2020/09/01 Leighton Consulting, Inc. Certificate of Liability Insurance (14) page 2 of 9
Client#: 1257049 305LEIGHGRO
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY)
s/28/2020
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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
N M ; Lori McKay _
McGriff Insurance Services PHONE
.Ext,714 941-281 5 No):
2400 E Katella Ave Suite 1100 rr-NMIL LMcNa �mc ritf.Ca[n
anDpESS:. Y 9
Anaheim, CA 92806 - ---
714 941-2800 INSURER S)AFFORDING COVERAGE NAIC If
INSURER A:Travelers Property Casualty Co of Amer 25674
INSURED INSURER B..
Leighton Consulting Inc INSURERC;
17781 Cowan Ste.100
Irvine,CA 92614-6009 INSURERD;
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 CONTRACTOR 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.
Ns ADDL lJBR POLK:Y EFF POL Y F��fP
LTR TYPE OF INSURANCE ryyy POLICY NUMBER MMIDp1YYYY MR7 YE LIMITS
LNg _ 1{f4_--- -
COMMERCIAL GENERAL LIABILITY pEpA�CHH OCCURRENCE $
CLAIMS-MADE n OCCUR PFiEM)SE -fa we]" $
MED EXP(Anyone person) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO.
71 POLICY C]JECT L7 LOG PRODUCTS-COMP/OP AGO $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
(Esagaiderill
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY Per accident
AUTOS ONLY AUTOS ( ) $
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY jPerBCCldanl
UMBRELLA LIAB H OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
A WORKERS COMPENSATION UB1R5099812043 39/01/2020 09/01/2021 X PER OTH-
AND EMPLOYERS'LIABILITY za--
ANY PROPRIETOR/PARTNER/EXECUTIVE Y' E.L.EACH ACCIDENT $1 000 000
OFFICER/MEMBEREXCLUDED? �]� N/A •— +-•—�--
(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,OD0,013f3
T - -
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
Waiver of Subrogation applies to Workers Compensation per endorsement WC990376(A), per written contract.
Re: Proj#11051.007 PMP 20-02: Quail Valley Street Resurfacing Project, Menifee.
CERTIFICATE HOLDER CANCELLATION
(LC)City of Menifee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
29714 Haun Road ACCORDANCE WITH THE POLICY PROVISIONS.
Menifee,CA 92586-0000
AUTHORIZED REPRESENTATIVE
01988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD
4093 #S26401714/M26401547 LXMCN
page 4 of 9
Leighton Consulting Inc
'�� WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
ENDORSEMENT WC 99 03 76( A)—
POLICY NUMBER: UB1 R5 09981 2 043
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT - CALIFORNIA
(BLANKET WAIVER)
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 this endorsement shall be % of the California workers compensation pre-
mium.
Schedule
Person or Organization Job Description
ANY PERSON OR ORGANIZATION FOR
WHICH THE INSURED HAS AGREED BY
WRITTEN CONTRACT EXECUTED PRIOR
TO LOSS TO FURNISH THIS WAIVER.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise
stated.
(The information below is required only when this endorsement is issued subsequent to preparation of
the policy.)
Endorsement Effective Policy No. Endorsement No.
Insured Premium
Insurance Company Countersigned by
DATE OF ISSUE: - _ ST ASSIGN: Page 1 of 1
4095