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2019/08/01 L & S Construction, Inc. Certificate of Liability Insurance �1 USCONS-01 BMAR CERTIFICATE OF LIABILITY INSURANCE DATE(M 7/24/201YYY) 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 endorsement(s). PRODUCER License#0757776 CONTACT NAME: Newport Beach,CA-HUB International Insurance Services Inc. PHONE FAX 4695 MacArthur Court,Suite 600 Arc,Na,FL).(949)623-3980 (vc,Nal:(949�891-0407 Newport Beach,CA 92660 E AI INSURERS AFFORDING COVERAGE NAIC# INSURER A:Executive Risk Indemnity 35181 INSURED INSURER B:Federal Insurance Company 20281 L&S Construction,Inc. INSURER C: 674 North Batavia Street INSURER D: Orange,CA 92868 I 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. IHSR TYPE OF INSURANCE AQGL.SU9R POLICY NUMBER PM@�EFF MOUCy LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 4+000,000 CLAIMS-MADE F)71:,OCCUR X �54303181 8/1/2019 8/1/2020 DAMAGE TO RENTED 100,000 MED EXP Mny one S $,000 PERSONAL&AOV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE S 2,000,000 X POLICY X.3ECT 17 LOC PRODUCTS-COMPIOP AGG S 2-000=000 OTIiER X Per Proj Gen Agg per contradt S B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 ~X ANY AUTO J154303180 8/1/2019 8/1/2020 ODiLYerit)INJURY P n S OWNED f - SCHEDULED AUTOS ONLY AUTOS BODILY INJURY P aocident S HIRED O�ONLY AOTOS ONE PerOBcaR'denIAMAGE S S UMBRELLA LIAB OCCUR y EACH OCCURRENCE !S EXCESS LIAB id CLAIMS-MADE I S DED I 1 RETENTIONS Is B WORKERS COMPENSATION X {PER OTH- AND EMPLOYERS'LIABILITY �.==1- ER/ 54303182 8/1/2019 8/1/2020 L. crl ACCIDENT ,ANY PRdPRlETgR1PARTNERIEXECUTIVE 1 000 fJ00 ❑FFI .,7EM8 R EXCLUDEW YINN/A E_L.DISER$E-EA EMP OYES + (Mandatary rn N�f 1000,000 H yyeess descnbe under DESCRIPTEON OF OPERATIONS belaw E.L.DISEASE.POLICY IMIT S 1,000,000 'DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Encroachment Permit for L&S Construction,Inc.Job#934.Watt Communities at Mosaic,LLC.Project Address:Tract 28206,Garbani Road and Palomar Road,Menifee,CA. glai City of Menifee is included as Additional Insured where required by an executed written contract as respects General Liability per attached endorsements. CERTIFICATE HOLDER S I CANCELLATION ity ! �I I I S'= i ty "F SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 29714 Haun Road ACCORDANCE WITH THE POLICY PROVISIONS. i� �} 7 •.nth Menifee,CA 92586 = - AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:L&SCONS-01 BMARIN LOC#: 1 . 1114. � ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY License#4757776i NAMED INSURED Newport Beach, CA-HUB International Insurance Services Inc. fi7L 4 S Construction,Inc. ' A North Batavia Street POLICY NUMBER iOrange,CA 92868 EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEEP 1 EFFECTNE DATE:SEE PAGE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance _ Cancellation: *Should the policy(ies)be cancelled before the expiration date,Hub International Insurance Services Inc.(Hub), independent of any rights which may be afforded within the policies to the certificate holder named below,will provide to such certificate holder notice of such cancellation within thirty(30)days of the cancellation date,except in the event the cancellation is due to non-payment of premium, in which case Hub will provide to such certificate holder notice of such cancellation within ten(10)days of the cancellation date. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 54303181 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) JLocation And Description Of Completed Operations WHERE REQUIRED BY WRITTEN CONTRACT, BUT ONLY ALL LOCATIONS WHERE REQUIRED BY WRITTEN CONTRACT. WHERE THE CONTRACT SPECIFIES COVERAGE FOR COMPLETED OPERATIONS. 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 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 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 54303181 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) Location(s) Of Covered Operations WHERE REQUIRED BY WRITTEN CONTRACT. ALL LOCATIONS 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" This insurance does not apply to "bodily injury" or caused, in whole or in part, by: "property damage" occurring after: 1. Your acts or omissions; or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 20 10 04 13