2021/03/01 Hill Crane Service, Inc. Certificate of Liability InsuranceCERTIFICATE OF LIABILITY INSURANCE
FDAT'EIMMIbblYYYY)
`r
02/26/2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOZES 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($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT If the certificate holder Is an ADDITIONAL INSURED, the poliey(les) 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(&).
PRODUCER
NAME: Crystal TarreS
Tolman & Wiker Insurance Services, LLC
PHONE (805) 922-7301 � w�y(t3D5) 585-6200
WC No E.,: AIC, Na
1ei ADDRESS: aorreslttolmanandwikel'.cam
196 S. Fir Street
PO Box 1388
INSURER S) APPOROING COVERAGE
NAIC 4
Ventura CA 93002-1388
INSURER A ; Clear Blue Specialty Ins CO
37745
INSURED
INSURERS: Clear Blue Ins Co
28860
Hill Crane, Service, Inc.
INSURER C : Zurich American
16535
3333 Cherry Avenue
INSURER P ; Indian Harbor Ins Co
36940
INSURER E :
Long Beach CA 90807
INSURERF:
UVVLKAQ1:5 CERTIFICATE NUMBER a!Iree-ULlALP wuAs RFVICInM NIIMRFR-
THIS IS TO CERTIFY THAT TI1E POLICIES OF INSURANCE t,JSTEP 5EI„OW IAAVE I4EEN ISSUE) 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 Af'FORDED BY THE POLICIES DESCRIBrE Q f1BREIN 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
0,400
Mo.
POLICY NUMBER
ImMiDONMI
IMM/pplYYYY
LIMITS
x
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
PREMISES ESOCG1rfCN7t9
g 250,000
CLAIMS -MADE OCCUR
On-xcolG
MED EXP (Any one Doman)
s 10.000
X
Over the Road
1,000,000
A
Y
AW03-RS-2000069-01
03/01/2021
03/01/2022
PERSONAL aADV INJURY
$
GEN'LAGGREGATELIMIT APPLIES PER:
GENERAL AGGREGATE
S 2,000,000
POLICY PRO-
"— ❑ LOC
JECT
PRODUCTS-COMplOPAGO
5 2,000,000
�
C}r14ER;
AUTOMOBILE
LIABILITY
GUMIMN15.0 INO1-E LiMI'r
EA BCO(Will
$ 1,000,000
BODILY INJURY (Pot ootdon)
$
ANYAUTO
g
OWNED ^ClArDULED
At.1706 ONLY AUTOS
AW02-RS-2000058-01
03/01/2021
03/01/2022
RODILYINJ(1RY(P9rns:nldRn0
S
HIMPt.) NON-OWNFO
11it15iIFRTY tl 6 .
Per acowbot
$
AUTOS ONLY AUTOS ONLY
S
UMBRELLA LIAB
X OCCUR
EACH OCCURRENCE
$ 5,000,000
A
x
EXCESS LIAR
CLAIMS -MADE
AW042000029-01
03/01/2021
03/01/2022
AGGREGATE
3 5,000,000
OED 1
WORKERS COMPENSATION
PER OT11•
x
AND EMPLOYERS' LIABILITY YIN
S7 T1 " i�
C
ANY PROPRIETOR/PARTNER/EXECUTIVE,000,000
OI-PI(:F:R/MEMHEREX(J.U0F.:r;'I
MIA
WC5084565-09
11/01/2020
11/01/2021
E.L.ELEACISACCIDCNT
3
E L. DISEASE - &.A EMPLOYEE
$ 11000,000
(Mandatory In NH)
It yee, deadrlbe under
DESCRIPTION OF OPERATIONS below
E. L. DISEASE - POLICY LIMIT
1000,000
$ ,
_
Each Occurrence: $5,000,000
Excess Liability:IE
O SXSOO56130.01 03/01/2021 03/01/2022 Aggregate; $6,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE& (ACORD 101, Additional Ramarks Schedule, may be atlachad if mara space I rrequlrad)
RE: 1,2. GL: Certificate Holder Is Additional Insured as respects to Operations of the Named Insured per form CG20100413. Endorsement applies only as
required by current written contract on file. *"GL: EXCLUDES ALL WRAP/OCIP PROJECTS
M".rau
City of Monlfee
29714 Haun Road
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
Menifee CA 92586 I �� _� A—V,
9)1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: AW03-RS-2000069-01
COMMERCIAL GENERAL LIABILITY
CG20100413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS -- SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
1. Or Organization(s) I Location(s) Of Covered Operations
Any and all jobs/projects of the insured, where
required by written contract, executed prior to a
�Aaim.
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" "property
damage" or "personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf;
in the performance of your ongoing operations for
the additional insured(s) at the location(s)
designated above.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
a. 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.
R. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
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
location 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.
CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2
C. 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,
1. Required by the contractor 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.
Page 2 of 2 0 Insurance Services Office, Inc., 2012 CC 2010 0413
POLICY NIJMBER:AW03-RS-2000069-0l
RHI GL 0510 0619
EXCLUSION - CONTROLLED INSURANCE PROGRAM(S)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Location of Operation(s):
Any and all controlled insurance program locations
SCHEDULE
(Information required to complete this Schedule, if not shown above, will be shown in the Declarations.)
(A) The following exclusion is added to Paragraph 2. Exclusions of Section I - Coverage A — Bodily
Injury And Property Damage Liability and Paragraph 2. Exclusions of Section I — Coverage B —
Personal And Advertising Injury Liability:
This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury"
arising out of either your ongoing operations or operations included within the "products -completed
operations hazard", "your product', or "your work" that is in any way performed by you, or on your
behalf, at the location described in the Schedule of this endorsement, if you are enrolled in a
"controlled insurance program" relating to any construction projects at such location. .
This exclusion applies whether or not the controlled Insurance program:
(1) Provides coverage identical to that provided by this Coverage Part,
(2) Has limits adequate to cover all claims, or
(3) Remains in effect-
(B) The following definition is added to the Definitions section:
"Controlled insurance program", commonly referred to as a wrap up program, means any agreement
or arrangement, Including self-insurance, any contractor -controlled, owner -controlled or similar
insurance program, under which some or all of the contractors working on a specific construction
project, or specific construction projects, are required to enroll in a program to obtain insurance that:
a. Includes the same or similar insurance as that provided by this Coverage Part; and
b. Is issued specifically for injury, damage or an offense arising out of such construction project(s).
Includes copyrighted material of Insurance Services Office, Inc, with its permission
RHI GL 0510 06 19