2016/12/15 T Maus Grading & Paving, Inc. Certificate of Liability InsuranceACC)R ®w CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
07/27/2017
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 LIC #OH79377 1-949-222-0444
ISII Insurance Services - ERM Insurance Brokers
2101 Business Center Drive #150
CONTACT
NAME:
PHONE 949-222-0444 FAX 949-222-0445
A/C No
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
Irvine, CA 92612
INSURERA:BERKLEY ASSIIR CO
39462
INSURED
-INSURER B: FINANCIAL PACIFIC INS CO
31453
T Maus Grading & Paving, Inc.
INSURERC: STARSTONS NATL INS CO
25496
INSURERD:
31900 Mission Trail #205
INSURER E:
INSURERF:
Lake Elsinore, CA 92530
COVERAGES CERTIFICATE NUMBER: 50446448 REVISION NIIMRFR-
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
LTR
TYPE OF INSURANCE
ADDL
INSD
SUBR
D
POLICY NUMBER
POLICY EFF
MMIDD/YYYY
POLICY EXP
MM/DDIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE LK OCCUR
X
X
VUMA0143730
04/15/17
04/15/18
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 100, 000
MED EXP (Any one person)
$ Excluded
PERSONAL &ADV INJURY
$ 1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY PEA LOC
I GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
B
AUTOMOBILE
LIABILITY
60484858
12/15,116
12/15/17
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
X1AUTOS
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
HIRED AUTOS NON -OWNED
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
CLAIMS -MADE
DED RETENTION$
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED? Y❑
N / A
T20170530
03/18/17
03/18/18
X STATUTE OH
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 1, 000, 000
(Mandatory In NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT I
S 1, 000, 000
DESCRIPTION OF OPERATIONS below
B
Contractors Equipment
60484858
01/09/17
12/15/17
Leased/Rented 100,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The certificate holder is additional insured per CG 2010 0704/CG2037 0704; general liability waiver of subrogation
per CG 2404 1093; primary/non-contributory wording per VCAS 2035 1110
re: Romoland Area Emergency Street Repair Project
VGr%I lr Mlk%1 C nuL.Ur-M GANGtLLAI IUN
SHOULD ANY Or THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
29714 Haun Rd. AUTHORIZED REPRESENTATIVE
Menifee, CA 92586
1 USA
ACORD 25 (2014/01)
lorenaerm
50446448
91988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Or anization s : Locations Of Covered Operations
As required by written contract executed prior to the date of Construction project sites at which you performed
occurrence but only to the extent work for such additional insured.
permitted by law and the insurance afforded to such
additional insured will not be broader than that which you
are required by the contract or agreement to provide for
such additional insured.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but 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 for
the additional insured(s) at the location(s)
designated above.
B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. 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
2. 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 another contractor or subcontractor
engaged in performing operations for a
principal as a part of the same project.
CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 13
THIS ENDORSEMENT CHANGES THE 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
SCHEDULE
Name Of Additional Insured Person(s)
Or Or anization s :
Location And Description Of Completed Operations
As required by written contract executed prior to the
Construction project sites at which you performed work
date of occurrence but only to the extent
for such additional insured.
permitted by law and the insurance afforded to such
additional insured will not be broader than that which
you are required by the contract or agreement to
provide for such additional insured.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only with
respect to liability for "bodily injury" or "property
damage" caused, in whole or in part, by "your work"
at the location designated and described in the
schedule of this endorsement performed for that
additional insured and included in the "products -
completed operations hazard".
CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
To any person or organization provided you entered into the contract with that person or organization prior to any
claim or loss to which this insurance applies.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV —
COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following:
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 0410 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 0
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY WORDING
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE
With respect to coverage provided to an additional insured via attachment of an Additional Insured endorsement to
this policy, such coverage is primary insurance and we will not seek contribution from any other insurance available
to that additional insured.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED
VCAS2035 11 10 Page 1 of 1