2020/06/01 Language Line Services, Inc. Certificate of Liability Insurance (4)DocuSign Envelope ID: 42048F6E-18EE-4924-6750-AE4131`1BFA44 Page I of 1
.��carrc�` CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD(YYYY)
L 05/19/2020
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 Willis Towers Watson Certificate Center
_NAME:
Willis Towers Watson Northeast, Inc. PHONE 1-877-945-7378 FAX
1-BBB-467-2378
c/o 26 Century Blvd _ AIC,. No).
P.O. Box 305191 EMMAIL certificates@willis.com
DbREB .
Nashville, TN 372305191 USA ,.,e„o.e,e .=„e,, _
CITY
F N h £IEEE INSUR£AA: Great Northern Insurance Company 20303
INSURED INSURER B • Federal Insurance Company 20281
Language Line Services, Inc.
One Lower Ragsdale Drive �UN U 2 2020 IIJSURERC: Vigilant Insurance Company 20397
Building 2 INSURER D:
Monterey, CA 93940 RECEIVED INSURERE�:
INSURER F
COVERAGES CERTIFICATE NUMBER: W16490417 REVISlnN N[IMRFR-
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
INSH AdDL,5UBR POLICY EFF POLICY E%P
LTR TYPE OF INSURANCE I v POI.[CYNI,lpnLiCR MMiDDIYYYY M tDD;YYYY LIMITS
X COMMERCIAL GENERAL LIABILITY
EACHOCCURRENCE $ 1,000,000
CLAIMS -MADE J X 1 OCCUR
RENTED
Pri MISER{E)e-ge4urljT $ 1,000,000
A
MED EXP (Any one person) $ 10,000
Y
3595-61-78 06/01/2020
06/01/2021 PERSONAL & ADV INJURY $ 1,000,000
GENAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $ 2,000,000
X PRO U
POLICY JECT LOC
Lam'I
PRODUCTS - COMP/OPAGG S 2,000,000
OTHER
$
AUTOMOBILE LIABILITY
COMBINED WN E LI IT
accidon0 _ _
$^ 1,000,000
^$
I_a
ANY AUTO
I
BODILY INJURY (Per person)
B
OWNED SCHEDULED ,
AUTOS ONLY AUTOS
73576109
06/01/2020
06/01/2021 BODILY INJURY (Per acoldont)
$
X NON -OS
E
$
AUU OHIRED
AUTOS ONLY ONLY
(Pet #cccldTecil)
B
X
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
$ 5,000,000
EXCESS LIAB CLAIMS•MADE
7987-71-21
06/01/2020
06/01/2021 AGGREGATE
$ 5,000,000
DED F-1 RETENTION$
$
WORKERS COMPENSATION
X
AND EMPLOYERS' LIABILITY Y / N
TAT T ERH _
C ANYPROPRIETOPJPARTNER/EXECUTIVE
E.L. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBEREXCLUDED?
NIA
7174-35-69 06/01/2020
06/01/2021
-
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
II yea, 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 It more space is required)
City of Menifee and its officers, employees, agents, and authorized volunteers are included as Additional Insureds as
respects General Liability.
The General Liability policy shall be Primary and Non -Contributory with any other insurance in force for or which may
be purchased by the Additional Insureds.
%,rrs I Irrt-A t t MULLItFI GANULLLA I IUN
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
29844 Road
Menifeee,, C CA 92566
9)1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
sR iD: 19629514 BATCH: 1684774
2 of 2 2060
DocuSign Envelope ID: 42048F6E-18EE-4924-B750-AE413F1 BFA44
Dated: 05/20/20
CA848143
7114 7389 6621 3761 0695
CALIFORNIA PRELIMINARY NOTICE
This is not a Lien. Civil Code Sections 8200, et seq., 9300, et seq.
Reputed Owner or Public Entity
CITY OF MENIFEE
05/20/20 CA848143
FINANCE
CITY OF MENIFEE
29844 HAUN RD
JUN 0 2 2020
MENIFEE CA 92586
RECEIUtD
Reputed Construction Lender or Lessee
CO# R-687/BOND# 36KO13524
CULBERSTON INS SERVICES INC
5500 E SANTA ANA CANYON RD
#201/ANAHEIM CA 92807
Reputed Direct Contractor
DBX INC
ATTN: ACCOUNTS PAYABLE
42024 AVENIDA ALVARADO #A
TEMECULA CA 92590
NOTICE TO PROPERTY OWNER
EVEN THOUGH YOU HAVE PAID YOUR
CONTRACTOR IN FULL, if the person or firm that has
given you this notice is not paid in full for labor,
service, equipment or material provided or to be
provided to your construction project, a lien may be
placed on your property. Foreclosure of the lien may
lead to loss of all or part of your property. You may wish
to protect yourself against this by (1) requiring your
contractor to provide a signed release by the person
or firm that has given you this notice before making
payment to your contractor, or (2) any other method that
is appropriate under the circumstances. This notice is
required by law to be served by the undersigned as a
statement of your legal rights. This notice is not intended
to reflect upon the financial condition of the contractor
or the person employed by you on the construction
project. If you record a notice of cessation or completion
of your construction project, you must within 10 days
after recording, send a copy of the notice of completion
to your contractor and the person or firm that has given
you this notice. The notice must be sent by registered
or certified mail. Failure to send the notice will extend
the deadline to record a claim of lien. You are not
required to send the notice if you are a residential
homeowner of a dwelling containing four or fewer units.
1 - You are hereby notified that
REXEL USA INC DBA GEXPRO
2099 S STATE COLLEGE BLVD #200
ANAHEIM CA 92806
2 - Has furnished or will furnish labor,
services, equipment, or materials of
the following general description:
ELECTR. EQUIPMENT & SUPPLIES
3 - An estimate of the total price of the
labor, services, equipment, or materials
furnished or to be furnished is:
$142,000.00
4 - The building, structure or other work of
improvement is located at:
R-687 TRAFFIC SIGNAL @
MENIFEE-HOLLAND TS &
MENIFEE/CAMINO CRYSTAL RD
MENIFEE/HOLLAND RD
MENIFEE CA 92586
5 - The party to or for whom the work is provided.
1081356/DBX INC
42024 AVENIDA ALVARADO #A
TEMECULA CA 92590-3405
The relationship to the party(ies) giving this notice is:
Material Supplier
6 - Name and address of Trust Funds to which
Supplemental Fringe Benefits are payable
(if applicable):
7 - Federal Public Work Jobsite Title 40 USC Sec. 270A-270E
Contract #
Bond Co:
Authorized Agent
1-800-366-5660
This undersigned declares as follows: I am over the age of 18 and employed by Construction Notice Services, Inc., whose business address is 9520 Padgett St
#208, San Diego, CA 92126. 1 am employed in the County of San Diego, where this mailing occurs, and not a party to this action. On the date shown below,
in the City of San Diego, I served within California Preliminary Notice, sealed and deposited in the mail in the manner prescribed by law, by first class
registered or certified mail, postage fully prepaid, to the person(s) at the address shown thereon. _
Signature: = �— [ �— Date: 05/20/20