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2018/04/15 T Maus Grading & Paving, Inc. Certificate of Liability InsuranceP52GIip28N+2 DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE ka� 03/15/2019 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 F REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, p IMPORTANT: If tho certiFicate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to `q 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 endorsoment(s). °O PRODUCER LIC #CH79377 1-949-222-0444 ISU Insurance Services - ERM Insurance Brokers NTACT NAM .' PHONE PAX J2IlIlI 949-222-0444�e$ 949-222-0445 EMAIL D E S: 3000 W. MacArthur Blvd., Suite #120 z W INSURS}_AFFORDINQ COV�RAOE NAIC u Santa Ana, CA 92704 INSURER A: COLONY INS CO 39993 INSURER8: EMPLOYERS MUT CAS CO 21415 INSURED T Maus Grading & Paving, Inc. INSURERC: NATIONAL UNION FIRE INS CO OF PITTS 19445 INSURERD: INSURANCE CO OF THE WEST 27847 31900 Mission Trail #205 INSURER E : INSURERF: _ Lake Elsinore, CA 92530 COVERAGES CERTIFICATE NUMBER: 55627951 RFVIS(CIN NIIII 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 TYPE OF INSURANCE ADilLr9U8q POLICY EFr ' POLICY EXP JNSD POLICY NUMBER MMr0O/YyYYI (MMPDffyYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxD OCCUR X X 103 GL 0023229-00 04/15/18 04/15/19 EACHOCCURRENCE $ 1,000,000 $ 100,000 DAMAGE TO RENITD- MlSES(4aad X MED EXP (Any one person) Deductible $5, 000 $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENt AGGREGATE LIMIT APPLIES PER: POLICY JET LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY SE80189 12/15/18 12/15/19 C0 OINE05iNGLE1JMtT e.Id., cd I $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS $ BODILY INJURY (Per accident) HIRED AUTOS NON -OWNED _ AUTOS OPERTYDAMAGE $ $ C UMBRELLA LIAB X OCCUR BE069966380 06/14/18 04/05/19 EACH OCCURRENCE $ 2,000,000 AGGREGATE X EXCESS LIAR CLAIMS -MADE $ 2,000,000 DED RETENTION $ $ D 'WORKERS COMPENSATION .AND EMPLOYERS' LIABILITY YIN .ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? N 1 A WSD504700400 03/18/19 03/18/20 X SERT RH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 000 $ 1500,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L,DISEASE- POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addltlonal Remarks Schedule, may be attached If more space Is required) The certificate holder is additional insured per CG2010 0704/CG2037 0704; general liability waiver of subrogation per CG 2404 0509; primary/non-contributory wording per CG2001 0413 A,r-K I IrIUA I t NVI-UrK UANGtLLA I IUN SHOULD ANY OF 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 Menifes, CA 92586 USA 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD terrierm 55627951 Policy Number: 103 GL 0023229-00 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. W w CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 0 Policy Number: 103 GL 0023229-00 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 w O WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US M 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: Information required 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 Page 1 of 1 13