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2020/10/01 A.M. Ortega Construction, Inc. Certificate of Liability Insurance (4)
Acorro CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) lk- � 10/1/2020 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 CONTACT NAME: Wella Campbell Alliant Insurance Services, Inc. PHONE 619.849.3924 FAx 701 B Street, 6th floor WC.i�. we Nnl: San Diego CA 92101 E-MAIL RIESS: wcam bell alliantcom INSURERS AFFORDING COVERAGE NAIC P Licen INSURERA: Executive Risk Indemnity Inc 35181 INSURED AMORTEG•02 INSURER B: Federal Insurance Company 20281 A.M. Ortega Construction, Inc. 10125 Channel Road INSURERC: Lakeside CA 92040 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1702840437 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 TYPE OF INSURANCE DL SU$R POLICY EFF POLICY EXP _LTRPOLICY NUMBER MM/DDJYYYY M! LIMITS A X COMMERCIAL GENERAL LIABILITY 54303214 10/1/2020 10/1/2021 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR DAM PREMISES Ea occurrence $100.000 MED EXP(Anyone person) $5,000 PERSONAL&ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY 1 JE C LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: DEDUCTIBLE $5,000 B AUTOMOBILE LIABILITY 54303213 10/1/2020 10/1/2021 �eB�N�EnDIs]NGt.F LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS ( ) X HIRED X NON-OWNED PR+DPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Pe ecc=1 $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 54303215 10/1/2020 10/1/2021 X PER OTH- AND EMPLOYERS'LIABILITY Y 1 N STATUTE I ER ANYPROPRI ETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) This certificate only applies to the operations for which our insured actually performs work and Is referenced by written contract between the certificate holder and our Insured.Certificate holder is named as an additional insured (GL)per the captioned operations of the Named Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Menifee ACCORDANCE WITH THE POLICY PROVISIONS. 29714 Haun Rd. AUTHORIZED Sun City CA 92586 _ k-— - ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 54303214 COMMERCIAL GENERAL LIABILITY CG20100413 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 This insurance does not apply to "bodily injury" or damage or personal and advertising injury "property damage" occurring after: caused, in whole or in part, by: 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 POLICY NUMBER: 54303214 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, ALL LOCATIONS WHERE REQUIRED BY WRITTEN BUT ONLY WHEN THE CONTRACT SPECIFIES CONTRACT 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: 54303214 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): ALL OF YOUR DESIGNATED CONSTRUCTION PROJECTS WHERE REQUIRED BY CONTRACT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by 'occur- damages or under Coverage C for medical rences" under Section I — Coverage A, and for all expenses shall reduce the Designated Con- medical expenses caused by accidents under struction Project General Aggregate Limit for Section I — Coverage C, which can be attributed that designated construction project. Such only to ongoing operations at a single designated payments shall not reduce the General Ag- construction project shown in the Schedule gregate Limit shown in the Declarations nor above: shall they reduce any other Designated Con- t. A separate Designated Construction Project struction Project General Aggregate Limit for General Aggregate Limit applies to each des- any other designated construction project ignated construction project, and that limit is shown in the Schedule above. equal to the amount of the General Aggregate 4. The limits shown in the Declarations for Each Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, ex- General Aggregate Limit shown in the Decla- cept damages because of "bodily injury" or rations, such limits will be subject to the appli- "property damage" included in the "products- cable Designated Construction Project Gen- completed operations hazard", and for medi- eral Aggregate Limit. cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or"suits" brought; or c. Persons or organizations making claims or bringing "suits". CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 ❑ B. For all sums which the insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by "occur- "products-completed operations hazard" is pro- rences" under Section I —Coverage A, and for all vided, any payments for damages because of medical expenses caused by accidents under "bodily injury" or "property damage" included in Section I — Coverage C, which cannot be at- the "products-completed operations hazard" will tributed only to ongoing operations at a single reduce the Products-completed Operations Ag- designated construction project shown in the gregate Limit, and not reduce the General Ag- Schedule above: gregate Limit nor the Designated Construction 1. Any payments made under Coverage A for Project General Aggregate Limit. damages or under Coverage C for medical D. If the applicable designated construction project expenses shall reduce the amount available has been abandoned, delayed, or abandoned under the General Aggregate Limit or the and then restarted, or if the authorized contract- Products-completed Operations Aggregate ing parties deviate from plans, blueprints, de- Limit, whichever is applicable; and signs, specifications or timetables, the project will 2. Such payments shall not reduce any Desig- still be deemed to be the same construction pro- nated Construction Project General Aggre- ject. gate Limit. E. The provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 03 05 09 ❑ POLICY NUMBER: 54303214 COMMERCIAL GENERAL LIABILITY 10-02-2461 (Ed. 7-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE FOR SCHEDULED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Additional Insured: Location Of Covered Operations: WHERE REQUIRED BY WRITTEN CONTRACT ALL LOCATIONS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect only to the Additional Insured and at (1)The Additional Insured is a named the Location Of Covered Operations shown in the insuredunder such other insurance; and Schedule,the following is added to SECTION IV— (2)You have agreed in writing in a contract COMMERCIAL GENERAL LIABILITY CONDITIONS, oragreement that this insurance would Paragraph 4.Other Insuranceand supersedes any beprimary and would not seek provision to thecontrary: contributionfrom any other insurance Primary And Noncontributory Insurance available to theAdditional Insured. This insurance is primary to and will not seekcontribution from any other insurance available to the Additional Insured with respect to the Location Of Covered Operations shown in the Schedule under thispolicyprovided that: 10-02-2461 (Ed. 7-15) Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. POLICY NUMBER: 54303214 c. Method Of Sharing To the extent that the insured's rights to recover If all of the other insurance permits contribution all or part of any payment made under this Cover- by equal shares, we will follow this method al- age Part have not been waived, those rights are so. Under this approach each insurer contrib- transferred to us. The insured must do nothing af- utes equal amounts until it has paid its appli- ter loss to impair them. At our request, the insured cable limit of insurance or none of the loss will bring "suit" or transfer those rights to us and remains, whichever comes first. help us enforce them. If any of the other insurance does not permit This condition does not apply to Coverage C. contribution by equal shares, we will contribute 9. When We Do Not Renew by limits. Under this method, each insurer's If we decide not to renew this Coverage Part, we share is based on the ratio of its applicable lim- will mail or deliver to the first Named Insured it of insurance to the total applicable limits of shown in the Declarations written notice of the insurance of all insurers. nonrenewal not less than 30 days before the expi- 5. Premium Audit ration date. a. We will compute all premiums for this Cover- If notice is mailed, proof of mailing will be sufficient age Part in accordance with our rules and proof of notice. rates. SECTION V— DEFINITIONS b. We may audit your books and records as they 1. "Advertisement" means an electronic, oral, written relate to this insurance at any time during the or other notice, about goods, products or services, term of this policy and up to three years after- designed for the specific purpose of attracting the wards. general public or a specific market segment to use c. The first Named Insured must keep records of such goods, products or services. the information we need for premium computa- "Advertisement" does not include any e-mail ad- tion, and send us copies at such times as we dress, Internet domain name or other electronic may request. address or metalanguage. 6. Representations 2. "Advertising injury" means injury, other than "bodi- By accepting this policy, you agree: ly injury", "property damage"or "personal injury", a. The statements in the Declarations are accu- sustained by a person or organization and caused rate and complete; by an offense of infringing, in that particular part of b. Those statements are based upon representa- your "advertisement" about your goods, products tions you made to us; and or services, upon their: c. We have issued this policy in reliance upon a• Copyrighted "advertisement"; or your representations. b. Registered collective mark, registered service 7. Separation Of Insureds mark or other registered trademarked name, Except with respect to the Limits of Insurance, and slogan, symbol or title. any rights or duties specifically assigned in this 3• "Asbestos" means asbestos in any form, including Coverage Part to the first Named Insured, this in- its presence or use in any alloy, by-product, com- surance applies: pound or other material or"waste". a. As if each Named Insured were the only 4. "Auto" means: Named Insured; and a. A land motor vehicle, trailer or semitrailer de- b. Separately to each insured against whom signed for travel on public roads, including any claim is made or"suit" is brought, attached machinery or equipment; or 8. Transfer Or Waiver Of Rights Of Recovery b. Any other land vehicle that is subject to a com- Against Others To Us pulsory or financial responsibility law or other We will waive the right of recovery we would oth- motor vehicle insurance law in the state where it is licensed or principally garaged. erwise have had against another person or organ- ization, for loss to which this insurance applies, However, "auto" does not include "mobile equip- provided the insured has waived their rights of re- ment". covery against such person or organization in a 5."Bodily injury" means physical: contract or agreement that is executed before a. Injury; such loss. b. Sickness; or c. Disease; Page 12 of 16 Includes copyrighted material of ISO Properties, Form 10-02-1800 (Rev. 6-09) Inc., with its permission POLICY NUMBER: 54303213 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s)who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: A.M. Ortega Construction, Inc. Endorsement Effective Date: 10/1/2020 SCHEDULE Name Of Person(s) Or Organization(s): WHERE REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured"for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: 54303213 COMMERCIAL AUTO 16-02-0316 Ed. 10 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY LIABILITY INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: A.M. Ortega Construction, Inc. Endorsement Effective Date: 10/1/2020 SCHEDULE Name(s) Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Item 5. —"Other Insurance" of Item B.—"General Conditions" under Section IV—"Business Auto Conditions": e. Regardless of the provisions of Paragraph 5.a. through d. above, for any liability arising out of the ownership, maintenance, use, rental, lease, loan, hire or borrowing by an "insured" of a covered "auto" for which an "insured" is contractually obligated to provide primary insurance coverage to a client, this Coverage Form will be primary and non-contributory with respect to the Persons or Organizations in the schedule, regardless of the availability or existence of other collectible insurance under any other Coverage Form or policy that applies on a primary basis. 16-02-0316 Ed. 10 14 Page 1 of 1 POLICY NUMBER: 54303213 COMMERCIAL AUTO CA 04 4410 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: A.M. Ortega Construction, Inc. Endorsement Effective Date: 10/1/2020 SCHEDULE Name(s) Of Person(s) Or Organization(s): WHERE REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the 'loss" under a contract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 99 03 04 (Ed. 7- 08) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENTCALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need to be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 10/1/2020 at 12:01 A. M. standard time, forms a part of (DATE) Policy No. 54303215 of the Federal Insurance Company (NAME OF INSURANCE COMPANY) issued to A. M. Ortega Construction, Inc. Endorsement No. Authorized Representative We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional premium for the blanket waiver offered by this endorsement shall be 0.00 % of total California premium. Schedule Person or Organization Job Description WHERE REQUIRED BY WRITTEN WHERE REQUIRED BY WRITTEN CONTRACT. CONTRACT. WC 99 03 04(Ed. 7-08)