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2013/08/14 Richard Lee Sherman's Plumbing Certificate of Liability InsurancePage 3 WORKERS' COMPENSATION INSURANCE This contractor: ❑ has no employees and is exempt from workers' compensation requirements. ® carries workers' compensation insurance for all employees. A copy of the contractor supplied certificate of workers' compensation insurance coverage is attached to this Contract. COMMERCIAL GENERAL LIABILITY INSURANCE This contractor: ❑ does not carry commercial general liability insurance ❑ carries commercial general liability insurance written by: You may call the insurance company at AT Walters Insurance Company Phone - (909) 383-5023 to check the contractor's insurance coverage. A copy of the contractor supplied certificate of general liability insurance coverage is attached to this Contract. 007 Dec 10 00 09:13p Shermans Plumbing 9512428220 p.1 h e J POLICYHOLDER COPY NA • P.O, BOX 8192, PLEASANTON, CA 94568 ■ CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 12-05-2013 GROUP; POLICY NUMBER: BOBE73B-2013 CERTIFICATE ID: 1 CERTIFICATE EXPIRES: 07-27-2014 07-27-2019/07-27-2Ot4 CITY OF MENIFEE NA 29714 HAUN RD SUN CITY CA 92580-6540 This Is to certify that we have issued a valid Workers' Compensetian Insurance policy In a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to Its normal expiration. This certificate of Insurance Is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein, Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the Insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditlaos, of such policy. Authorized Representative President and CEO UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER Ol A HUSBAND AND WIFE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVEPERSONALLIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW, _— EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51,000,000 PER OCCURRENCE. EMPLOYER SHERMAN, RICKARD AND SHERMAN, ROCHELLE NA 30623 JEDEOIAH SMITH RO TEMECULA CA 92S62 [JAT,CS) IREV.1-zoim PRINTED : 12-05-2013 0011 08 13 02146p n T WFILTERS INS 9093835030 P.I tlAT%�B%I I DD YVVV) ACORr_) CERTIFICATE OF LIABI_LI INSURANCE Ie03 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 COVERAGIS 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 cartificgte holder la an ADDITIONAL INSURED, IhR Pollsylles) must he endorsed. If SUBROGATION IS WAIVED, subjw to the terms and conditions of the pollcy, oadaln policies may require an ondoresment A statement on this certificate does not cantor rights to the cortificato holder In lieu of such endoreemant(s), PRODUOSR A T WALTERS INSURANCE AGENCY 242 E AIRPORT DRIVE SUITE 105 SAN BERNARDINO CA 92406 INSURED RICHARD LFE SHERNANIS PLUMBING 30623 aDEDIAH SMITH RU• ......... . ....50.,...� yU9 3E3-5023 ��,ol 33 INSURER APFORry� 01 aOOVDRAG N._... ,. A; COLONY INBVtTANC& TEMECULA CA 92592 ItSURER PI I I navieiinm AItIMrAHQ, V THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIS'fE0 BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OIi ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS •0 MAY OR MAY PERTAIN THE INSURANCEBY THE PcOLIL'ILS ' O HEREIN S BJECT 1 ALL THE TL%iMS, ANG CO NDIT(ON9- OF SU4H YA 1'IAVY, DI:LN MEc9oCRleY S �L gjjgri LTx%C1'IFICA TtFS OF WBUSRANcg INSTSNEHALLIABUTYB NUMEpJtRDEC LIM 7S 0ed oTIFICA 0L9056T 6MAY 14/301Y100/lA/701P EACH OCCURRENCE 1 lin 0eon1 �__ ... L LIAtlILITY VONIMERCIALGENSRA,n. ,jRUMIVCA MAM Iee 0 Oy;,. ,y,�t__— IMd cN 050�0 CLAIMS MADE >/.I OCCUR F ,_ INJURY` ._J E 1000 tl00 A....___.. ...-_.—_. —..._..00 GEdS RAL AaGI,r Rnre p — .0000 GEN'LAOOREGATCLIMIi APPLIES PER: 4A000CTS, COMPIOR AGG $ 2000000 —_ POLICY Lon LOC OWED 61N4LE LIMIT $ a VT0m0eaE LIADnITY 11 MJORY`Per il• ODDLY porwC ANY AUTO ••'ALL OLANED '15CHEDUL`0 __..... ....__........ 90OILY INJVRY PeI'ecol0onl) _�. .._ $ ... AVYOS AUTOS 'GRCPCRfY OARnnc�"". -n^.^._...._. HIHLUAUIUB AV ubNavFO (per Pd� — $`— UMaRELU LIAR OCCUR _ EACH OCCUkRENCE _ S •-,,,__, E;CESe%144 CLAIMS MAUL AGGREGATE 5 DBO RETENTIONS WO STATW GTH WORKERS COMPONSAT10N IARIUYY AND EMPLOYERVLY� ANY Pj0PnIETOH/PARTNCRM.XECUI'NP NIA NIA —��-'J,0 CAL. EACrI ACCIDENT Y _--,,,,-,,,_„•„ OFFICERIMCNIBER EXCLUDED? (Nfend0101Y In Nil) L. OIBEA5t EAEMPLOYE i It ,• ggP80ib0 U4ddr OIPT10 OF OPFRATIONSb@I0w E.L. DISEASE • PODCv LIMN L DeSORIPYION CV UPRRATIONE I LDCAI'IONS I VEHICLES (AO0011 ACODO 101, Addulonal Rom01k@ SaHadulO, If IIIOI4 4pava Ic NGVIINI Certificate 1lolder is named as additional insured as respects Operations of the d insured. E CERTIFICATE HOLDER CANCELLATION _ City Of Menifee SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: M8Tg8Yi to C'oPen o ACCORDANOB WITH THE PVLIOY PROV18100M, 29714 HE= Rd. AUTHORIZED REPRESENTATIVE AU • c\` Menifee Ca 92506 V IIlobdUlU AVVKU I.VKMVKHIIV IVN Alr4tglllS leSery eu. ACORO 25 (2010105) The ACORO name and logo arm ro&tered marks or ACORO