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2018/12/31 Wayne Perry, Inc. Certificate of Liability InsuranceACORD� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 12/14/2018 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 NAME: Catherine Montoya Milestone Risk Management & Insurance Services HOo 2-0909 (949)852 -1131"ICNEx ) NU: E-MAIL ADDRESS: cmontoya@milestonepromise.com License No. OB72766 8 Corporate Park, Suite 130 ('(ty Of {Menifee INSURERS AFFORDING COVERAGE NAIC # INSURER A: Everest Indemnity Insurance 10851 Irvine CA 926d6(gy rk INSURED INSURERB:West American Insurance Company 44393 Wayne Perry, Inc. DEC A 02018 it INSURER C: Everest National Ins. Co. 10120 8281 Commonwealth Ave. INSURERD:Ohio Casualty Insurance Company 24074 INSURER E : Buena Park CA 90621 Received INSURER F: COVERAGES CERTIFICATE NUMBER:18-19 CITY 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 LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EFlML00079-181 EACH OCCURRENCE S 1,000,000 A CLAIMS -MADE ❑X OCCUR DAMAGE T RENTED PREMISES Ea occurrence S 300,000 X MED EXP(Any one person) S 25,000 Contr. Pollution Liab. $1,000,000 Each occurrence 12/31/2018 12/31/2019 X Prof. Liab - Claims Made PERSONAL &ADV INJURY S 1,000,000 $1,000,000 Each Claim GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 Each Subject to $2,000,000 E PRO ❑ Policy Aggregate POLICY JECT LOC PRODUCTS - COMP/OPAGG S 2,000,000 S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 Ea accident BODILY INJURY (Per person) S B X ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS BAA(19) 59235968 12/31/2018 12/31/2019 BODILY INJURY Per accidentPi ( ) S NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Peracciden[ S S UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 10,000,000 4DED AGGREGATE S 10,000,000 A EXCESS LIAB CLAIMS -MADE X I RETENTIONS 0 S 1 iEFlCU00052-181 12/31/2018 12/31/2019 WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY Y / N. ISTATUTE ER E.L. EACH ACCIDENT S 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE C OFFICERIMEMBER EXCLUDED? Li (Mandatory In NH) I A N/A CA10003737-181 12/31/2018 12/31/2019 E.L. DISEASE - EA EMPLOYEE S 1,000,000 If yes. describe under E.L. DISEASE -POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS below D Installation Floater BM059216368 12/31/2018 12/31/2019 Limit/Deductible $250K / $2,500 D Rented/Leased Equipment BM059216368 12/31/2018 12/31/2019 Limit/Deductible $150k / $2,500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Encroachment Permit. City of Menifee is named as an additional insured per the attached EIL04550 (CG2012) endorsement. *30 Days Notice of Cancellation/10 Days Notice for Non -Payment of Premium. CERTIFICATE HOLDER CANCELLATION City of Menifee Engineering Department 29714 Haun Rd. 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 REPRESENTATIVE therine Montoya/CAM /(L-C1� �.-JJIp i-Lt66je_U� (7 1988-2014 ACOR❑ rORPnRATION All rinhfc rpcar rarl ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) POLICY NUMBER: EF1 ML00079-181 INTERLINE EIL 04 550 12 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: EVEREST CONTRACTORS ENVIRONMENTAL PLUS COVERAGE PART EVEREST ENVIRONMENTAL PLUS COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: As required by written contract. I 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 any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, 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. 2. This insurance does not apply to: a. 'Bodily injury", "property damage", "personal and advertising injury" or "environmental damage" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; 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. EIL 04 550 12 18 Copyright, Everest Reinsurance Company, 2018 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. All other terms, conditions and exclusions shall remain the same. EIL 04 550 12 18 Copyright, Everest Reinsurance Company, 2018 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc. used with its permission.