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2018/09/30 Slater, Inc. Certificate of Liability InsuranceSLATE-H OP ID: CCON CERTIFICATE OF LIABILITY INSURANCE DATE/1'1'1'Y) 01l0112112019 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 poiicy(les) 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 CONTACT NAME Crosby Insurance PNONE 8181 E. Kaiser Blvd CIh� of Menifee No E : 714-221-5200: 714-221-5210 Anaheim Hills, CA 92808 `r �� City Clerk ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Great American Assurance Co 26344 INSURED Slater, Inc. jAN 2 3 2019 INSURERS:AMERICAN ZURICH INS.CO. 40142 P.O. Box 759 INSURERC:Travelers Property Casualty25674 Fontana, CA 92334-0759 RECEIV 1;U INSURERDt INSURER E : INSURER F r ' rnvpFzAAPS rPPTIFICATF Kill IIIACICO, orvrerner Rn rnnninn. 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. TYPE OF INSURANCE ADDLm'UBR' POLICY EFF LTR P b LICYY1{ LIMITS POLICY NUMBER fMMlpp MhUOD A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I X . OCCUR X GLP2722324 09/30/7018 09/30/2019 EACH OCCURRENCE $ 1,000,00 PREMISES tEa occurrence $ 50,00 X MED EXP (Any one persons $ Exclude OWnedCont Prot. PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY El JECT LOC GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,00 Em Ben. $ 1,000,00 OTHER AUTOMOBILE LIABILITY iBAP3736463-10 INEC3 a! LIMIT$ Es 3ccidarlt 1,000,00 X BODILY INJURY (Per person) $ B ANY AUTO 10/01/2018 10/01/2019 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Peracaden[ ( ) $ HIRED AUTOS NON -OWNED AUTOS TYDAMAGE tPar agcidaN $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 C EXCESS LIAB CLAIMS -MADE ,i'UP-13T41849-18-NF 09/30/2018 09/30/2019 DEG I X I RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y f N ANVPROPRIErORfPARTNFR1EXECUTVE OFFICERfMEMBER EXCLUDED? n (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N f A WC3736462-10 10/01/2018 10/01/2019 X PEF2 01H- STATUTE ER EL EACHACCIDENT $ 1,000,00 E L DISEASE - EA EMPLOYEE $ 1,000,00 E L DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) *Ten days notice of cancellation will be given for non-payment of premium* JOb #08981802 Storm Drain Installation, Menifee, CA Tract #28206 "Encroachment Permit'. Certificate holder is named as an additional insured. 1 Iris. J C CITMENI City of Menifee 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 E ID��t REPR-,ES�E/NTATIVE C V,�/"_117 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Policy Number: GLP2722324 CG 20 33 (Ed 07 041 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS — AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II - WHO IS AN INSURED is amended to include as an Additional Insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an Additional In- sured on your policy. Such person or or- ganization is an Additional Insured only with respect to liability for "bodily injury," "prop- erty damage" or "personal and advertising in- jury" caused, in whole or in part, by: 1, your acts or omissions; or 2. the acts or omissions of those acting on your behalf; in the performance of your ongoing oper- ations for the Additional Insured A persons or organization's status as an Ad- ditional Insured under this endorsement ends when your operations for that Additional In- sured are completed. B, With respect to the insurance afforded to these Additional Insureds, the following addi- tional exclusions apply: This insurance does not apply to., 1. "Bodily injury," `property damage" or "per- sonal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. the preparing, approving, or failing to orepare or approve. maps, shop drawings, opinions, reports, Surveys, field orders, change orders or draw- ings and specifications; or b, supervisory, inspection, architectural or engineering activities. 2- "Bodily injury," or "property damage" oc- curring afte-: a. all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the Additional Insured[s) at the location of the covered operations has been completed; or b. that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than an- other contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project CG 20 33 (Ed. 07iO4I XS Copyright, ISO Properties, Inc_ 2004 Policy Number: GLP2722324 CG 20 37 (Ed. 07 04) THIS ENDORSEMENT CHANGES T"E POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Additional Insured Person(s) or Organ! zatlon(s}: Any person Of organization that "you" and such person or organization have agreed in writing in a contract that such person or organization be added as an addi- tional insured on "your" policy, but only for "your work" performed during this policy period, Schedule Location and Description of Completed Operations: "Your work" but only for work performed by the insured during this policy period when required by written contract, Additional Premium: Included Information required to complete this Schedule, if not shown above, will be shown in the Declarations. SECTION 11 - WHO IS AN INSURED is amended to include as an Additional Insured the person(s) or organization(sl shown in the Schedule, but only with respecr to liability for "bodily injury" or "property damage' caused. in whole ❑r ir part, by 'your work" at the location designated and described in the schedule of this endorsement pe0ormgd for that Addi*ional Insured and included in the "products -completed operations hazard." Copyright, ISO Properties, Inc., 2004 CG 2a 37 (Ed OW04) PRO (Page 1 of 11