy. Where required by contract, the officers, officials, employees, directors, subsidiaries, partners, successors, parents, divisions, architects, surveyors and engineers are included as additional insureds. All other entities, including but not limited to agents, volunteers, servants, members and partnerships are included as additional insureds, if required by contract, only when acting within the course and scope of their duties controlled and supervised by the primary (first) additional insured. If an Owner Controlled Insurance Program is involved, the coverage applies to off - site operations only. If the purpose of this endorsement is for bid purposes only, then no coverage applies. WHO IS AN INSURED: (Section II) This section is amended to include as an insured the person or organization within the scope of the qualifying language above, but only to the extent that the person or organization is held liable for your acts or omissions in the course of "your work" for that person or organization by or for you. The "products - completed operations hazard" portion of the policy coverage as respects the additional insured does not apply to any work involving or related to properties intended for residential or habitational occupancy (other than apartments). This clause does not affect the "products - completed operations" coverage provided to the named insured(s). WAIVER OF SUBROGATION: We waive any right of recovery, when required by written contract, that we may have against the person or organization within the scope of the qualifying language above because of payments we make for injury. LOCATION OF JOB: The job location must be within the State of domicile of the named insured, or within any contiguous State thereto. DESCRIPTION OF WORK: The type of work performed must be that as described under classifications in the CGL Coverage Part Declarations. PRIMARY CLAUSE: When this endorsement applies and when required by written contract, such insurance as is afforded by the general liability policy is primary insurance and other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. EXCLUSION This insurance provided to the additional insured does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering or failure to render any professional services, including: 1. The preparing, approving, or failing to prepare or approve, maps, designs, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. Endorsement EFFECTIVE DATE: SEE DEC Endorsement EXPIRATION DATE: SEE DEC CG 201011112 11 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission ~� 0 DATE (MMIDD/YYYY) AC"RU CERTIFICATE OF LIABILITY INSURANCE L _ Acct/l: 2530463 7/30/2019 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 ON Willis of Greater Kansas City Inc. PHONE FAx .[Alp, . 844-290�908 Nok- 5700 W 112th Street, Ste. 100 E-MAIL Overland Park, KS 66211 ADDRESS:BBSloerts®IocktonefBnRy.00M A: Ace American Insurance Co. INSURED Barrett Business Services, Inc. UC/F ROAD WORKS, INC. 303 SHORT ST POMONA, CA 91768 CAVFRArF3 CFRTIFICOTF NIiMRFR• REVISION NUMBER' NAIL # 22667 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. 7NSR TYPE OF INSURANCE A L LiR POLICY lY UMBER MM1 LTR D0YYY MMIDOfYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ A CLAIMS -MADE 11 OCCUR pRM75llEMS'i E5 [Ea o9 $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ N AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE HGE__ POLICY PRO- LOC JEGT PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SIR E LIMIT awd t $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAG Psfa 'd t $ _ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA C65212584 12/1/2018 12/1/2019 X STATUTE I ER E.L. EACH ACCIDENT $ 2,000,000 E.L DISEASE - EA EMPLOYEE $ 2,000,000 EL DISEASE -POLICY LIMIT $ 2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Policy State = CA CERTIFICATE HOLDER CANCELLATION CITY OF MENIFEE 29844 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. REPRESENTATIVE 3�_ A/r1;i_ 01988-2014 ACORD COI ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD