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2017/06/01 Superior Pavement Markings, Inc. Certificate of Liability InsuranceSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 9/28/2017 Patriot Risk & Insurance Services 2415 Campus Drive, Suite #200 Irvine, CA 92612 (949) 486-7900 (949) 486-7950 www.patrisk.com 0K07568 Leonard E. Ziminsky Superior Pavement Markings, Inc. 5312 Cypress St. Cypress CA 90630 38095201 3 3 3 City of Menifee is named as Additional Insured as respects to General Liability per endorsement attached where required by written contract. *30-day notice of cancellation / 10-days for non-payment of premium. City of Menifee 29714 Haun Road Menifee CA 92586 Re: All California Operations Usual to the Named Insured Waiver of Subrogation applies to General Liability and WC and in favor of the additional insured per attached endorsement. A 1,000,000WPP1583161009/18/2017 9/18/2018 300,000 3 5,000 3 1,000,000 2,000,000 2,000,0003 A WPP1573693 8/1/2017 8/1/2018 1,000,000 3 B TUE219131500 9/18/2017 9/18/2018 5,000,00033 5,000,000 C SWC1154448 6/1/2017 6/1/2018 3 1,000,000Y 1,000,000 1,000,000 Wesco Insurance Company 25011 Great American Insurance Company 16691 Security National Insurance Company 33120 38095201 | 17/18 GL/AU/UMB/WC | Annette Romero | 9/28/2017 3:40:27 PM (PDT) | Page 1 of 11 This certificate cancels and supersedes ALL previously issued certificates. Superior Pavement Markings, Inc. WPP158316100 38095201 | 17/18 GL/AU/UMB/WC | Annette Romero | 9/28/2017 3:40:27 PM (PDT) | Page 2 of 11 This certificate cancels and supersedes ALL previously issued certificates. 38095201 | 17/18 GL/AU/UMB/WC | Annette Romero | 9/28/2017 3:40:27 PM (PDT) | Page 3 of 11 This certificate cancels and supersedes ALL previously issued certificates. Superior Pavement Markings, Inc. WPP158316100 38095201 | 17/18 GL/AU/UMB/WC | Annette Romero | 9/28/2017 3:40:27 PM (PDT) | Page 4 of 11 This certificate cancels and supersedes ALL previously issued certificates. GL990078 Page 1 of 6 Ed 0912 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROADENED COVERAGE FOR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. PROPERTY DAMAGE TO BORROWED EQUIPMENT Paragraph (1), of j. Damage To Property, under 2. Exclusions, of SECTION I – COVERAGES COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY is amended to add the following: Paragraphs (3) and (4) of this exclusion do not apply to tools or equipment loaned to you, provided that they are not being used to perform operations at the time of the loss. With respect to “property damage” to borrowed equipment the following additional provisions apply: 1. The most we will pay for “property damage” to borrowed equipment is $100,000 for any and all such losses regardless of the number of: a. Insureds; b. Claims or “suits” brought; or c. Persons or organizations bringing claims or “suits”. B. NON-OWNED WATERCRAFT EXTENSION Subparagraph (2) of g. Aircraft, Auto Or W atercraft, under 2. Exclusions, of SECTION I – COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY is deleted and replaced with the following: This exclusion does not apply to: (2) a watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used to carry persons or property for a charge. C. DAMAGE TO PREMISES RENTED TO YOU The last paragraph of 2. Exclusions of SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is deleted and replaced with the following: Exclusions c. through n. do not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: 1. Fire; 2. Explosion; Superior Pavement Markings, Inc. WPP158316100 38095201 | 17/18 GL/AU/UMB/WC | Annette Romero | 9/28/2017 3:40:27 PM (PDT) | Page 5 of 11 This certificate cancels and supersedes ALL previously issued certificates. GL990078 Page 2 of 6 Ed 0912 3. Lightning; 4. Smoke resulting from such fire, explosion or lightning; or 5. Water. A separate limit of insurance applies to this coverage as described in Section III Limits of Insurance. This insurance does not apply to damage to premises rented to you, or temporarily occupied by you, with permission of the owner caused by: 1. Rupture, bursting, or operation of pressure relief devices; 2. Rupture or bursting due to expansion or swelling of structural components or the contents of any building or structure, caused by or resulting from water; 3. Explosion of steam boilers, steam pipes, steam engines or steam turbines. Paragraph 6. of SECTION III LIMITS OF INSURANCE is d eleted and replaced with the following: Subject to paragraph 5. of SECTION III – LIMITS OF INSURANCE, the Damage to Premises Rented to You Limit is the most we will pay under COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY. for the sum of all damages because of “property damage” to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: fire; explosion; lightning; smoke resulting from such fire, explosion , or lightning; or water. The Damage To Premises Rented To You Limit will apply at all “property damage” proximately caused by the same “occurrence”, whether such damage results from: fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water; or any combination of any of these causes. The Damage To Premises Rented to You Limit will be the higher of: a. $300,000; or b. The amount shown on the Declarations for Damage To Premises Rented To You Limit. Paragraph a. of 9. “Insured Contract”, under SECTION V – DEFINITIONS, is deleted and replaced with the following: An “Insured contract” means a contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: fire: explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water, is not an “insured contract”. D. PROPERTY DAMAGE COVERAGE FOR PERSONAL PROPERTY WHILE IN YOUR POSSESSION Sub-paragraphs (3) and (4) of Paragraph j. Damage To Property, of 2. Exclusions. of SECTION I – COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY do not apply to “property damage” to the property of others while in your possession. With respect to the insurance provided by this section of the endorsement, the following provisions apply: The limit of this coverage is $25,000 per “occurrence” and $25,000 aggregate in any annual policy period starting with the beginning of the policy period in the Declarations, regardless of the number of: a. Insureds; 38095201 | 17/18 GL/AU/UMB/WC | Annette Romero | 9/28/2017 3:40:27 PM (PDT) | Page 6 of 11 This certificate cancels and supersedes ALL previously issued certificates. GL990078 Page 3 of 6 Ed 0912 b. Claims or “suits” brought; or c. Persons or organizations bringing claims or “suits”. We will pay for damages on your behalf, only to the amount of damages for each "occurrence" on your behalf applies only to the amount of damages for each “occurrence” which are in excess of a $1,000 deductible. We may pay any part, or all of the deductible amount, to effect settlement of any claim or “suit” and, upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount, as has been paid by us. E. PROPERTY DAMAGE COVERAGE FOR TENANTS – REAL PROPERTY Sub-paragraph j. (5) Damage To Property, of 2. Exclusions of SECTION I – COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY is deleted and replaced with the following: While under your care, custody or control we will pay for “property damage” to property of others arising out of operations incidental to your business when: a. Damage is caused by the insured; b. Damage occurs while in the insured’s possession The most we will pay under this provision for loss or damage during the policy period is $25,000 per “occurrence” and $25,000 aggregate in any annual policy period starting with the beginning of the policy period in the Declarations. We will pay damages on your behalf, only to the amount of damages for each "occurrence" which are in excess of a $1,000 deductible. The limits of insurance will not be reduced by the application of such deductible amount. We may pay any part or all of the deductible amount to effect settlement of any claim or “suit” and, upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us; or F. SUPPLEMENTARY PAYMENTS Paragraphs 1.b. and 1d. under SUPPLEMENTARY PAYMENTS – COVERAGES A AND B of SECTION I is amended as follows: a. In paragraph 1.b., the amount we will pay for the cost of bail bond is increased to $2,500 b. In paragraph 1.d., the amount we will pay for loss of earnings is increased to $500 a day. G. NEWLY ACQUIRED OR FORMED ORGANIZATIONS Paragraph 3.a. of SECTION II – WHO IS AN INSURED is deleted and replaced with the following: Coverage under this provision is afforded until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier. H. PAST PARTNERSHIPS AND JOINT VENTURES The following is added to SECTION II – WHO IS AN INSURED: 38095201 | 17/18 GL/AU/UMB/WC | Annette Romero | 9/28/2017 3:40:27 PM (PDT) | Page 7 of 11 This certificate cancels and supersedes ALL previously issued certificates. GL990078 Page 4 of 6 Ed 0912 If you are an insured, as shown in the Declarations, you are an insured for your interest in a partnership or joint venture that ended prior to this policy-period. This insurance applies: a. Only to the extent of your interest in the partnership or joint venture. b. Only if no other similar insurance is available to you for your interest in the joint venture or partnership. The last paragraph of SECTION II – WHO IS AN INSURED is deleted and replaced with the following: Except as provided in H. PAST PARTNERSHIPS AND JOINT VENTURES, no person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. I. ADDITIONAL INSURED The following is added to SECTION II – WHO IS AN INSURED: Any person or organization with whom or with which you have agreed in writing in a contract or agreement that such person(s) or organization(s) shall be included as an additional insured on your policy is an additional insured. The contract must be executed before the “bodily injury or “property damage” occurs or the “personal injury” or “advertising injury” offense is committed, to name such person or organization as an additional insured, but only with respect to liability arising out any tenancy operation or use of equipment leased to you by such an additional insured. The following provisions apply to such additional insured: a. The limits of insurance afforded to the additional insured shall be the limits which you agreed to provide in the written contract, or the limits shown on the Declarations, whichever is less. b. The insurance afforded to the additional insured does not apply to: i. A ny “bodily injury” or “property damage” that occurs, or “personal injury” or “advertising injury” caused by an offense which is committed, after you cease to be a tenant in that premises; ii. Liability arising out of any premises for which coverage is excluded by endorsement; or iii. L iability arising out of structural alterations, new construction or demolition operations performed by or on behalf of such additional insured(s) The insurance afforded to the additional insured is excess over any valid and collectible insurance available to the insured, unless you have agreed in the written contract that this insurance must be primary or non-contributory with such other insurance. J. BROADENED NAMED INSURED Paragraph 1.d. of SECTION II – WHO IS AN INSURED is deleted and replaced with the following: The person or organization named in the Declarations, and any organization, other than a partnership, joint venture or limited liability company, of which you maintain ownership or in which you maintain the majority interest on the effective date of the policy. Your “executive officers” and directors are insureds, but only with respect to their duties as your officers or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders. However, coverage for any such additional organization will cease as of the date, if any, during the policy 38095201 | 17/18 GL/AU/UMB/WC | Annette Romero | 9/28/2017 3:40:27 PM (PDT) | Page 8 of 11 This certificate cancels and supersedes ALL previously issued certificates. GL990078 Page 5 of 6 Ed 0912 period, that you no longer maintain ownership of, or the majority interest in, such organization. K. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS The following is added to paragraph 6. Representations of SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS: Based on our reliance on your representations as to existing hazards, if you unintentionally fail to disclose any such hazards prior to the beginning of the policy period of this coverage part, we shall not deny coverage under this coverage part because of such failure. However, the provision does not affect our right to collect additional premium or to exercise our right of cancellation or nonrenewal in accordance with applicable state insurance laws, codes or regulations. L. BROADENED NOTICE OF OCCURRENCE The following is added to paragraph 2 Duties in the Event of Occurrence, Offense, Claim or Suit of SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS: a. Notice of an “occurrence” or of an offense which may result in a claim covered by this policy, the failure to report such “occurrence” to us at the time of the “occurrence shall not be deemed a violation of this condition unless such “occurrence” or offense becomes known to. you, or one of the following if designated by you to give such notice: your “executive officers” (if you are a corporation), one of your partners who is an individual (if you are a partnership), one of your managers (if you are a limited liability company), or an “employee” (such as an insurance, loss control or risk manager or administrator)., However, you or your designated representative must give us notice as soon as practicable after being made aware that the particular claim. b. Knowledge by any other “employee” of an “occurrence” or offense does not imply that you also have such knowledge. c. This provision does not apply as respects the specific number of days within which you are required to notify us in writing of the abrupt commencement of a discharge, release or escape of “pollutants” that causes “bodily injury” or “property damage” which may otherwise be covered under this policy. M. WAIVER OF SUBROGATION The following is added to paragraph 8. Transfer of Rights of Recovery Against Others to Us of SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: premises owned or occupied by or rented or loaned to you; ongoing operations performed by you or on your behalf, done under contract with that person or organization; “your work”; or “your products”. We waive this right where you have agreed to do so as part of a written contract, executed by you before the “bodily injury” or “property damage” occurs or the “personal injury” or “advertising injury” offense is committed. N. BROADENED CONTRACTUAL LIABILITY – WORK WITHIN 50’ OF RAILROAD PROPERTY Paragraph 9.c. of the definition “Insured Contract” under SECTION V – DEFINITIONS is deleted and replaced with the following: “Insured contract” means any easement or license agreement in connection with construction or demolition operations on or within 50 feet of a railroad. 38095201 | 17/18 GL/AU/UMB/WC | Annette Romero | 9/28/2017 3:40:27 PM (PDT) | Page 9 of 11 This certificate cancels and supersedes ALL previously issued certificates. GL990078 Page 6 of 6 Ed 0912 Paragraph f.(1) of 9. “Insured contract” under SECTION V – DEFINITIONS is deleted. O. BODILY INJURY DEFINITION The definition of “bodily injury” in paragraph 3. of SECTION V – DEFINITIONS is deleted and replaced with the following: “Bodily injury” means bodily injury, mental anguish, mental shock, fright, disability, humiliation, sickness or disease sustained by a person, including death resulting from any of these at any time. 38095201 | 17/18 GL/AU/UMB/WC | Annette Romero | 9/28/2017 3:40:27 PM (PDT) | Page 10 of 11 This certificate cancels and supersedes ALL previously issued certificates. Superior Pavement Markings, Inc. 6/1/2017 SWC1154448 38095201 | 17/18 GL/AU/UMB/WC | Annette Romero | 9/28/2017 3:40:27 PM (PDT) | Page 11 of 11 This certificate cancels and supersedes ALL previously issued certificates.