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2020/09/30 HHS Construction, LLC Certificate of Liability Insurance (4)
�1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 9/30/2021 9/16/2020 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 Lockton Companies NAM Ei 444 W.47th Street,Suite 900 _PHONE PJC,No,Ex!); AIC,No Kansas Cityy MO 64112 1906 E-MAILs (816)960.9000 NSURE RDING COVERArpE NAIC 71 INSURER A: Hartford Underwrilers Insurance Coin arty 30104 INSURED HHS CONSTRUCTION,LLC INSURER B: Hartford Casualty Insurance Company CompEy 29424 1451971 2042 S.GROVE INSURER c: HDI Global Insurance Co an •41343 ONTARIO CA 91761 761 m INSURER D: INSURER E: INSURER F: COVERAGES- CERTIFICATE NUMBER: 16 2 4 REVISION NUMBER: XX XXXX 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, LT R TYPE OF INSURANCE ADDL SUER POLICY EFF POLICCY EXP LIMITS N50 yyyp POLICY NUMBER 1rfFyyyl A COMMERCIAL GENERAL LIABILITY Y N 37 UENOL5263 9/30/2020 9/30/2021 EACH OCCURRENCE S1,000,000 CLAIMS-MADE OCCUR PpR4EMIAGI ORENTEDre ne 1.(I00 000 MED EXP one rson 10,000 PERSONAL S ADV INJURY s l 000 000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2.000.000 �3POLICY Pile LOC PRODUCTS-COMPIOP AGG S 2 000 OQ0 OTHER: $ $ AUTOMOBILE LIABILITY Y N 37 UENOL5264 9/30/2020 9/30/2021 Ea ar den StN E 1MIT $ $$1 000 000 I} X ANY AUTO BODILY INJURY(Per person) $ YYMxxx OWNED SCHEDULED X AUTOS ONLY AUTOS BODILY INJURY(Peraca dent $ XXXYXXX X AUTOS ONLY X AUUTOS ONLYY PROP a DAMAGE $ XxxxXxX $ xxxxxxx $ UMBRELLA LIAB X OCCUR N N 37XHUOL5265 9/30/2020 9/30/2021 EACH OCCURRENCE $ 10,000,000 C "ED XCESS LIAB CLXD5674800 9/30/2020 9/30/2021 AGGREGATE $ 10,000,000 CLAIMS•MADi I I RETENTION$ $ xxxxxxx I wQ>3xERs coIdPENsnrloN AND EMPLOYERS'LIABILFTY YIN NOT APPLICABLE PA7UTE I I ET v� ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED'? ❑ N/A E L EACH ACCIDENT S xxxxxxx xx (Mandatoryin under E L DISEASE.EA EMPLOYEE If yes,describe a under xxxxxxxV V Vv DESCRIPTION OF OPERATIONS below E L DICFASE-POLICY LIMIT xxxxxxx DESCRIPTION OF OPERATIONS 1 LOCATION 1 VEHI C LES;ACOR D 101.Additional Remarks Schedule,may be attached if more apace Is required) CITY OF MEN]FEE ITSCOUNCILMEMBERS,OFFICERS,AGENT'S AND EMPLOYEES ARE ADDITIONAL INSURED AS RESPECTS TO GENERAL AND AUTOMOBILE LIABILITY ON A PRIMARY NONCONTRIBUTORY BASIS AS REQUIRED BY WRITTEN CONTRACT,COVERAGE IS SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. CERTIFICATE HOLDER CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 16663254 AUTHORIZED REPRESENTATIVE CITY OF MENIFEE DEPARTMENT OF FINANCE 29714 HAUN ROAD MANIFEE CA 92586 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION.All rights reserved The ACORD name and logo are registered marks of ACORD Attachment Code :D555319 Certificate ID : 16663254 POLICY NUMBER: 37 UENOL5264 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other than for nonpayment of premium, notice of such cancellation will be provided at least thirty (30)days in advance of the cancellation effective date to the certificate holder(s)with mailing addresses on file with the agent of record of the Company. B. If this policy is cancelled by the Company for nonpayment of premium, or by the insured, notice of such cancellation will be provided within (10)days of the cancellation effective date to the certificate holder(s)with mailing addresses on file with the agent of record or the Company. If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to the active certificate holder(s)who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s)will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. Form IH 03 13 06 11 Attachment Code :D558764 Certificate ID : 16663254 POLICY NUMBER: 37 UENOL5263 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other than for nonpayment of premium, notice of such cancellation will be provided at least thirty (30)days in advance of the cancellation effective date to the certificate holder(s)with mailing addresses on file with the agent of record of the Company. B. If this policy is cancelled by the Company for nonpayment of premium, or by the insured, notice of such cancellation will be provided within (10) days of the cancellation effective date to the certificate holder(s)with mailing addresses on file with the agent of record or the Company. If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s)on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to the active certificate holder(s)who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s)will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. Form I H 03 13 06 11 �1 ACOR"° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/30/2021 9/16/2020 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 Lockton Companies CONTACT 444 W.47th Street,Suite 900 Wohi A/C,No.Ex PAX N❑ Kansas City MO 64112-1906 as IL (816)960.9000 INSURER AFF RDING COVERAGE blAIC INSURER A: Hartford Underwriters Insurance Company 30104 INSURED HHS CONSTRUCTION,LLC INSURER B: Hartford Casualty Insurance Company 29424 1466311 2042 S.GROVE AVE. INSURER C: HDI Global Insurance CoMpany 41343 ONTARIO CA 91761 INSURER D: Indian Harbor Insurance Com an 36940 INSURER E: INSURER F COVERAGES - CERTIFICATE NUMBER. 16616202 REVISION NUMBER: XXXXXXX 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. LTR TYPE OF INSURANCE INSD ADDL SW VC POLICY NUMBER MPOLICY EFF POLICY EXP LIMITS MIDD MMIO A X COMMERCIAL GENERAL LIABILITY Y N 37 UENOL5263 9/30/2020 9/30/2021 EACH OCCURRENCE 1.000 000 CLAIMS-MADE OCCUR PREAISES occurrence) $eENTED 1,000 OOO MED EXP(Anyoneperson) 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LJMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY N N 37 UENOL5264 9/30/2020 9/30/2021 COMBINED SINGLE LIIuIIT $ 1 OOO OOO ]C ANY AUTO (BODILY INJURY(Per person) $ XXXXXXX AUTOS ONLY SCHEDULED (BODILY INJURY(Per accident $ XXXXXXX AUTOS ONLY AUUTO ONLY Pei aE Z 1 $ XXXXXXX $ XXXXXXX B UMBRELLA LIAB X OCCUR Y N 37XHUOL5265 9/30/2020 9/30/2021 EACH OCCURRENCE $ 10,000 000 C X EXCESS LIAB CLAIMS-MADE CLXD5674800 9/30/2020 9/30/2021 AGGREGATE $ M000 000 DED I I RETENTION$ $ XXXXXXX' WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NOT APPLICABLE IEL EACH ACCIDENT $ XXXXXXX OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) P_L DISEASE-EA EMPLOYEE XXXXXXX If yes,describe under `7 DESCRIPTION OF OPERATIONS below EL DISEASE-POV.CY LIMIT XXXXXXX D CONTRACTORS N N CE07421075 9/30/2020 9/30/2021 EACH CLAIM$5.000,000 POLLUTION/ AGGREGATE$5.000,000 PROFESSIONAL LIABILITY DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 701,Additional Remarks Schedule,may be anachad if more spate Is required) THE CITY OF MENEFEE,ITS COUNCILMEMBERS,OFFICERS AGENTS AND EMPLOYEES ARE NAMED ADDITIONAL INSUREDS AS RESPECTS LIABILITY AND 1F REQUIRED BY WRITTEN.CRTRACT PPR THE TERMS AND CONDITIONS OF THE POLICY.COVERAGE IS PRIMARY AND NONCONTRIBUTORY.30 DAY NOTICE OF CANCELLATION.APPLIES, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 16616202 AUTHORIZED REPRESENTATIVE THE CITY OF MENIFEE 29714 HAUN ROAD MENIFEE CA 92586 ACORD 25(2016/03) ©1 2045 ACORD CORPORATION.All rights reserved The ACORD name and logo are registered marks of ACORD ` Y CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) Acct#: 2795388 10/01/2020 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 Lockton Companies,LLC PHONE FAX 3657 Briarpark Dr.,Suite 700 888-a2s-8365 (AJC No): EMAIL Houston,TX 77042 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: Indemnity Insurance Co,of North America 43575 INSURED INSURER B HHS CONSTRUCTION,LLC 2042 S GROVE AVE INSURER C: ONTARIO,CA 91761-5617 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. 1NSA TYPE OF INSURANCE .SUBRI POLL YEFF PDLICY EXP LTA POLICY NUMBER MM/DD/YYYY MMJDDIYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ❑ OCCUR tv CLAIMS-MADE aa nce $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PI LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY GOM81Ni`D SINGLE LIMIT $ Ea aoc ant ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED tid P BODILY INJURY(Per accident) $ AUTOS AUTOS ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Aar aeddenl F $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PEA OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE 7 1 ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N/A X C68802477 10/01/2020 10/01/2021 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1.000-000 If yes,describe under DESCRIPTION OF OPERATIONS below I J E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Waiver of Subrogalion in favor of Certificate Holder when required by written contract RE:ALL OPERATIONS PERFORMED BY THE NAMED INSURED DURING THE CURRENT POLICY PERIOD. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THE CITY OF MENIFEE AUTHORIZED REPRESENTATIVE 29714 ROAD _ J MENIFEEEE,CA 92586 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Workers'Compensation and Employers' Liability Policy Named Insured Endorsement Number Insperity, Inc. L/C/F HHS CONSTRUCTION, LLC Policy Number 19001 Crescent Springs Drive Symbol: RWC Number:C68802477 Kingwood,TX 77339 Policy Period Effective Date of Endorsement 10/01/2020 TO 10/01/2021 10/01/2020 Issued By(Name of Insurance Company) Indemnity Insurance Co. of North America Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparatiofl of the olic . CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. (X ) Specific Waiver Name of person or organization: THE CITY OF MENIFEE 29714 HAUN ROAD MENIFEE, CA 92586 ( ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: RE: ALL OPERATIONS PERFORMED BY THE NAMED INSURED DURING THE CURRENT POLICY PERIOD. 3. Premium: The premium charge for this endorsement shall be IINCLUDED percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium : INCLUDED u orize epresen a we WC 99 03 22 AC�R CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) Acct#: 2795388 1 10/01/2020 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 Lockton Companies, LLC PHONE FAX 3657 Briarpark Dr.,Suite 700 v.EW- 8&&-82&-8365 (A/C.No): E-MAIL Houston,TX 77042 ADDA INSURERS AFFORDING COVERAGE NAIC# INSURER A: Indemnity Insurance Co.of North America 43575 INSURED INSURER B: HHS CONSTRUCTION,LLC 2042 S GROVE AVE INSURER C4 ONTARIO,CA 91761-5617 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. ILIA TYPE OF INSURANCE JNSD$lf D POLICY NUMBER MM/DDIYPOLICY YYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES Ea eccurtenca. $ MED EXP(Anyoneperson) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECT D LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED 5INGLE LIMIT $ rEa widen ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED pROraEAZS'�DA (3E $ AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YINI STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N/A X C68802477 10/01/2020 10/01/2021 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Waiver of Subrogation in favor of Certificate Holder when required by written contract RE:ALL OPERATIONS PERFORMED BY THE NAMED INSURED DURING THE CURRENT POLICY PERIOD, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF MENIFEE AUTHORIZED REPRESENTATIVE MENIFEE,CA 92586-6539 01983-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Workers'Compensation and Employers' Liability Policy Named Insured Endorsement Number Insperity, Inc. L/C/F HHS CONSTRUCTION, LLC Policy Number 19001 Crescent Springs Drive Symbol: RWC Number:C68802477 Kingwood,TX 77339 Policy Period Effective Date of Endorsement 10/01/2020 TO 10/01/2021 10/01/2020 Issued By(Name of Insurance Company) Indemnity Insurance Co. of North America Insert the policy number.The remainder of the information Is to be completed only when this endorsement is issued subsequent to the preparation of the policy CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule I. (X ) Specific Waiver Name of person or organization: CITY OF MENIFEE 28944 Haun Rd MENIFEE, CA 92586-6539 ( ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: RE: ALL OPERATIONS PERFORMED BY THE NAMED INSURED DURING THE CURRENT POLICY PERIOD. 3. Premium: The premium charge for this endorsement shall be INCLUDED percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium : INCLUDED u orize epresen a ive WC 99 03 22 '� 1 DATE(MM/DD/YYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE �% � Acct#: 2795388 10/01/2020 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 Lockton Companies,LLC PHONE FAX 3657 Briarpark Dr.,Suite 700 ..tpJ.C..I>!e•Ext); 888-828-8365 IA C NNo): Houston,TX 77042 E-MAIL INSURERS AFFORDING COVERAGE NAIC# INSURER A: Indemnity Insurance Co,of North America 43575 INSURED INSURER B.,.HHS CONSTRUCTION,LLC 2042 S GROVE AVE INSURER C: ONTARIO,CA 91761-5617 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. IPOLICY EFF POLICY EXP �TR TYPE OF INSURANCE JN-D-AMC Wo BR POLICY NUMBER MM/D0.rYYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE ❑ OCCUR f PREMISES Ea r $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED STN LE UM1T $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS (Per accident) BODILY INJURY(P $ HIRED AUTOS NON-OWNED PA.OPERTY DAMAGE $ AUTOSdgCldenl UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION X PER - AND EMPLOYERS'LIABILITY Y/N S TE ER ANY PROP RI /A OFFICER/MEMBEEREXCLUDED?ECUTIVE ❑ N/A X C68802477 10/01/2020 10/01/2021 E.L EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E,L,DISEASE-EA EMPLOYE $ 1.000-000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Waiver of Subrogation in favor of Certificate Holder when required by written contract RE:ALL OPERATIONS PERFORMED BY THE NAMED INSURED DURING THE CURRENT POLICY PERIOD. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF MENIFEE AUTHORIZED REPRESENTATIVE DEPARTMENT OF FINANCE MENIFEE,CA 92586-6539 01968-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Workers'Compensation and Employers' Liability Policy Named Insured Endorsement Number Insperity, Inc. L/C/F HHS CONSTRUCTION, LLC Policy Number 19001 Crescent Springs Drive Symbol: RWC Number:C68802477 Kingwood,TX 77339 Policy Period Effective Date of Endorsement 10/01/202o TO 10/01/2021 10/01/2020 Issued By(Name of Insurance Company) Indemnity Insurance Co.of North America Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy, CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. (X ) Specific Waiver Name of person or organization: CITY OF MENIFEE; DEPARTMENT OF FINANCE 29844 Haun Rd MENIFEE, CA 92586-6539 ( ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: RE: ALL OPERATIONS PERFORMED BY THE NAMED INSURED DURING THE CURRENT POLICY PERIOD. 3. Premium: The premium charge for this endorsement shall be INCLUDED percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium : INCLUDED u orize epresen a ive WC 99 03 22