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Copp Contracting Inc 04-08-2019
CALIFORNIA PRELIMINARY NOTICE In accordance with section 8102,8202 and 9303 California Civil Code. THIS IS NOT A LIEN. This is NOT a reflection on the integrity of any contractor or subcontractor. CONSTRUCTION LENDER OR REPUTED CONSTRUCTION LENDER NAME AND ADDRESS OF CLAIMANT GIVING NOTICE: ONE REPORTED OWNER OR REPUTED OWNER(S)/PUBLIC BODY CITY OF MENIFEE 29844 HAUN ROAD MENIFEE qe City of Menifee CiT, City Clerk 401%d APR 042019 A4!-I a556 Received AI DIRECT CONTRACTOR OR REPUTED ORIGINAL CONTRACTOR COPP CONTRACTING INC 6761 STANTON AVE BUENA PARK, CA 90621 CUSTOMER or (OTHER) COPP CONTRACTING INC 9751 STANTON AVE BUENA PARK, CA 90621 ALL AMERICAN ASPHALT- J.C.N. 31237 PO BOX 2229. CORONA CA 92878-2229 has furnished or will furnish labor, service, equipment or material of the following general description: Asphalt concrete/ A gregaterack I Labor Equipment/ Tack -Coat $ Petromat/ Glass Pave DESCRIPTION OF JOB SITE SUFFICIENT FOR IDENTIFICATION: STREET RESURFACING AND ADA RAMP RETROFIT MIRALAGO/LAKE POINTE NEIGHBORHOODS LOCATED SOUTH OF NEWPORT ROAD. EAST ANTELOPE ROAD AND NORTH OF LA PIEDRA ROAD MENIFEE, CA 92586 The name of the person or firm who contracted for the purchase of such labor, services, equipment or material furnished is: COPP CONTRACTING INC An estimate of the total price of the labor, services, equipment or material is: 69000.00 PLEASE ISSUE JOINT CHECKS NOTICE TO PROPERTY OWNER EVEN THOUGH YOU HAVE PAID YOUR CONTRACTOR IN FULL, if the person or firm that has given you this notice is not paid in full for labor, service, equipment, or material provided or to be provided to your construction project, a lien may be placed on your property Foreclosure of the lien may lead to loss of all or part of your property. You may wish to protect yourself against this by (1) requiring your contractor to provide a signed release by the person or firm that has given you this notice before making payment to your contractor, or (2) any other method that is appropriate under the circumstances. This notice is required by law to be served by the undersigned as a statement of your legal rights. This notice is not intended to reflect upon the financial condition of the contractor or the person employed by you on the construction project. If you record a notice of cessation or completion of your construction project, you must within 10 days after recording, send a copy of the notice of completion to your contractor and the person or firm that has given you this notice. The notice must be sent by registered or certified mail. Failure to send the notice will extend the deadline to record a claim of lien. You are not required to send the notice if you are a residential homeowner of a dwelling containing four or fewer units. Project Number Contract Number PMP 19-01 Tract Number Customer Job Number 1535 P.O. Number DIR Number 277159 Awarding Body Number 100011119 Date: 4/2/2019 f Signature: Telephone: 951-736-7600 'From: Bolton & Company 3475 E. Foothi€I Blvd., Suite 100 Pasadena, CA 91107 (626)799-7000 0008309 www.boltonco.com { City of Menifee 29714 Haun Road Menifee, CA 92586 FAX DOCUMENT Certificate of Insurance Delivery by ecertsonline 711 From: Nancy Cadwallader ...� _.. Subject: Date: F Delivery Via: No. of Pages: Cert No. 47848504 - Renewal Certificate of Liability: Pacific Utility Installation, Inc. 3/29/2019 FAX 19516793843 5 . - ... - .. .�.. .. ..... i.. _ ��+r.r-,+r r-�. Y r••rM w•v rh•�awy�ww!••h..r F. ♦�ww. r�w•,Y•..•�iiM•wwy r.a�...-r �ywr.�•rw.w+•nx••rr •,.ir.�•��r .�•r m.� This certificate replaces the one you currently have on file. Following is the requested certificate of insurance for the insured in the subject above. The certificate was created in eCertsOnline and is in PDF format. You need to have Adobe Acrobat Reader installed on your system to view the certificate. To download the Adobe Reader for free, please visit www,Adobe.com. If you have any questions on the certificate, please contact Bolton & Company at 626-799-7000. If you have any questions or need revisions please reply to t1-:- ncadwallader@boltonco.com. ncadwallader@boltonco.com. City of Menifee City Clerk Received _RrIc Q-,� \U THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT, OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US IMEDIATELY BYTELEPH ONE, AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE. Certificate of Insurance Delivered by ecertsonlineTM Insurance Visions, Inc. All rights reserved. eC:PR�� !7 1►� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) F3/29rz010 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 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 endorsements). PRODUCER Bolton & Compan 3475 E. Foothill Blvd,, Suite 100 Pasadena, CA 91107 CONTACT NAME; PHONE FAX E-MAIL 0 626 799-7000 ! (AIC,.No: 626 583-2117 ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURERA: Executive Risk Indemnity_Inc 35181 www.boltonco.com 0008309 INSURED Pacific Utility Installation, Inc. Pacific Energy and Light 1585 Harmony Circle Anaheim CA 92807 INSURER B: Federal Insurance Company 20281 INSURERC: IINSURERD: INSURERE: INSURER F: CClvl 4_! .Y[i�FS CFRTI FIrATF KIIIMRFR• A70AonnA 09:11/I1zlflhl HIIIMQGR• 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. ICBR TYPE OF INSURANCE INSD SUER POLICYNUMBER POLICY MM7f DNYri LIMITS A r COMMERCIAL GENERAL LIABILITY 54303390 4/1/2019 4/1/2020 EACH OCCURRENCE $1 000000 CLAIMS -MADE OCCUR DAMAGE TO RE RTff5- PREMISES aoccurrence) $100 00 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1 ,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY ✓� JECT LOC PRODUCTS - COMP/OP AGG $2 000,000 $ OTHER: B AUTOMOBILE LIABILITY 54303389 4/1/2019 4/1/2020 00 PIT Ea>laciden I I $1,000,000 ✓ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTyDAMAGE Pe ao dent $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DFD RETENTION $ B 'WORKERS COMPENSATION .AND EMPLOYERS' LIABILITY YIN :OFF OFF I CERIMEMBER EXCLUDED? N/A 54303391 4/1/2019 4/1 /2020 PER STATUTE OTH E.L. EACH ACCIDENT $ 1 00O 000 E.L. DISEASE - EA EMPLOYEE $1 (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, Additional Remarks Schedule, may be attached if more space Is required) GL Additional Insured applies per CG20100413 & CG20370413 attached, only if required by written contract. Additional Insured (s): City of Menifee CERTIFIGA rE HOLDER CANCELLATION Cityy of Menifee 29714 Haun Road 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 Chau Tran f" ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 47848504 PACUTIL-CL 19-20 GL, Auto, XS, WC, Ls/Rnt Equip, Inst FLtr Nancy Cadwa Llader 3/29/2019 3:40:09 PM (PDT) Page 1 of 4 POLICY NUMBER: 54303390 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 Organizations) I Location(s) Of Covered Ooerations WHERE REQUIRED BY WRITTEN CONTRACT. WHERE REQUIRED BY WRITTEN CONTRACT. 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, However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. 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. CG 20 10 04 13 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. © Insurance Services Office, Inc,, 2012 Page 1 of 2 47848504 PACUTIL-Cl 19-20 GL, Auto, X5, WC, Ls/Rnt Equip, Inst Eltr Nancy CadwalLader 3/29/2019 3:40:09 PM (POT) Page 2 of 4 C. 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase applicable Limits of Insurance shown in Declarations. Of the the Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 47848504 PACUTIL-Cl 19-20 GL, Auto, X5, WC, LS/Rnt Equip, Inst FLtr Nancy Cadwallader 3/29/2019 3:40:09 PM (PDT) POLICY NUMBER: 54303390 COMMERCIAL GENERAL LIABILITY CG 20 37 04 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization(s) Location And Description Of Completed Operations WHERE REQUIRED BY WRITTEN CONTRACT, BUT ONLY WHERE THE CONTRACT SPECIFIES COVERAGES FOR COMPLETED OPERATIONS. WHERE REQUIRED BY WRITTEN CONTRACT. 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 organizabon(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". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. 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. 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. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 47848504 PACUTIL-Cl 19-20 CL, Auto, XS, WC, Ls/Rnt Equip, Inst Fltr Nancy Cadwa LLader 3/29/2019 3:40:09 PM (POT) Page 4 of 4 :From:..T..�w.................._.,..�.,, _.._. ...... �. �.......� t Bolton & Company ' 3475 E. Foothill Blvd., Suite 100 Pasadena, CA 91107 l (626)799-7000 0008309. www.boltonco.com City of Menifee 29714 Haun Road Menifee, CA 92586 S FAX DOCUMENT Certificate of Insurance Delivery by ecertsonline Im From: Nancy Cadwallader Subject: Cart No. 47848503 - Renewal Certificate of Liability: Pacific Utility Installation, Inc. Date: 3/29/2019 Delivery Via: FAX 19516793843 No. of Pages' 5 This certificate replaces the one you currently have on file. Following is the requested certificate of insurance for the insured in the subject above. The certificate was created in eCertsOnline and is in PDF format. You need to have Adobe Acrobat Reader installed on your system to view the certificate. To download the Adobe Reader for free, please visit www.Adobe.com. If you have any questions on the certificate, please contact Bolton & Company at 626-799-7000 If you have an questions or need revisions please reply to this email to ncadwallader@boltonco.com. THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT, OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US IMEDIATELY BYTELEPHONE, AND RETURN THE ORIGINAL MESSAGE. TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE. Certificate of Insurance Delivered by ecertsonlineTM Insurance Visions, Inc. All rights reserved. CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) 3/29/2019 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 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 endorsements . PRODUCER Bolton & Company CONTACT NAMIS3475 PHONE 626 799-7000 FAX 626 583-2117 xtl E. Foothill Blvd,, Suite 100 Pasadena, CA 91107 E-MAIL ADDRESS: INSURER 8 AFFORDING COVERAGE NA1C # INSURERA: Executive Risk Indemnity Inc 35181 www.boltonco.com 0008309 INSURED Pacific Utility Installation, Inc. Pacific Energy and Light 1585 Harmony Circle Anaheim CA 92807 INSURER B : Federal Insurance Company 20281 INSURERC: Starr Indemnity & Liability Company 38318 INSURERD : Zurich American Insurance Company 16535 INSURERE: INSURER F : UUVthWGt=5 CERTIFICATE NUMBER' dYR4R;,rii RFVIRICIN Nl1MRFR- 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. 1LTR TYPE OF INSURANCE JNSD WVD SUER POLICY NUMBER MWDDrt"WY CYEFF POLICY M DDDN LIMITS A COMMERCIAL GENERAL LIABILITY 54303390 4/1/2019 4/1/2020 EACH OMumCCURRENCE $1,000,000 CLAIMS -MADE OCCUR PREMISES Ea occrurence $100 000 MED EXP (Any one person) $ 5 000 PERSONAL & ADV INJURY $1 ,000 000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY E] FJERC"T� LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OPAGG $2,000,000 $ OTHER. B AUTOMOBILE LIABILITY 54303389 4/1/2019 4/1/2020 COMBlEo o c' ant LIMIT$1.000.000 ✓ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON•OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTYDAMAGE Par aGcidanl $ $ C UMBRELLA LIAB ,/ OCCUR 1000585010191 4/1/2019 4/1/2020 EACH OCCURRENCE $10,000,000 AGGREGATE $10.000 000 EXCESS LIAB CLAIMS -MADE DFD I I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFF CERIMEMBER EXCLUDED? ECANYPROPRIETORIPARTNEPJEX� N /A 5003391 411/2019 4/1/2020 S T OR E.L. EACH ACCIDENT $ 1 OOO OOO E L. DISEASE - EA EMPLOYE $ U_Q (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT I $1,000,000 DESCRIPTION OF OPERATIONS below D (Leased / Rented Equipment CPP 0276188-02 4/112019 41112020 $250,000 D Installation Property CPP 0276188-02 4/1/2019 4/1/2020 $250,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GL Additional Insured applies per CG20100413 & CG20370413 attached, only if required by written contract. Job: Menifee to Celebrate Veteran's Day with 5K Run on Saturday Nov. 9 and Nov. 11 at Wheatfeld Park, 30627 Menifee Road at La Piedra Road. Additional Insured (s): City of Menifee. (;LRiIFiGAIE HOLDER CANCELLATION Menifee to Celebrate Veteran Cityy of Menifee 29714 Haan Road 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 Chau Tran F 0)1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 47848503 PACUTIL-Cl 19-20 GL, Auto, XS, WC, Ls/Rnt Equip, Inst FLtr Nancy Cad—ILader 3/29/2019 3:40:09 PM (POT) Page 1 of 4 POLICY NUMBER: 54303390 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 Organization(s) I Location(s) Of Covered Operations WHERE REQUIRED BY WRITTEN CONTRACT. WHERE REQUIRED BY WRITTEN CONTRACT. 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. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. 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. CG 20 10 04 13 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. © Insurance Services Office, Inc., 2012 Page 1 of 2 47848503 PACUTIL-Cl 19-20 GL, Auto, XS, NC, Ls/Pnt Equip, Inst PLtr Nancy Cad—Llad— 3/29/2019 3:40:09 PM (POT) Page 2 of 4 C. 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 Page 2 of 2 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. © Insurance Services Office, Inc., 2012 CG 20 10 04 13 47948503 PACUTIL-Cl 19-20 GL, Auto, X5, WC, Ls/Rnt Equip, Inst Fltr Nancy Cadwallader 3/29/2019 3:40:09 PM (POT) Page 3 of 4 POLICY NUMBER: 54303390 COMMERCIAL GENERAL LIABILITY CG 20 37 04 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations WHERE REQUIRED BY WRITTEN CONTRACT, BUT ONLY WHERE THE CONTRACT SPECIFIES COVERAGES FOR COMPLETED OPERATIONS. WHERE REQUIRED BY WRITTEN CONTRACT. 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" 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". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. 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. CG 20 37 04 13 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. © Insurance Services Office, Inc., 2012 Page 1 of 1 47648503 PACUTIL-Cl 19-20 GL, Auto, XS, WC, Ls/Rnt Equip, Inst FLtr Nancy CadwaLLader 3/29/2019 3:40:09 PM (POT) Page 4 of 4 ;From: �.�vrvw....,.v,..,...�.._.w. ..._.........,.....,.....�... � .�� Bolton & Company 3475 E. Foothill Blvd,, Suite 100 Pasadena, CA 91107 (626) 799-7000 0008309 ` www.boltonco.com City of Menifee. 29714 Haun Menifee, CA 92586 a FAX DOCUMENT Certificate of Insurance Delivery by ecertsonline TM From: Bolton Certificate Processing Subject Cart No. 47852117 - Certificate of Liability: Merchants Building Maintenance Company - City of Menifee Date: 3/29/2019 Delivery Via: FAX 19516793843 No. of Pages: 15 Attached is the Certificate of Insurance as requested and forwarded to the below parties: Email: rvelarde mbmonline.com; Fax: (951) 679- 843 Following is the requested certificate of insurance for the insured in the subject above. The certificate was created in eCertsOnline and is in PDF format. You need to have Adobe Acrobat Reader installed on your system to view the certificate. To download the Adobe Reader for free, please visit www.Adobe.com. If you have any questions on the certificate, please contact Bolton & Company at 626-799-7000. THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT, OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED, IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US IMEDIATELY BYTELEPH ONE, AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE. Certificate of Insurance Delivered by ecertsonlineTM Insurance Visions, Inc. All rights reserved.. A►C�RL7`� �� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/2972019 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 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 endorsements . PRODUCER Bolton &Company NAME: PHONE 626 799-7000 � N ti26 583.211T 3475 E. Foothill Blvd., Suite 100 Pasadena, CA 91107 6.MAIL ADDRESS: INSIIR S AFFORDING COVERAGE NAIC.9 -www.boltonco.com 0008309 INSURERA: Nationwide Mutual Insurance Company A+XVI 23787 INSURED Merchants Building Maintenance 1190 Monterey Pass Road INSURER B : Safety National Casualty Corporation A+ XIVI 15105 INSURERC: Federal Insurance Company (A++XV) 20281 INSURER D: AMCO Insurance Com anv (A+XV 19100 Monterey Park CA 91754 E: Berkshire Hathaway Homestate Ins. Co. (A++XV 20044 .INSURER INSURER F : Great American Insurance Com DanV 16691 COVERAGES CERTIFICATE NUMBER: 47852117 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. INbR LTR TYPE OF INSURANCE ADDL SUER POLICYNUMBER POLICY EY POLICY EXP LIMITS A , f COMMERCIAL GENERAL LIABILITY ,� ACP3008735298 611 /2018 6/1 /2019 EACH OCCURRENCE $ 1 000 000 PREMI ES a occurrence] S1,000,000 CLAIMS -MADE u OCCUR MED EXP (Any one person) so _ PERSONAL & ADV INJURY $ 1 ,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER; POLICY E]pIERC0T. 1-1LOC PRODUCTS - COMP/OP AGO $2.000,000 $ OTHER: A AUTOMOBILE LIABILITY ACP3008735298 6/1/2018 6/1 /2019 Es 81NE ,I LIMIT$1.000.000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NOW OWNED AUTOS ONLY AUTOS ONLY r— BODILY INJURY (Per accident) $ P11 ERTYOAMAGE P r c an $ $ D / UMBRELLA LIAR ,/ OCCUR ACP3008735298 6/1/2018 6/1/2019 EACH OCCURRENCE $ 2,000,000 AGGREGATE $2.000.000 EXCESS LIAB CLAIMS -MADE DED RETENTI N O $ B E WORKERS COMPENSATION AND EMPLOYERS'LIABILRY YIN ANYPROPRiETOR/PARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED? N/A SP4054972 Excess WC (CA) MEWCO23295 (AOS) 611/2018 1/1/2019 6/1/2019 1/1/2020_LJ PEATurE ERH $ 1 000 000 E-L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ (IHer:dalery is NH) If yes, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $1 000 000 C Fidelity/3rd Party Crime 81585028 61112018 6/112019 Limit $1 MIL/Ded. $25,000 A (Rented Equipment ACP3008735298 6/1/2018 6/1/2019 Limit: $40,000/item; Ded. $2,500 F (Excess Liability - Occurrence TUE257195100 6/1/2018 6/1 /2019 $8,000,000 Excess of $2,000,000 Umbrella A Limited Job Site pollution ACP3008735298 6/1/2018 6/l/2019 $1.000.000 Each Incident/$1.000 Deductibl DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Workers Camp Is Self -Insured under California Certificate of Consent to Self Insure #1793 for California operations. GL Additional Insured applies par CCG74721216 & CG7246115 attached, only if required by written contractfagreement. GL Primary and Non Contributory Wording applies per CG74721216 attached. Auto Additional Insured applies per AC70060316 attached. GL & XSWC Waivers of Subrogation apply per CG747212% & 0456000113XWC attached. GL, Auto & XWC Cancellation Clauses apply per IL00171198, ACY0060316 & SPWC0908 attached. Additionat Insured(s): City of Menifee and its officers, employees, agents, and authorized volunteers. CERTIFICATE HOLDER CANCELLATION Cityy of Menifee 29714 Hnun 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. AU I H ORME: D REPRESENTATIVE Cheryl Fe:a 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD (lb) MBM 1.1.19 RenewaL including Po LLution Bo Lton Certificate Processing 3/29/2019 5:30:44 PM (PDT) Page 1 of 14 ACP3008735298 COMMERCIAL AUTO AC 70 06 03 16 A. EFFECT OF THIS ENDORSEMENT Coverage provided under this policy is modified by the provisions of this endorsement. If there is any conflict between the provisions of this endorsement and the provision(s) of any state - specific endorsement also attached to this poli- cy, then the provision(s) of the state -specific endorsement shall apply instead of the provi- sions of this endorsement that are in conflict, but only to the extent of the conflict, and only to the extent necessary to bring such provisions into conformance with the state requirement(s) contained in the provision(s) of the state -specific endorsement. B. NEWLY ACQUIRED OR FORMED ENTITIES The Named Insured shown in the Declarations is amended to include any organization you newly acquire or form, other than a partnership, joint venture, or limited liability company, and over which you maintain ownership or majority (more than 50%) interest; if there is no other similar in- surance available to that organization. Coverage under this provision is afforded until the 180" day after you acquire or form the organization or the end of the policy period, whichever is later. C. EMPLOYEES AS INSUREDS — NONOWNED AUTOS The following is added to paragraph A.I. Who Is An Insured of SECTION II — COVERED AUTOS LIABILITY COVERAGE: d. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your per- sonal affairs. D. ADDITIONAL INSURED BY CONTRACT, PERMIT OR AGREEMENT The following is added to A.1. Who Is An In- sured of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person or organization that you are re- quired to name as an additional insured in a written contract or agreement that is executed or signed by you prior to a "bodily injury' or "property damage" occurrence is an "insured" for Covered Auto Liability coverage. How- ever, with respect to covered "autos", such person or organization is an insured only to the extent that person or organization qualifies as an "insured" under A.I. Who is an Insured of SECTION II — COVERED AUTOS LIABILITY COVERAGE: If specifically required by the written contract or agreement referenced in the paragraph above, any coverage provided by this endorsement to an additional insured shall be primary and any other valid and collectible insurance avail- able to the additional insured shall be non- contributory with this insurance. If the written contract does not require this coverage to be primary and the additional insured's coverage to be non-contributory, then this insurance will be excess over any other valid and collectible insur- ance available to the additional insured. E. SUPPLEMENTARY PAYMENTS — BAIL BONDS Supplementary Payments of SECTION II — COVERED AUTOS LIABILITY COVERAGE is revised as follows: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic law violations) re- quired because of an "accident" we cover. We do not have to furnish these bonds. F. SUPPLEMENTARY PAYMENTS — LOSS OF EARNINGS Supplementary Payments of SECTION II — COVERED AUTOS LIABILITY COVERAGE is revised as follows: (4) All reasonable expenses incurred by the "in- sured" at our request, including actual loss of earnings up to $1,000 a day because of time off from work. G. PERSONAL EFFECTS AND PROPERTY OF OTHERS EXTENSION 1. The Care, Custody or Control Exclusion of SECTION II — COVERED AUTOS LIABILITY COVERAGE, does not apply to "property dam- age" to property, other than your property, up to an amount not exceeding $500 in any one "acci- dent". Coverage is excess over any other valid and collectible insurance. 2. The following paragraph is added to A.4. Coverage Extensions of SECTION III - PHYSICAL DAMAGE COVERAGE: c. We will pay up to $1,000 for your prop- erty that is lost or damaged as a result of a covered "loss", without applying a deductible. Coverage is excess over any other valid and collectible insur- ance. Page 2 of 7 Includes copyrighted material of Insurance Services Office, Inc. with its permission 47852117 MERCH-1 (lb) MBM 1.1.19 Renewal incLuding Pollution Bolton Certificate Processing 3/29/2019 5:30:44 PM (POT) AC 70 06 0316 /-kurouuoi oazzao considered breached unless the breach occurs after such claim or "suit" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer or insurance manager, if you are a corporation. X. HIRED CAR — COVERAGE TERRITORY Item (5) of the Policy Period, Coverage Territory General Condition is replaced by the following: (5) Anywhere in the world if a covered "auto" is leased, hired, rented or borrowed without a driver for a period of 30 days or less; and Y. EMERGENCY LOCKOUT We will reimburse you up to $100 for reasonable expense incurred for the services of a locksmith to gain entry into your covered "auto" subject to these provisions: 1. Your door key, electronic key or key entry pad has been lost, stolen or locked in your COMMERCIAL AUTO AC 70 06 0316 covered "auto" and you are unable to enter such "auto" , or 2. Your keyless entry device battery dies and you are unable to enter such "auto" as a result, 3. Your key, electronic key or key entry pad has been lost or stolen and you have changed the lock to prevent an unauthorized entry; and 4. Original copies of receipts for services of a locksmith must be provided before reimbursement is payable. Z. CANCELLATION CONDITION Paragraph A.2. of the COMMON POLICY CONDITION — CANCELLATION applies except as follows: If we cancel for any reason other than nonpay- ment of premium, we will mail or deliver to the First Named Insured written notice of cancella- tion at least 60 days before the effective date of cancellation. This provision does not apply in those states that require more than 60 days prior notice of cancellation. AC 70 06 0316 Includes copyrighted material of Insurance Services Office, Inc. Page 7 of 7 with its permission 47852117 MERCH-1 (lb) MBM 1.1.19 Renewal including Pollution Bolton Certificate Processing 3/29/2019 5:30:44 PM (POT) Page 3 of 14 ACP3008735298 CG 74 72 12 15 This insurance is primary to any expanded property damage coverage provided by a separate endorsement attached to this policy, and it will supplant any deductible in said endorsement E. Damage To Premises Rented To You 1. Under Section I — Coverages, Coverage A Bodily Injury And Property Damage Liability, the last paragraph of 2. Exclusions of is replaced with: If Damage To Premises Rented To You is not otherwise excluded, Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner. 2. Under Section III — Limits Of Insurance, Paragraph 6 is replaced with: 6. Subject to 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion, smoke, or sprinkler leakage, while rented to you or temporarily occupied by you with permission of the owner. The limit is increased to $1,000,000. 3 Under Section IV — Commercial General Liability Conditions, 4. Other Insurance, b. Excess Insurance (1) (a) (11) is replaced with: (ii) That is Fire, Lightning, Explosion, Smoke, or Sprinkler leakage insurance for premises rented to you or temporarily occupied by you with permission of the owner. F. Supplementary Payments Under Section I — Coverages, Supplementary Payments — Coverages A and B Paragraphs 1.b and 1.d. are replaced with: b. Up to $2,500 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. G. Newly Formed And Acquired Organizations Under SECTION II — WHO IS AN INSURED Paragraph 3.a. is replaced with: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; H. Additional Insured — Automatic Status When Required In An Agreement Or Contract With You Section 11 — Who Is An Insured is amended to include: 1. Any person(s) or organization(s) described in Paragraph 2. a. — d. below with whom you have agreed in writing in a contract or written agreement that such person or organization be added as an additional insured on your policy during the policy period shown in the Declarations. 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above. The person or organization added as an insured by this endorsement is an insured only for liability due to: a. Lessors of Leased Equipment — with respect to their liability for "bodily injury", "property damage", or "personal and advertising injury", caused in whole or in part by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). This insurance does not apply to any ,.occurrence" which takes place after the equipment lease expires. However, their status as additional insured under this policy ends when their lease, contract, or agreement with you for such leased equipment expires. b. Managers or Lessors of Premises — with respect to liability arising out of the ownership, maintenance, or use of that part of the premises you own, rent, lease, or occupy. Page 2 Of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 74 72 12 16 with its permission. 47852117 MERCH-1 (Lb) MBM 1.1.19 Renewal including Pollution Bolton Certificate Processing 3/29/2019 5:30:44 PM (POT) Page 4 of 14 This insurance does not apply to: (1) Any "occurrence" which takes place after you cease to be a tenant in that premises. (2) Structural alterations, new con- struction or demolition operations performed by or on behalf of the person or organization. However, their status as additional insured under this policy ends when you cease to be a tenant of such premises. c. State or Political Subdivision — Permits Relating to Premises — with respect to the following hazards for which the state or political subdivision has issued a permit or authorization in connection with premises you own, rent, or control and to which this insurance applies. (1) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures; or (2) The construction, erection, or removal of elevators; or (3) The ownership maintenance or use of any elevators covered by this insurance. This insurance does not apply to: (1) "Bodily injury" or "property damage" or "personal or advertising injury" arising out of operations performed for the state or municipality; or (2) "Bodily injury" or "property damage" included within the "products - completed operations hazard". However, such state or political subdivision's status as additional insured under this policy ends when the permit ends. d. Owners, Lessees, or Contractors — 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 CG 74 72 12 16 (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations performed for that additional insured, whether the work is performed by you or on your behalf. The insurance does not apply to: (1) "Bodily injury", "property damage", or "personal and advertising injury" arising out of the rendering of or the failure to render any professional architectural, engineering, or survey services, including: (a) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, survey, field orders, change orders, or drawings and specifications; or (b) Supervisory, inspection, archi- tectural 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 failure to render, any professional, architectural, engineering or surveying services. (2) "Bodily injury" or "property damage" occurring after: (a) 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 CG 74 72 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 5 with its permission. 47852117 MERCH-1 (lb) MBM 1.1.19 Renewal including Pollution Bolton Certificate Processing 3/29/2019 5:30:44 PM (POT) Page 5 of 14 CG 74 72 12 16 (b) 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. However, a person or organization's status as additional insured under this policy ends when your operations for that additional insured are completed. With respect to the insurance afforded to such additional insureds a. — d. described above the following is added to the 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. a. The additional insured is a Named Insured under such other insurance; and b. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. Employee Bodily Injury To Another Employee Under Section II — Who Is An Insured The following is added to Paragraph 2.a.(1): Paragraphs 2.a.(1)(a), (b). and (c) do not apply to "bodily injury" to a co -"employee" in the course of the co -"employee's" employment by you, or to "bodily injury" to a co -"volunteer worker" while performing duties related to the conduct of your business. J. Broad Form Named Insured However, the insurance afforded to such additional insureds a. — d. described above: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you K. are required by the contract or agreement to provide for such additional insured. 3. Primary and Noncontributory — Other Insurance Conditions The following is added to the Other Insurance Condition and supersedes any provisions to the contrary: Primary and Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: Under Section II — Who Is An Insured The following is added to Paragraph 2.: e. Any business entity incorporated or organized under the laws of the United State of America (including any State thereof), its territories or possessions or Canada (including any Province thereof) in which the Named Insured shown in the Declarations owns, during the policy period, an interest of more than fifty percent. If other valid collectible insurance is available to any business entity covered by this solely by reason of ownership by the Named Insured shown in the Declarations in excess of fifty percent, this insurance is excess over the other insurance, whether primary, excess, contingent, or on any other basis. Aggregate Limit Per Location Under Section III — Limits Of Insurance the following is added to Paragraph 2: The General Aggregate Limit under Section III Limits Of Insurance applies separately to each of your locations owned by or rented to you or temporarily occupied by you with the permission of the owner. For the purposes of this provision, location means premises involving the same or connecting lots, or premises whose connection is interrupted only by a public street, roadway, waterway, or railroad right-of-way. Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 74 72 12 16 with its permission. 47852117 MERCH-1 (lb) MBM 1.1.19 Renewal including Pollution Bolton Certificate Processing 3/29/2019 5:30:44 PM (PDT) Page 6 of 14 ACP3008735298 COMMERCIAL GENERAL LIABILITY CG 72 46 11 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured: Ongoing Operations 1. Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; and 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above. Such person(s) or organization(s) 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: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured described above: Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured for ongoing operations ends when your operations for the person or organization described in Paragraph 1. above are completed. With respect to insurance afforded to these additional insureds for ongoing operations, this insurance does not apply to "bodily injury" or "property damage" occurring after: a. All work, including material, 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 b. that operation 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. B. Section II — Who Is An Insured is amended to include as an additional insured: Products —Completed Operations Any person or organization with whom you have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" performed for such person or organization and included in the "products -completed operations hazard". However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. C. With respect to the insurance afforded to these additional insureds, this insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering CG 72 46 11 15 Includes copyrighted material of Insurance Services Office, Inc with its permission. Page 1 of 2 47852117 MERCH-1 (lb) MBM 1.1.19 Renewal including Pollution Bolton Certificate Processing 3/29/2019 5:30:44 PM (PDT) CG 72 46 11 15 of, or the failure to render, any professional architectural, engineering or surveying services, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or 2. 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. D. With respect to the insurance afforded to these additional insureds, 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 described in Paragraph A.1. or Paragraph B.; or 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. E. With respect to the insurance afforded to these additional insureds, the following is added to Section IV — Commercial General Liability Conditions, Condition 4. Other Insurance and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. All terms and conditions of this policy apply unless modified by this endorsement. Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc. CG 72 46 11 15 with its permission. 47852117 MERCH-1 (lb) MBM 1.1.19 Renewal including Pollution Bolton Certificate Processing 3/29/2019 5:30:44 PM (POT) Page 9 of 14 AUt'3UL16tJ JZ!Jb CG 74 72 12 16 (b) 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. However, a person or organization's status as additional insured under this policy ends when your operations for that additional insured are completed. With respect to the insurance afforded to such additional insureds a. — d. described above the following is added to the 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. However, the insurance afforded to such additional insureds a. — d. described above: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you K. are required by the contract or agreement to provide for such additional insured. 3. Primary and Noncontributory — Other Insurance Conditions The following is added to the Other Insurance Condition and supersedes any provisions to the contrary: Primary and Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: Page 4 of 5 a. The additional insured is a Named Insured under such other insurance; and b. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. Employee Bodily Injury To Another Employee Under Section II — Who Is An Insured The following is added to Paragraph 2.a.(1): Paragraphs 2.a.(1)(a), (b). and (c) do not apply to "bodily injury" to a co -"employee" in the course of the co -"employee's" employment by you, or to "bodily injury" to a co -"volunteer worker" while performing duties related to the conduct of your business. Broad Form Named Insured Under Section II — Who Is An Insured The following is added to Paragraph 2.: e. Any business entity incorporated or organized under the laws of the United State of America (including any State thereof), its territories or possessions or Canada (including any Province thereof) in which the Named Insured shown in the Declarations owns, during the policy period, an interest of more than fifty percent. If other valid collectible insurance is available to any business entity covered by this solely by reason of ownership by the Named Insured shown in the Declarations in excess of fifty percent, this insurance is excess over the other insurance, whether primary, excess, contingent, or on any other basis. Aggregate Limit Per Location Under Section III — Limits Of Insurance the following is added to Paragraph 2: The General Aggregate Limit under Section III Limits Of Insurance applies separately to each of your locations owned by or rented to you or temporarily occupied by you with the permission of the owner. For the purposes of this provision, location means premises involving the same or connecting lots, or premises whose connection is interrupted only by a public street, roadway, waterway, or railroad right-of-way. Includes copyrighted material of Insurance Services Office, Inc., CG 74 72 12 16 with its permission. 47852117 MERCH-1 (lb) MBM 1.1.19 RenewaL including Pollution Bolton Certificate Processing 3/29/2019 5:30:44 PM (PDT) c CG74721216 L. Aggregate Limit Per Project Under Section III — Limits Of Insurance The following paragraph is added to Paragraph 2: The General Aggregate Limit under Section III Limits Of Insurance applies separately to each of your construction projects away from premises owned by or rented to you. M. Knowledge Of An Occurrence Under Section IV — Commercial General Liability Conditions, The following is added to 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit: e. Knowledge of an occurrence, offense, claim, or suit by an agent or employee of any insured shall not in itself constitute knowledge of the insured unless you, a partner, if you are a partnership; or an executive officer or insurance manager, if you are a corporation receives such notice of an occurrence, offense, claim or suit from the agent or employee. f. The requirements in Paragraph b. will not be considered breached unless there is knowledge of occurrence as outlined in Paragraph e. above. N. Unintentional Failure To Disclose Hazard Under Section IV — Commercial General Liability Conditions, Condition 6. Representations the following paragraph is added: d. Your failure to disclose all hazards or prior "occurrences" or offenses existing as of the inception date of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior "occurrences" or offenses is not intentional. This provision does not affect our right to collect additional premium or exercise our right of cancellation or non -renewal. O. Waiver Of Subrogation Under Section IV — Commercial General Liability Conditions, 8. Transfer Of Rights Of Recovery Against Others To Us the following paragraph is added: If required by a written contract executed prior to loss, we waive any right of subrogation we may have against the contracting person or organization 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 hazards". P. Liberalization Under Section IV — Commercial General Liability Conditions, the following paragraph is added: 10. Liberalization If we revise this coverage form to provide more coverage without additional premium charge, your policy will automatically provide the additional coverage as of the day the revision is effective in your state. Q. Broadened Bodily Injury Definition (Mental Anguish) Under Section V — Definitions Definition 3. Bodily Injury is replaced with: 3. "Bodily injury" means physical injury, sickness, or disease to a person and if arising out of the foregoing, mental anguish, mental injury, shock, or humiliation, including death at any time resulting therefrom. All terms and conditions of this policy apply unless modified by this endorsement. CG 74 72 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 5 with its permission. 47852117 MERCH-1 (lb) MBM 1.1.19 Renewal including Po Llution Bolton Certificate Processing 3/29/2019 5:30:44 PM (POT) Page 10 of 14 ACP3008735298 IL 00 17 11 98 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Declara- tions may cancel this policy by mailing or deliv- ering to us advance written notice of cancella- tion. 2. We may cancel this policy by mailing or deliver- ing to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancel- lation if we cancel for nonpayment of premi- um; or b. 30 days before the effective date of cancel- lation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to US. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be ef- fective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be suffi- cient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C. Examination Of Your Books And Records We may examine and audit your books and rec- ords as they relate to this policy at any time during the policy period and up to three years afterward. D. Inspections And Surveys 1. We have the right to: a. Make inspections and surveys at any time; IL 00 17 11 98 b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any inspections, surveys, reports or recommendations and any such actions we do undertake relate only to in- surability and the premiums to be charged. We do not make safety inspections. We do not un- dertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes in- surance inspections, surveys, reports or rec- ommendations. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recom- mendations we may make relative to certifica- tion, under state or municipal statutes, ordi- nances or regulations, of boilers, pressure ves- sels or elevators. E. Premiums The first Named Insured shown in the Declara- tions: 1. Is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay- F. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representa- tive. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 p 47852117 MERCH-1 (Lb) MBM 1.1.19 Renewal including Pollution Bolton Certificate Processing 3/29/2019 5:30:44 PM (POT) Page 11 of 14 0456 00 0113 (XWC) ENDORSEMENT BLANKET WAIVER OF SUBROGATION Effective 12:01 A.M., Local Time June 1, 2018 In consideration of the paymentof premium and adherence by both parties to the terms of this Agreement, it is hereby understood and agreed that the Recovery From Others section of this Agreement is amended to include the following additional language The CORPORATION has the right to pursue subrogation recoveries from anyone liable for an injury covered by this Agreement. The CORPORATION will not enforce its right against any person or organization for whom the EMPLOYER performs work under a written contract that requires the EMPLOYER to obtain this agreement from the CORPORATION. All other terms, conditions, agreements and stipulations remain unchanged. Attach to and forming a part of Excess Workers' Compensation and Employers' Liability Insurance Agreement No SP4054972 issued by SAFETY NATIONAL CASUALTY CORPORATION of St. Louis, Missouri to MERCHANTS BUILDING MAINTENANCE COMPANY, ET AL, dated June 1, 2018. SAFETY NATIONAL CASUALTY CORPORATION President Secretary 47852117 MERCH-1 (lb) MBM 1.1.19 Renewal including Pollution Bolton Certificate Processing 3/29/2019 5:30:44 PM (POT) Page 12 of 14 SP4054972 Excess WC (CA) unreasonably refuse to settle any claim which, in the exercise of sound judgment with respect to the entire claim, should be settled, provided, however, that the EMPLOYER shall not make any payment or agree to arty settlement for any sum which would involve the limits of the CORPORATION'S liability hereunder without the approval of the CORPORATION. If the CORPORATION is prejudiced by the EMPLOYER's failure to exercise diligence, prudence, and good faith, the CORPORATION may elect to disclaim coverage for Loss from such claim. L. Inspection and Audit The CORPORATION shall have the right, but not the obligation, to Inspect the premises and equipment and/or to audit the books and records of the EMPLOYER and of its agents and representatives, including all records relating to payroll and claims matters, at any reasonable time during the period of this Agreement and within three (3) years after final settlement of all claims due to Occurrences happening during Lhe term of this Agreement. An audit to determine Manual or Standard Premium shall supersede any and all prior voluntary payroll reports by the EMPLOYER, and will be used to determine the final adjustment of premiums due to the CORPORATION. Should a determination be made that additional audit premium is due to the CORPORATION, the due date for payment of such audit premium shall be thirty (30) days after the date of billing. M. Other Insurance If the EMPLOYER carries other valid and collectible insurance, reinsurance, or Indemnity with any other insurer or reinsurer covering a Loss also covered by this Agreement (other than insurance or reinsurance that is purchased to apply in excess of the sum of the Self -Insured Retention and the Maximum Limits of Indemnity hereunder), the insurance afforded by this Agreement shall apply in excess of and shall not contribute wilh such other insurance or reinsurance. Recovery from Others The EMPLOYER agrees to prosecute any and all valid claims the EMPLOYER may have against any other party or source that may mitigate any Loss under this Agreement and return to the CORPORATION any amount so recovered, less the reasonable expense of collecting such amounts. The CORPORATION shall have the EMPLOYER's rights to Prosecute any and all valid claims against any other party or source that may mitigate any Loss under this Agreement. The EMPLOYER agrees that it will assist the CORPORATION in any prosecution of any and all valid claims against any other party or source that may mitigate any Loss under this Agreement. Any amounts recovered by the EMPLOYER or the CORPORATION from any party or source that may mitigate any Loss under this Agreement shall First be used to pay the expenses of collection and to reimburse the CORPORATION for any amount it may have paid the EMPLOYER for the Liability Period concerned, and all SPWC•09G8•AI remaining amounts collected shall be paid to the EMPLOYER. O. Change in Agreement No condition, provision, or declaration of this Agreement shall be waived or altered at any time, except as spedRed in Section F, except by endorsement signed by the President or a Senior Vice President and the Secretary or an Assistant Secretary of the CORPORATION. This Agreement hereby terminates, supersedes, and replaces all previously Issued Workers' Compensation Insurance or Reinsurance Agreements, as amended, between the EMPLOYER and the CORPORATION. If terms of this Agreement are in conflict with any law applicable to this Agreement, this statement amends this Agreement to conform to such law. In addition, in the event any terms are in conflict with applicable laws, the remaining terms of the Agreement shall be enforceable. P. Cancellation This Agreement may be cancelled by either party giving the other party written notice not less than sixty (60) days prior to the date of cancellation, except, that if the CORPORATION cancels for non-payment of any premium, the cancellation shall become effective ten (10) days after dispatch of notice by the CORPORATION, The date of cancellation then becomes the termination date of the final Liability Period. This Agreement does not apply to Loss as a result of Occurrences taking place after the effective date of such cancellation. If cancellation is effected by the EMPLOYER, the Manual or Standard Premium shall be determined by the short rate tables used for casualty insurance, and the Earned Premium shall be the product of the Premium Rate (Item 9) times the Manual or Standard Premium (or the Total Annual Remuneration) so arrived at, but not less than the Minimum Premium specified in the Declarations. If cancellation is effected by the CORPORATION for non- payment of premium, the EMPLOYER shall pay the CORPORATION Earned Premium for the period up to the date of cancellation. If the CORPORATION cancels for any other reason, the Manual or Standard Premium (or the Total Annual Remuneration) shall be determined upon a pro rata basis and the Eamed Premium adjusted in accordance therewith. Q. Assignment An assignment of interest under this Agreement will not bind the CORPORATION unless an endorsement signed by the President or a Senior Vice President and the Secretary or an Assistant Secretary of the CORPORATION assigning Interest under this Agreement is issued by the CORPORATION, IL Bankruptcy or Insolvency of Employer The bankruptcy or insolvency of the EMPLOYER will not -elieve the CORPORATION or the EMPLOYER of its duties and liabilities under this Agreement. After payments have 47852117 MERCH-1 (lb) MBM 1.1.19 Renewal including Pollution Bolton Certificate Processing 3/29/2019 5:30:44 PM (POT) Page 13 of 14 ACP3008735298 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation I. The first Named Insured shown in the Declara- tions may cancel this policy by mailing or deliv- ering to us advance written notice of cancella- tion. 2. We may cancel this policy ay mailing or deliver- ing to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancel- lation if we cancel for nonpayment of premi- um; or b. 30 days before the effective date of cancel- lation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to US. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rats. The cancellation will be ef- fective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be suffi- cient proof of notice. B. Changes C C This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to mane changes in the terms of this Policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. Examination Of Your Books And Records We may examine and audit your books and rec- ords as they relate to this policy at any time during the policy period and up to three years afterward. Inspections And Surveys 1. We have the right to: a. Make inspections and surveys at any time; IL 00 17 11 98 b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any inspections, surveys, reports or recommendatlons and any such actions we do undertake relate only to in- surability and the premiums to be charged. We do not make safety inspections. We do not un- dertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2, of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which mares in- surance inspections, surveys, reports or rec- ommendations_ 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recom- mendations we may make relative to certifica- tion, under state or municipal statutes, ordi- nances or regulations, of boilers, pressure ves- sels or elevators, E. Premiums The first Named Insured shown in the Declara- tions: 1. Is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay. F. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representa- tive. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 p 47852117 MERCH-1 (lb) MEM 1.1.19 Renewal including Pollution Bolton Certificate Processing 3/29/2019 5:30:44 PM (POT) Page 14 of 14