2021/02/14 Leighton Consulting, Inc. (3)page 2 of 23
Client#: 1257049 305LEI G HG RO
ACORD. CERTIFICATE OF LIABILITY INSURANCE D�2111
(MM/DD/YYYY)
5/2021
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(a).
PRODUCER NA r Lori MCNay
McGriff Insurance Services PHONE -- --- —�w
2400 E Katella Ave Suite 1100 ,n/c, No,
Ext): 714 941-2815 AdC, No ,
A ` LMcNay ®mcgriff.com
Anaheim, CA 92806 �-`
714 941-2800 INSURER(S) AFFORDING COVERAGE NAIC #
INs Lexington Insurance Company 19437
INSURED
Leighton Consulting Inc
17781 Cowan Ste. 100
Irvine, CA 92614-6009
URER A .
INSURER B : Travelers Indemnity Co of CT 25682
INSURER C.
INSURER D :
INSURER E i
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.
NSA
LTR
DDL
)N$RYr7
U9R
` POLICY NUMBER
LIMITS
TYPE OF INSURANCE
POLICY SFF
tMMfDAIYYYYj
PAL CY g%R
{MAU,BDIYYYYj
X
COMMERCIAL GENERAL LIABILITY
X OCCUR
A
065463440
32/14/2021
02/14/202
EACH OCCURRENCE $1,000000
ppppMMMGTO RENTED
ICLAIMS-MADE
$50r000
MED EXP (AnX. oneperson)
$ EXCLUDED
_
PERSONAL & ADV INJURY
$1,000000
_GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY �PRJECOT X I LOC
_
PRODUCTS - COMP/OP AGG
s2,000,000
$ $5 000 000
_
OTHER:
Overall Policy
3eneral
AMre�ate
B
AUTOMOBILE
LIABILITY
BA3R7084312143G
)2/14/2021
02114/2022
COMBINED SINGLELIMIT
1,000 000
BODILY INJURY (Per person)
$
X
ANY AUTO
X
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY X AUTOS ONLY
BODILY INJURY Per accident
( )
$
P11 ERTYDAM!E
P4r CrJclen
$
$
006546318
32/14/2021
A
X
UMBRELLA LIAR
X
OCCUR
02114/2022
EACH OCCURRENCE
s5,000,000
AGGREGATE
$5 000,000
EXCESS LIAR
CLAIMS -MADE
DED I X1 RETENTION $10000
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YPN—.
ANY PROPRIETORIPARTNER/EXECUTIVEI
OFFICER/MEMBEREXCLUDED7
N/A
PER I JOTH-
E.L. EACH ACCIDENT $
(Mandatory In NH)
I1 yes, describe under
E.L. DISEASE - EA EMPLOYEE $
_DESCRIPTION OF OPERATIONS below
_ E.L. DISEASE -POLICY LIMIT 1 $
02/14/2022 $2,000,000 Per Claim
A
Prof/Polutn Liab
013001524
32/14/2021
Claims Made
$4,000,000 Aggregate
$100.000 Ded
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required)
Additional Insured applies on General Liability per Lexington's Additional Insured Owners, Lessees or
Contractors endorsement LX4316 06114 and LX9605 10/01 attached to the General Liability policy as required
by written contract.
Primary wording applies to General Liability per Lexington's endorsement LX9838 08/05 attached to policy.
Additional Insured and Primary wording applies on Automobile Liability per Travelers endorsement CAT474
(See Attached Descriptions)
ua=Fi I I `K;A 11; HULL7t-H UANGLLLA I ION
(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
AUTHORIZED REPRESENTATIVE
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
5160 #S27361144/M27355854 LXMCN
SAGITTA 25.3 (2016/03) 2 of 2
#S27361144/M27355854
5161
page 3 of 23
page 4 of 23
ENDORSEMENT
02/14/2021
This endorsement, effective 12:01 AM
Forms a part of policy no.: 065463440
Issued to: Leighton Consulting Inc
By:LEXINGTON INSURANCE COMPANY
CANCELLATION AMENDMENT
In consideration of the premium charged, it is hereby agreed that the cancellation provision is amended
to 90 days in lieu of (30) days, except for non-payment of premium which remains (10) days.
All other terms and conditions remain unchanged.
Authorized Representative OR
Countersignature (In states where applicable)
LX9586 (02/031
5162
FOX _
page 5 of 23
This page has been left blank intentionally.
5163
page 6 of 23
ENDORSEMENT
This endorsement, effective 12:01 AM 02/14/2021
Forms a part of policy no.: 065463440
Issued to: Leighton Consulting Inc
By:LEXINGTON INSURANCE COMPANY
PRIMARY/NON CONTRIBUTORY ENDORSEMENT
This endorsement modifies insurance provided by the policy:
Notwithstanding any other provision of the policy to the contrary, the insurance afforded by this policy
for the benefit of the Additional Insured shall be primary insurance, but only with respect to any claim,
loss or liability arising out of the Named Insured's operations; and any insurance maintained by the
Additional Insured shall be non-contributing.
All other terms and conditions of the policy remain the same.
Authorized Representative OR
Countersignature (In states where applicable)
LX9838 (08/05)
5164
page 7 of 23
This page has been Left blank intentionally.
5165
page 8 of 23
Leighton Consulting Inc
BA3R7084312143G
COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED - PRIMARY AND
NON-CONTRIBUTORY WITH OTHER INSURANCE
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
PROVISIONS
1. The following is added to Paragraph A.1.c., Who
Is An Insured, of SECTION II — COVERED
AUTOS LIABILITY COVERAGE. -
This includes any person or organization who you
are required under a written contract or
agreement between you and that person or
organization, that is signed by you before the
"bodily injury" or "property damage" occurs and
that is in effect during the policy period, to name
as an additional insured for Covered Autos
Liability Coverage, but only for damages to which
this insurance applies and only to the extent of
that person's or organization's liability for the
conduct of another "insured".
2. The following is added to Paragraph B.5., Other
Insurance of SECTION IV — BUSINESS AUTO
CONDITIONS:
Regardless of the provisions of paragraph a. and
paragraph d. of this part 5. Other Insurance, this
insurance is primary to and non-contributory with
applicable other insurance under which an
additional insured person or organization is the
first named insured when the written contract or
agreement between you and that person or
organization, that is signed by you before the
"bodily injury" or "property damage" occurs and
that is in effect during the policy period, requires
this insurance to be primary and non-contributory.
CA T4 74 02 16 u 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc. with its permission
5166
7, N
page 9 of 23
This page has been left blank intentionally.
5167
page 10 of 23
POLICY NUMBER: 065463440 ENDORSEMENT# 004
COMMERCIAL GENERAL LIABILITY
CG 20101001
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
AS REQUIRED BY WRITTEN CONTRACT
�LC)City of Menifee
29714 Haun Road
Menifee, CA 92586-0000
Re: Proj #11051.007 PMP 20-02: Quail Valley Street Resurfacing Project, Menifee. Additional Insured to include per specifications: City of Menifee and its
officers, employees, agents, and authorized volunteers.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
A. Section II - Who Is An Insured is amended
to include as an insured the person or organization
shown in the Schedule, but only with respect to
liability arising out of your ongoing operations
performed for that insured.
B. With respect to the insurance afforded to these
additional insureds, the following exclusion is
added:
2. Exclusions
This insurance does not apply to "bodily in-
jury" or "property damage" occurring after:
CG 20 10 1001
LX9605
(1) All work, including materials, parts or
equipment furnished in connection with
such work, on the project (other than
service, maintenance or repairs) to be
performed by or on behalf of the additional
insured(s) at the site of the covered
operations has been completed; or
(2) That portion of "your work" out of which
the injury or damage arises has been put
to its intended use by any person or
organization other than another contractor
or subcontractor engaged in performing
operations for a principal as a part of the
same project.
ISO Properties, Inc., 2000
Page 1 of 1 ❑
5168
o
page 11 of 23
ENDORSEMENT # 021
This endorsement, effective 12-01 AM 02/14/2021
Forms apart of policy no.: 065463440
Issued to: LEIGHTON GROUP, INC.
By: LEXINGTON INSURANCE COMPANY
ADDITIONAL INSURED- OWNERS, LESSEES
OR CONTRACTORS- COMPLETED
OPERATIONS
(Based on CG2037 04/13)
This endorsement modifies insurance provided by the following:
COMMERCIAL GENERAL LIABILITY POLICY
SCHEDULE
Name of Additional Insured Person(s) Location of Completed Operations
or Organization(s)
AS REQUIRED BY WRITTEN CONTRACT
(LC)City of Menifee
29714 Haun Road
Menifee, CA 92586-0000
Re: Proj#11051.007 PMP 20-02: Quail Valley Street Resurfacing Project, Menifee. Additional Insured to include per specifications: City of Menifee and
its officers, employees, agents, and authorized volunteers.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations
A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", or
"property damage" caused, in whole or in part, by "your work" at the location designated and
described in the Schedule of this endorsement performed for that additional insured and included in
the "products -completed operations hazard".
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law,
and
2. If coverage provided to the additional insured is required by a contract or agreement, the
insurance afforded to such additional insured will not be broader than that which you are
required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to
Section III - Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we
will pay on behalf of the additional insured is the amount of insurance:
16 (06 14) 1 riclucles copyrig l'ited Intormationo t e nsurance Services Page I of 2
Offices, Inc., with its permission_ All Rights Reserved.
5169
page 12 of 23
1. Required by the contract or agreement; or
2. Available under the applicable Limits of Insurance shown in the Declarations;
whichever Is less.
This endorsement shall not increase the applicable Limits of Insurance shown In the Declarations
All other terms and conditions of the policy remain the same.
Authorized Representative
Includes Copyrighted Intormationotthe Insurance Services Page 2 o
Offices, Inc.,with its permission. All Rights Reserved.
5170
ON
page 13 of 23
Client#: 1257049 305LEIGHGRO
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE2/YYYY)
2/15120/2021
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 pollcy(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 NAM 'T Lori McNay
III Insurance Services PH NE Pt;X— T
2400 E Katella Ave Suite 1100 �o. £xl : 714 941-2815 , No):
ADiYgE$&; y
LMcNa 0mc riif.com
-- - �
Anaheim, CA 92806 INSURER(S) AFFORDING COVERAGE NAIC #
714 941-2800
INSURER A: Lexington Insurance Company 119437
INSURED
Leighton Consulting Inc
17781 Cowan Ste. 100
Irvine, CA 92614-6009
INSURER B : Travelers Indemnity Co of CT
INSURER C :
INSURER E
INSURER F :
25682
GUVtHA1Jil GtH I IFIGA It NUMtSt:H REVISION NUMBER:
THIS
INDICATED.
CERTIFICATE
EXCLUSIONS
IS TO CERTIFY THAT THE POLICIES
NOTWITHSTANDING ANY REQUIREMENT,
MAY BE ISSUED OR MAY PERTAIN,
AND CONDITIONS OF SUCH
OF
POLICIES.
INSURANCE
THE
LISTED BELOW HAVE BEEN
TERM OR CONDITION OF ANY
INSURANCE AFFORDED BY THE
LIMITS SHOWN MAY HAVE BEEN
POLICY NUMBER
ISSUED TO
CONTRACTOR
POLICIES
REDUCED
THE INSURED
OTHER DOCUMENT
DESCRIBED
BY PAID CLAIMS.
NAMED ABOVE FOR THE POLICY PERIOD
WITH RESPECT TO WHICH THIS
HEREIN IS SUBJECT TO ALL THE TERMS,
INSfi
LTR
TYPE OF INSURANCE
DDL
ly p
a
yyyD
POLICY EFF
MDf1'YYY
02/1412021
3eneral
D2/14/2021
POLICY :14�P
N6rOpIYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
065463440
Overall Policy
BA3R7084312143G
006546318
02/14/202
ASare te
02/14/202
.PoEACH OCCURRENCE
$1 000 000
PSEMISES EaoccurrDance
$50,000
MED EXP (Any one person)
$EXCLUDED
PERSONAL & ADV INJURY
$1 000 000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY JECTPRO- LOG
OTHER:
GENERAL AGGREGATE
s2,000,000
PRODUCTS -COMP/OP AGG
$2,000 000
q5,000,000
B
A
AUTOMOBILE
X
X
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY X AUTOS ONLY
UMBRELLA LABX OCCUR
EXCESS LIAB CLAIMS -MADE
COMBINED SINGLE LIMIT
.i�rrn
1 000 000
�r
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
IPer accident)
$
_
$
2/14/2021
02/14/202
EACH OCCURRENCE
s5,000.000
AGGREGATE
$5 QOO OOO
DED X RETENTION$10000
$
WORKERS COMPENSATION
AND EMPLOYERW LIABILITY Y / N
ANY PAOPRIETOFVPARTNERfEXECUTIVE[--]
OF FIG ERIM EMBER EXCLUDED?
N /A
PER I JOTH-
E.L. EACH ACCIDENT
$
{Nlandalory In NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below _ _ _ _ _ E.L. DISEASE - POLICY LIMIT . $
A Prof/Polutn Liab 013001524 2/14/2021 02/14/202 $2,000,000 Per Claim
Claims Made $4,000,000 Aggregate
$100.000 Ded
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Additional Insured applies on General Liability per Lexington's Additional Insured Owners, Lessees or
Contractors endorsement LX4316 06/14 and LX960510101 attached to the General Liability policy as required
by written contract.
Primary wording applies to General Liability per Lexington's endorsement LX9838 08/05 attached to policy.
Additional Insured and Primary wording applies on Automobile Liability per Travelers endorsement CAT474
(See Attached Descriptions)
(.;th I IPIL;A1 = HULUEH GANC:ELLANON
(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
AUTHORIZED RE�PPRREESEENTTA�TIVE
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
5171 #S27361145/M27355854 LXMCN
page 14 of 23
DESCRIPTIONS (Continued from Page 1 )
0216, Blanket Additional Insured -Primary and Non -Contributory with Other Insurance, attached to the
Automobile policy as required by written contract.
Re: Pro) #11051.010 CIP 21-13 (McCall Blvd Resurfacing-Encanto to Antelope) Materials Testing &
Geotechnical Services.
Additional Insured to include per specifications: City of Menifee and its officers, employees,
agents, and authorized volunteers.
SAGITTA 25.3 (2016/03) 2 of 2
# S27361145/M27355854
5172
page 15 of 23
ENDORSEMENT
This endorsement, effective 12:01 AM 02/14/2021
Forms a part of policy no.: 065463440
Issued to: Leighton Consulting Inc
By:LEXINGTON INSURANCE COMPANY
CANCELLATION AMENDMENT
In consideration of the premium charged, it is hereby agreed that the cancellation provision is amended
to 90 days in lieu of (30) days, except for non-payment of premium which remains (10) days.
All other terms and conditions remain unchanged.
Authorized Representative OR
Countersignature fin states where applicable)
LX9586 (02103)
5173
page 16 of 23
This page has been left blank intentionally.
5174
page 17 of 23
ENDORSEMENT
This endorsement, effective 12,01 AM 02/14/2021
Forms a part of policy no.: 065463440
Issued to: Leighton Consulting Inc
By:LEXINGTON INSURANCE COMPANY
PRIMARY/NON CONTRIBUTORY ENDORSEMENT
This endorsement modifies insurance provided by the policy:
Notwithstanding any other provision of the policy to the contrary, the insurance afforded by this policy
for the benefit of the Additional Insured shall be primary insurance, but only with respect to any claim,
loss or liability arising out of the Named Insured's operations; and any insurance maintained by the
Additional Insured shall be non-contributing.
Al other terms and conditions of the policy remain the same.
Authorized Representative OR
Countersignature (In states where applicable)
LX9838 (08/05)
5175
page 18 of 23
This page has been left blank intentionally.
5176
0
page 19 of 23
Leighton Consulting Inc
BA3R7084312143G
COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED - PRIMARY AND
NON-CONTRIBUTORY WITH OTHER INSURANCE
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
PROVISIONS
1. The following is added to Paragraph A.1.c., Who
Is An Insured, of SECTION II — COVERED
AUTOS LIABILITY COVERAGE:
This includes any person or organization who you
are required under a written contract or
agreement between you and that person or
organization, that is signed by you before the
"bodily injury" or "property damage" occurs and
that is in effect during the policy period, to name
as an additional insured for Covered Autos
Liability Coverage, but only for damages to which
this insurance applies and only to the extent of
that person's or organization's liability for the
conduct of another "insured".
2. The following is added to Paragraph B.5., Other
Insurance of SECTION IV — BUSINESS AUTO
CONDITIONS:
Regardless of the provisions of paragraph a. and
paragraph d. of this part 5. Other Insurance, this
insurance is primary to and non-contributory with
applicable other insurance under which an
additional insured person or organization is the
first named insured when the written contract or
agreement between you and that person or
organization, that is signed by you before the
"bodily injury" or "property damage" occurs and
that is in effect during the policy period, requires
this insurance to be primary and non-contributory.
CA T4 74 02 16 u 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
5177
page 20 of 23
This page has been left blank intentionally.
6178
page 21 of 23
POLICY NUMBER: 065463440 ENDORSEMENT# 004 COMMERCIAL GENERAL LIABILITY
CG 20 10 10 01
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
i � ice, L ■ � i ■
lop P:
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
3 REQUIRED BY WRITTEN CONTRACT
:)C[ly of Menifee
1714 Haun Road
enifee, CA 92586-0000
Proj #11051.010 CIP 21-13 (McCall Blvd Resurfacing-Encantoto Antelope) Materials Testing & Geotechnical Services. Additional Insured to include
ecifications: City of Menifee and its officers, employees, agents, and authorized volunteers.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
A. Section II - Who Is An Insured is amended
to include as an insured the person or organization
shown in the Schedule, but only with respect to
liability arising out of your ongoing operations
performed for that insured.
B. With respect to the insurance afforded to these
additional insureds, the following exclusion is
added:
2. Exclusions
This insurance does not apply to "bodily in-
jury" or "property damage" occurring after:
CG 20 10 1001
LX9605
(1) All vork, including materials, parts or
equipment furnished in connection with
such vwrk, on the project (other than
service, maintenance or repairs) to be
performed by or on behalf of the additional
insured(s) at the site of the covered
operations has been completed; or
(2) That portion of "your vvork" out of which
the injury or damage arises has been put
to its intended use by any person or
organization other than another contractor
or subcontractor engaged in performing
operations for a principal as a part of the
same project.
ISO Properties, Inc., 2000
Page 1 of 1 ❑
5179
page 22 of 23
ENDORSEMENT # 021
This endorsement, effective 12-01 AM02/14/2021
Forms apart of policy no.: 065463440
Issued to: LEIGHTON GROUP, INC.
By: LEXINGTON INSURANCE COMPANY
ADDITIONAL INSURED- OWNERS, LESSEES
OR CONTRACTORS- COMPLETED
OPERATIONS
(Based on CG2037 04/13)
This endorsement modifies insurance provided by the following:
COMMERCIAL GENERAL LIABILITY POLICY
SCHEDULE
Name of Additional Insured Person(s) Location of Completed Operations
or Organization(s)
AS REQUIRED BY WRITTEN CONTRACT
(LC)City ofMenifee
29714 Haun Road
Menifee, CA 92586-0000
Re: Proj ##11051.010 CIP 21-13 (McCall Blvd Resurfacing-Encantoto Antelope) Materials Testing & Geotechnical Services. Additional Insured to include
per specifications: City of Menifee and its officers, employees, agents, and authorized volunteers.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations
A. Section 11 - Who Is An Insured is amended to include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", or
"property damage" caused, in whole or in part, by "your work" at the location designated and
described in the Schedule of this endorsement performed for that additional insured and included in
the "products -completed operations hazard".
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law,
and
2. If coverage provided to the additional insured is required by a contract or agreement, the
insurance afforded to such additional insured will not be broader than that which you are
required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to
Section III - Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we
will pay on behalf of the additional insured is the amount of insurance:
ncu es opyrig to normationo t elnsurance ervices Page 1 of 2
Offices, Inc., vuith its permission. All Rights Reserved.
5180
page 23 of 23
1. Required by the contract or agreement; or
2. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations
All other terms and conditions of the policy remain the same.
Authorized Representative
�77=Includes Copyrighted n ormationo the nsurance Services age o
Offices, Inc., with its permission. All Rights Reserved.
5181