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2019/06/01 Superior Pavement Markings, Inc. Certificate of Liability Insurancecwa CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) %�� 1 9)19/2019 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 poltcy(tes) 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). PRODUCER Patriot Risk & Insurance Services NAME: 2415 Cam us Drive, Suite #200 PHONE G.JtExf?; (949) 486-7900 1FA[�C:No1: (948) 486-7950 Irvine, CA 92612 VMAILo, INSURER@1 AFFORDING COVERAGE NAIC Nww.patrisk.com OK07568 INSURER A: Zurich American Insurance Company 16535 INSURED INSURER B : Great American Insurance Company 16691 531 Sup2 Cypress St. Briar Pavement Markings, Inc. INSURERC: Cypress Insurance Company 10855 Cypress CA 90630 INSURER D : INSURER F : COVERAGES CERTIFICATE NUMBER: 51238045 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. INSR CY TYPE OF INSURANCE ADDL SUBR POLIEFF POLICY EXP LTRPOLICYNUMBER MM/DD/YYYY MWDD LIMITS A COMMERCIAL GENERAL LIABILITY `/ GLO137433800 9/18/2019 9/18/2020 EACH OCCURRENCE $1 000 00 CLAIMS -MADE �[ OCCUR E $ 300 000 MED EXP (Any one person $ 5 000 PERSONAL R ADV INJURY $1 000 000 _ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY✓ JE0 LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $2000000 $ OTHER: A AUTOMOBILE LIABILITY BAP137433900 9/18/2019 9/18/2020 LIMIT a N ED IS Ida $1 000 000 _INGLE BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY _ AUTOS tid BODILY INJURY (Per accident) ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE @n} $ B UMBRELLA LIAB OCCUR TUE 2191315 02 9/18/2019 9/18/2020 OCCURRENCE $ 9 000 000 HEACH AGGREGATE $ 9 000 000 EXCESS LIAR CLAIMS -MADE DED RETENTION$ 1 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? FY—] N / A SUWC033321 6/1/2019 6/112020 T T TE Ol1i E.L. EACH ACCIDENT $1 000 000 E.L. DISEASE - EA EMPLOY $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 DOD 000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Re: All Califomla Operations Usual to the Named Insured City of Menifee is named as Additional Insured as respects to General Liability per endorsement attached where required by written contract. Waiver of Subrogation applies to General Liability and WC and In favor of the additional insured per attached endorsement. '30-day notice of cancellation / 10-days for non-payment of premium. CERTIFICATE HOLDER CANCELLATION CITY OF MENIFEE Cityy of Menifee FINANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 29714 Menifee Haun Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Menifee CA 92586 ,Ep 2 h 2019 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE RECEIVED JK Dave Jacobson ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 51238045 19/20 GL/AU/UMB/WC I Annette Romero 1 9/19/2919 3:58:17 PM (PDT) I Page 1 of 5 This certificate cancels and supersedes ALL previously issued certificates. Additional Insured— Owners, Lessees Or Contractors — Scheduled Person Or Organization ZURKH F Policy No. I Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. AddT Prem Return Prem. 1GLO137433800 09/18/2019 09/18/2020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: Supperior Pavement Markings, Inc. 5312 Cypress St Address (including ZIP Code): cypress CA 90630 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Covered Operations Or Organization(s) A. Section II — Who Is An Insured is amended to include as an additional insured the person or organization shown in the Schedule above, whom you are required to add as an additional insured on this policy under a written contract or written agreement. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" 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 operations or "your work" as included in the "products -completed operations hazard", which is the subject of the written contract or written agreement at the Location designated and described in the Schedule above. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: U-GL-1177-F CW (04/13) Page 1 of 2 51230045 19/20 GL/AUYLrK51WC Ir s cp��y�i �tl�d tgya�,�f�I r n, �Se�noi�e3s Office, Inc., with its permission. i Alll:i'LLO This certificate cancels and Supersedes A T. previously issued cert ficates. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering or failure to render any professional architectural, engineering or surveying services including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved, the rendering of or the failure to render any professional architectural, engineering or surveying services. C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV — Commercial General Liability Conditions: The additional insured must see to it that: 1. We are notified as soon as practicable of an 'occurrence" or offense that may result in a claim; 2. We receive written notice of a claim or "suit" as soon as practicable; and 3. A request for defense and indemnity of the claim or "suit' will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured, if the written contract or written agreement requires that this coverage be primary and non-contributory. D. For the purpose of the coverage provided by this endorsement: 1. The following is added to the Other Insurance Condition of Section IV — Commercial General Liability Conditions: Primary and Noncontributory insurance This Insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV — Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same 'occurrence", offense, claim or "suit'. This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis. E. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement referenced in Paragraph A. of this endorsement; or 2. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions of this policy remain unchanged. U-GL-1177-F CW (04/13) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2 S1:!."045 119/20 GL/AU/UMH/WC I Ann.ttC Ro ro 9/19/2019 3:56:17 PM (PDT) I PacJe 3 0f 5 This certificate cancels and supersedes ALL previously iBsued certificates. POLICY NUMBER:GLO137433800 Superior Pavement Markings, Inc. COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Blanket as required by written contract. Information re uired to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or ,.your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 51;t36045 1 19/20 GL/AUJUMH/WC I Annette R[111gro I V1912019 3:58:17 PM (PDT) I ;—c, 4 of 5 This certificate cancels and supersedes ALL previously issued certir.,:ates. Page 1 of 1 ❑ WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 041013 (Ed. 9-14) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS We have the right to recover our payments from anyone liable for an Injury covered by this policy. We will not enforce our right against the person or organization named In the Schedule. (This agreement appl les only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) The additional premium for this endorsement shall be 2% of the total manual premium otherwise due on such remuneration. The minimum premium for this endorsement is This agreement shall not operate directly or Indirectly to benefit anyone not named In the Schedule. SCHEDULE BLANKET WAIVER Person/Organization Blanket Waiver — Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Premium This endorsement changes the policy to which It is attached and is effective on the date Issued unless otherwise stated. (The Informa0on below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective6/1/2019 Insured Superior Pavement Markings, Inc. Insurance Company Cypress Insurance Company WC 99 041013 (Ed. 9-14) Policy No. SUWC033321 Countersigned by Endorsement No. Premium $ `32,JU045 19/20 GL/AU/UL4H/WC I Annetto Romero I 9/19/2919 3:58:]7 PM (PDT) I Pnyc 5 c This certificate cancels and supersedes ALL previously issued certificates.