2018/11/28 CN Engineering, Inc. Liability Insurance Certificate AC R� CERTIFICATE OF LIABILITY INSURANCE DATE(MMMD/YYYY)
01/1412019
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 pollcy(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 C NTRCT
Hiscox Inc.d/b!a!Hiscox Insurance Agency in CA 1PHONE
Fxll_(888)202-3007 [f,he};
520 Madison Avenue AIL . Contact hiSCOX.COrR
32nd Floor INSURERS AFFORDING COVERAGE NAICN
New York,NY 10022 INSURER A: Hiscox Insurance Company Inc 10200
INSURED
INSURER B:
CN Engineering,Inc. INSURER C:
26776 Rhapsody Ct. INSURER D:
INSURER E:
Menifee CA 92584 L INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 TYPEOFINSURANCE A DL D POLICY EFF POL1CYExP
im POLICY NUMBER LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE a OCCUR P IS I n r $ 10D,DDD
MED EXP(Any oneperson) $ 5,000
A Y UDC-2413934-CGL-18 11/28/2018 11/28/2019 PERSONAL&ADV INJURY $ 1,000,000
�GEEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000
/\ POLICY PRO LOC PRODUCTS-COMPIOPAGG $ S(T Gen.A
JECI
OTHER: $
AUTOMOBILE LIABILITY
cnmEIINED SINGLE LIMIT $
n
ANY AUTO BODILY INJURY(Per person) $
ALL
AUTOS�ED AUTOS
UDC-2413934-CGL-18 11/28/2018 11/28/2019 BODILY INJURY(Per accident) $
NON-OWNED PRO A RTYOAMAGE $
HIREDAUTOS AUTOS p r n
Ix CGL HvedMon-Owned Auto $ 11000,000
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR Ld CLAIMS-MADE AGGREGATE $
➢ED I I RETENTIONS $
WORKERS COMPENSATION PER
OTH-
AND EMPLOYERS'LIABILITY Y/N S A7 T
ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E L DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY I.IMIT $
I
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
City of Menifee and its Officers,Employees,Agents,and Authorized Volunteers are listed as Additional Insured on the Commercial General Liability Policy
subject to the policy terms and conditions.
Reference FY 2018/19 on-call engineering services(recoverable).
CERTIFICATE HOLDER CANCELLATION
City of Menifee
29714 Haun Rd SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Menifee,CA 92586 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
A
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
T � CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
—` 01114/2019
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 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 CONTACT
Hiscox Inc.d/b/a/Hiscox Insurance Agency in CA PtrpNi (888)202-3007 r•Ax
520 Madison Avenue E-MML
32nd Floor H , Dontact9hiswx.cam
New York,NY 10022 INSURERS AFFORDING COVERAGE NAIC r
INSURER A: Hiscox Insurance Company Inc 10200
INSURED
INSURER B: _
CN Engineering,Inc. INSURERC:
26776 Rhapsody Ct.
Menifee,CA 92584 INSURER D
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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.
INSn IAPISL SIJt311 POLICY EFF POLICY EXP ---
TYPE OF INSURANCE DPOLICYNUMBER LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
i
CLAIMS-MADE LJ OCCUR PREMIS.• a $
MED EXP(Any oneperson) $
PERSONAL&ADV INJURY $
GEN'L AGGRWATEC LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY El JEST LOC PRODUCTS-COMP/OP AGG $
OTHER $
AUTOMOBILE LIABILITY COiIBINED5iNGL LIM $
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS PRDPERTY DAMAGE.
HIRED AUTOS NON-OWNED AUTOS $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR 1A CLAIMS-MADE AGGREGATE $
DEA i I RETENTION $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? ❑ N/A
(Mandatory In NH) E.L DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E,L-DISEASE-POLICY LIMIT 1 $
A Professional Liability Y UDC-2413934-EO-18 11/28/2018 11/28/2019 Each Claim:$1,000,000
Aggregate:$1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
City of Menifee and its Officers,Employees,Agents,and Authorized Volunteers are listed as Additional Insured on the Professional Liability Policy subject to the policy terms and c
onditions.Reference FY 2018/19 On-Call Engineering Services(Recoverable).
CERTIFICATE HOLDEN! CANCELLATION
City of Menifee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
29714 Haun Rd THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Menifee CA 92586 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
ENSWEERM
January 14,2019
Dear Ms. Margarita Cornejo:
CN Engineering,Inc. (CNE)is pleased to provide the attached requested insurance policies
with the City of Menifee as the additional insured. CNE currently is operated by owners
only and does not have any employees. Therefore, the Workers' Compensation and
Employer's Liability Insurance is not applicable at this time. Also,our company currently
hires or utilizes non-owned autos in lieu of owning any autos, As a result, the provided
insurance will cover hired and non-owned autos. In the event if any of the above
condition changes, CNE will provide updated insurance policies in accordance with the
City of Menifee's contract requirements.
Please feel free to contact me for any questions or clarification. We look forward to
providing quality engineering services for the City of Menifee.
Sincerely, A
Crysta Nguyen, PE
CEO/President
26776 Rhapsody Ct.
Menifee,CA 92584
(951)440-9890
crystal((D,cn engi neerservices.com