2019/02/15 Scorpion Backhoe, Inc. Certificate of Liability Insurance21—Jun-2819 15:58 From: 18552369748
Jun 21 2019 2:51 PM HP Fax
AC<> V CERTIFICATE OF LIA
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENIC
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITV
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the
the terms and conditions of the policy, certain policies may require an e
certificate holder in lieu of such andorsement s .
PRODUCER Neilson S Phillips Insurance Services, Inc.
2208 Plaza Drive
Suite115
Rocklin CA 95765-
INSURED
Scorpion Backhoe, Inc.
P.O. Box 5011
Hemet CA 92544-
To: 19516793843 PA
page 1
BILITY INSURANCE DATE(MM(DOIYYYY)
06/21/2019
f AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
rE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
Poltcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
ndorsement. A statement on this certificate does not confer rights to the
CONTACT David Neilson
PNI❑N=_ . (916)380-5952 FAx ,(916)380-5953
E-MAIL
QnM cer4ficates e@neilson-phillips.com
IH AFFORDING &OVERAGE
MpyC
INs .Financial Pacific Insurance CO
m
1453
.State CompensatiDn Insurance Fund
13507g
IRE .American Zurich Insurance Company
F R
I RE:
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.
ILTR NSR TYPEOFINBURAADDLSUBRNCE .I= Pol
POLICYEFF POLJCY
LIMITS
A X COMMERCIAL GENERAL LIABILITY X X $0472$72 0211512019 2J15/2020 EAcH occuRRENcE 1,000,000
CLAJM"ADE 0 OCCUR DAMAGE TO RENT±_o 100,000
IIII"1111 MED EXP 1Anv5.000
PERSONAL SADV INJURY
$ 1,000,000
i,I'L GEAGCREDATELIMITAPPLIESPER:
POLICY 1E JECT LOC
GEKERALAGGREGATE
S 2.000,000
PRODUCTS-COMPlOPAGG
2,000,000
=L*INGLE LIMIT
$
$ 1,000,000
A
afJTOMOBILELIABILITY
X
X
60472872
2/15/2019
�12/15/2020
ANY AUTO _
ALL OWNED SCHEDULED
BODILY INJURY (Per person)
$
BODILY INJURY (Per aoddent)
$
AUTOS AUTOS
OWNED
IX
HIRED AUTOS _ X • AUTOS
PROPERTY DAMAGE
a
$ 3,000,000
A
UMBRELLALWB I OCCURT711472872
2/15=19
2/1512020
EACH OCCURRENCE
X
EXCESSLIAB CLAIMS -
AGGREGATE
$ 3,00D,ODD
CIFO
X PER 24-
B
NTI N
COMPENSATION
AND EMPLOYERS'
ANDEMPLOYERS' LIABILITY
X
9093256-19
7/01/2019
7/D1/2020
YIN
ANY PROF RIEETO"ARTNERIEXECUTIVE
OFRCEf?,'ME B> R EXCLUDED?
NJA
E.L. EACH ACCIDENT IS1,000,000
iyes, d ory In rHil
it. 6e3Gnbe andsOF
EL. DISEASE - EA EMPLOY 1,000.000
Dr OP4C ;MMONSt)qjow
RentedlLeased Equipment
60472872
02115/2019
E.L. DISEA&E-POLICY T 1.000,00D
2/1512020
Limit: 300.000
Deductible: 1,000
DESCRIPTION OF OPERATIONS (LOCATIONS I VENICLF-s ACORD I01,Addltm*MI Pamitrka &-hadvle, ma Iw atwa?" it more space Is required)
CANCELLATION EXCEPTION: i-P
D DAYS NOTICE FOR NON-PAYMENT OF PREIVIIIUM. .
Project/Location: All work performed in the state of California.
City of Menifee is named as additional insured per attached endorsement.
CANCELLATION Al 03219E
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
29714 Haun Road ACCORDANCE WITH THE POLICY PROVISIONS,
Menifee CA 92586- AUTHORIZED REPRESENTATNE
Fax: (951)679-3843 01988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and Iot>Jo are realstered marks of ACORn
ACORD 25 (2D44101)
21—Jun-2819 15:58 From: 18552369746
Jun 21 2019 2:51 PM HP Fax
'� ,- �� CERTIFICATE OF LIA
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN[
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITU
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IIYIPURTANT: It the certificate holder Is an ADDITIONAL INSURED, the
the terms and conditions of the policy, certain policies may require an e
certificate holder in lieu of such endomementis).
PRODUCER Neilson & Phillips Insurance Services. Inc.
2208 Plaza Drive
Suite115
Rocklin CA 95765-
INSURED
A
Scorpion Backhos, Inc.
P.O. Box 5011
Hemet CA 92544-
To: 19516793843 p.2
page 2
,BILITY INSURANCE DATE (MM/UDNM)
0612112019
V AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
4 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
TE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
policy(its) must he endorsed. If SUBROGATION IS WAIVED, subject to
ndorsement. A statement on this certificate does not confer rights to the
CONITACT
NAM- David Neilson
PHONE (916)380.5952 FAX (91S}380-59ii3
(Air am Ezt1:
EMAIL Certi%cafes�neilson-phiilips.com
i S AFFOROING COMgMM
NAIC 0
L1_5 ERA:Financial Pacific Insurance CO
31453
RER a _State Compensation Insurance Fund
35076
INSU .American Zurich Insurance Company
KSLIRfA 13,
I _.
77—
OVERAGES 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 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_
R TYPE OF IILSURAt� Ate' U8R POLICY & POLICY .EX
I LIMIT$
X C011MERCUIL GENERAL LIABILn`Y X X 60472872 0zilI M019 A211512020 EACH OCCURRENCE 1,000,000
CLAIMS -MADE M OCCUR DAMAGE TO RENTED
r "IPM kkpAFF. .r..i—_ s 100.000
GE1PL AGGREG'AATE LIMrrAPPLIES PER:
�
POLICY ] LOC
JJEECT
A
AUTOMOBILE LIABILITY
X
X
X
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
X X NOWNMED
HIRED AUTOS AUTOS
A
UMBRELLA UABI oc'UR
X EXCESS I IAR r� uaM--ue..E
WORIGM COMPENSATION AND EMPLOYERS'LIABILITY
YIN
X 9932615
I
A7.YFFYECPR=ENBUERRFEAxCTNEDERDF7�CLTTM ❑ Nl (MandaSory in NH)
If yci, dewnbe under
RentedR eased Equipment 60472872
LwNica& AGGREGATE s 2,000,000
PROD UCTS-CCMPIOPAGG 2.000,000
a
512019 211512020 6Ovs�EDSINGLeLiMrr $ 1,000,000
BODILY INJURY(Perperacn) $
BODILY INJURY (Per accidanq S
PROPERTYOAMAGE S
$
512019 �2015/2020 EACH OCCURRENCE IS 3.000,000
I AGGREGATE I t 3,000,000
07/01/2019 07J01=20
.. CH ACCIDENT1,0 0,000
III+ E.L. DL4EASE - FA EMRLovr=E 1,000,000
E.L. DISEaSS-POLL _ IUT 1.000,000
52019 �V=D20 Limit: 300,000
Deductible: 11000
DESCRIPTION OF OPERATIONS I LOCATIONS E VEHI �{ ACORO 101, A6dliona! RrraaAls $erad4in. m�ayy be attached N more apace Is required)
CANCELLATM EXCEPTION: 10 DAYS NO. CE FOR NON-PAYMENTOF PREII+IIUM. .
Pro)ectitocation: Newport Rd. at Calle Pompeii, Menifee, CA. Replace two vlaves on Newport Rd at Calle Pompeii.
I.AiS C.. C:LLii 1IUiY Al 0368
City of Menifee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLE] BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Engineering Department ACCORDANCE WITH THE POLICY PROVISIONS.
29714 Haun Road
Menifee, CA 9258& AUTHORIZED REPRESENTATIVE
ZVI
Fax: ( } - 81988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
21-Jun-2819 15:59 From: 18552369748 To: 19516793843 p.3
Jun 21 2019 2:51 PM HP Fax page 3
POLICY NUMBER: 60472872 CIS 20 10R 1211
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
SUSINESSOWNERS. 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 ISAN INSURED: (Section 11)
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
habltational 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
CO 2010R 1212
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
prirrary 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:
t. The preparing, approving, or failing to
prepare or approve, reaps, 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
Includes copyrighted material of Insurance Services office, Inc., with its permission
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