2020/04/01 Becker Pipeline Co Certificate of Liability Insurance (5) AC40RE0 CERTIFICATE OF LIABILITY INSURANCE DATE
g/22/2020
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 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: Vanessa Gilbert
The Empire Company PHONEMo. t (909)476-0600 PAX N0, (111)116-0601
l.
10201 Trademark St. , Suite D E-MAIL vgilbert@empire-co.com
ADDRESS:
P.O. Box 5400 INSURERS AFFORDING COVERAGE NAIC#
Rancho Cucamonga CA 91729 INSURERA:Berkley Assurance Company 39462
INSURED INSURER B:California Auto Insurance Company 38342
Becker Pipeline Co INSURER C:Everest Premier Insurance Company 16045
1060 Northgate St, Ste B INSURERD:
INSURER E:
Riverside CA 92507 INSURERF:
COVERAGES CERTIFICATE NUMBER:19/20 BA 20/21 GL/WC/xS 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
TN-SR TYPE ADDLSUBR POLICY EFF POLICY EXP LIMITS
LTR POLICY NUMBER MIDD/YYYY DD/YYYY
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A CLAIMS-MADE OCCUR DAMA ET R ED 100,000
PRE 1 E Ea occuuence S
X VUMA0228000 9/20/2020 9/20/2021 MED EXP(Any one person) S 5,000
PERSONAL &ADV INJURY S 1,000,000
GENIAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY ❑ PRO JECT ❑LOC PRODUCTS-COMP/OP AGG S 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE EMIT $ 1,000,000
Ea"a6 dent
B X ANYAUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BA040000047525 10/20/2019 10/20/2020 BODILY INJURY(Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIREDAUTOS AUTOS Peraceldent
Uninsured motorist combined single $ 100,000
UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 2,000,000
A X EXCESS LIAB CLAIMS-MADE AGGREGATE S 2,000,000
DED I I RETENTION$ VUMA0228090 9/20/2020 9/20/2021 $
WORKERS COMPENSATION X PER OTH-
AND EMPLOYERS'LIABILITY Y/N AT T R
ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? ❑ N/A
C (Mandatory in NH) 7600017603201 4/1/2020 4/1/2021 E-L DISEASE-EA EMPLOYEE 5 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below I 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)
The City of Menifee, its officers, employees and agents are named as Additional Insured where required by
written contract per attached form CG2010 1219.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Menifee THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
29844 Haun Rd ACCORDANCE WITH THE POLICY PROVISIONS.
Menifee, CA 92586
AUTHORIZED REPRESENTATIVE
V Gilbert/VGILBE V� p { r
C 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025(201401)