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2019/11/01 Adame Landscape, Inc. Certificate of Liability InsuranceA`aRE) CERTIFICATE OF LIABILITY INSURANCE DATE (M D 9) / 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 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 Bulen & Associates Insurance Services CITY OF iR NiFEL 40750 Symphony Park In. NAME. Sondra Alvarado PHaNE (951) 674-0675 A!C No: (951)674-2375 E-MAIL ADDRESS. sondra@bulen.com INSURERS AFFORDING COVERAGE NAIC H Suite 101 INSURER A!XL Insurance America, Inc. 24554 Murrieta CA 92562 INSURED lf{ F 1/ INSURERB:XL S ecialt Insurance Co. 37885 INSURER C : f1 �}ryr i [ ` ) ` I ✓ E [J INSURERD: Adame Landscape, Inc- INSURER E: 41863 Juniper St. INSURER F: Murrieta CA 92562 COVERAGES CERTIFICATE NUMBER: CL1911131417 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 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. IIN5R LTR TYPE OF INSURANCE AL D 'oUE1R POLICY NUMBER POLICY EFF ME2MYYY POLICY EXP WDDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE FXI OCCUR PREMI ES Eaaccurrence $ 500,000 X MED EXP(Any one person) $ 10,000 Deductible $1,000 X Y NPC-102030-00 11/1/2019 11/1/2020 PERSONAL &ADV INJURY $ 1,000,000 GENIAGGREGATELIMITAPPUESMR GENERAL AGGREGATE $ 2,000,000 POLICY ❑ PRO ❑ LOC JECT PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY COMBIN I I 1 Me accident) $ 1,000,000 BODILY INJURY (Per person) $ A X ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS X Y NBA-1002032-00 11/1/2019 11/1/2020 BODILY INJURY (Per accident) $ NON -OWNED X HIRED AUTOS Ix AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB PEA I I RETENTION $ It WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / NSTATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ NIA PER om- I I ER EL EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ B Rented/Leased Equipment NIM-1002031-00 11/1/2019 11/1/2020 Limit (Deduclible$500) 50,000 B Installation Project NIM-1002031-00 11/1/2019 11/1/2020 Limit (Deductible $500) 50,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: All landscape operations performed by or on behalf of the named insured. City of Menifee, and its officers, employees, agents, and volunteers are named as Additional Insured in regards to General Liability per the attached CG2010 04/13 and CG2037 04/13 and Auto per the attached XIC421 10/13. Insurance is Primary and Non Contributory. Waiver of Subrogation included on General Liability and Auto Liability. 30-days notice of cancellation, except 10-days notice of cancellation for non-payment. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 29844 Haun Road ACCORDANCE WITH THE POLICY PROVISIONS. Menifee, CA 92586 AUTHORIZED REPRESENTATIVE :S Alvarado/SONDRA� ACORD 25 (2014/01) INS025 (201401) Q 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER:NPC-102030-00 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) ` Or Organization(s) I Location(s) Of Covered Operations Blanket as required by written contract Blanket as required by written contract 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", "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 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 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 i POLICY NUMBER: NPc-102030-00 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) I Location And Description Of Completed Operations lanket as required by written contract IBlanket as required by written contract 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. CG 20 37 04 13 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: 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. ENDORSEMENT # This endorsement, effective 12:01 a.m. November 1, 2019 , forms a part of Policy No. NPC-102030-00 issued to Adame Landscape, Inc. by XL Insurance America, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY XL Plus Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. The following listing is a general coverage description only. Limitations and exclusions may apply to these coverages. Read this endorsement carefully to determine rights, duties, and what is and is not covered. A. Reasonable Force — Bodily Injury or Property Damage B. Damage To Premises Rented To You Extension • Perils of fire, lightning, explosion, smoke, aircraft or vehicles, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage • Limit increased to $300,000 C. Aircraft Chartered with Crew D. Non -Owned Watercraft E. Personal and Advertising Injury — Assumed by Insured Contract F. Increased Supplementary Payments • Cost for bail bonds increased to $5,000 • Loss of earnings increased to $1,000 per day G. Broadened Named Insured H. Blanket Additional Insured — Managers or Lessors of Premises I. Blanket Additional Insured — Lessor of Leased Equipment J. Injury to Co -Employees and Co -Volunteer Workers K. Knowledge and Notice of Occurrence or Offense L. Unintentional Omission M. Liberalization N. Blanket Waiver of Subrogation O. Incidental Medical Malpractice Injury P. Extension of Coverage — Bodily Injury Q. Coverage Territory Form XIL 436 1208 © 2008, XL America, Inc. Page 1 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER: NBA-1002032-00 XIC 421 1013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XL PLUS BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM COVERAGE DESCRIPTION A. Temporary Substitute Auto Physical Damage B. Who Is An Insured 1. Broad Form Insured 2. Employees As Insureds 3. Additional Insured By Contract, Agreement or Permit 4. Employee Hired Autos C. Supplementary Payments D. Amended Fellow Employee Exclusion E. Physical Damage Coverage 1. Rental Reimbursement 2. Extra Expense — Broadened Coverage 3. Personal Effects Coverage 4. Lease Gap 5. Glass Repair — Waiver Of Deductible F. Physical Damage Coverage Extensions 1. Additional Transportation Expense 2. Hired Auto Physical Damage G. Business Auto Conditions 1. Notice Of Occurrence 2. Waiver Of Subrogation 3. Unintentional Failure To Disclose Hazards 4. Primary Insurance H. Bodily Injury Redefined I. Extended Cancellation Condition XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 1 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other Insurance, b. is replaced with the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". C. Supplementary Payments SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 2. Coverage Extensions, a. Supplementary Payments is changed as follows: Item (2) is deleted and replaced by the following: (2) Up to $3,500 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. Item (4) is deleted and replaced by the following: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. D. Amended Fellow Employee Exclusion SECTION II — COVERED AUTOS LIABILITY COVERAGE, B. Exclusions, 5. Fellow Employee does not apply. The insurance provided under this Provision D. is excess over any other collectible insurance. E. Physical Damage Coverage SECTION III — PHYSICAL DAMAGE COVERAGE, A. Coverage is changed by adding the following: 1. Rental Reimbursement a. We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto". Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". No deductibles apply to this coverage. b. We will pay only for those expenses incurred during the policy period beginning twenty-four (24) hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of the following number of days: XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 3 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 5. Glass Repair — Waiver Of Deductible No deductible applies to glass damage if the glass is repaired rather than replaced. F. Physical Damage Coverage Extensions SECTION III — PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions is amended by the following: 1. Additional Transportation Expense Sections a. and b. are amended to provide a limit of $50 per day and a maximum limit of $1,000. 2. Hired Auto Physical Damage The following section is added: Any "auto" you lease, hire, rent or borrow is deemed to be a covered "auto" for physical damage coverage. The most we will pay for each covered "auto" is the lesser of: (1) the actual cash value; (2) the cost for repair or replacement; or (3) $50,000, or higher limit if shown on the Declarations for Hired Auto Physical Damage Coverage. For each covered "auto" a deductible of $100 for Comprehensive Coverage and $1,000 for Collision Coverage will apply. G. Business Auto Conditions SECTION IV — BUSINESS AUTO CONDITIONS, A. Loss Conditions is changed by the following: 1. Notice Of Occurrence Section 2. — Duties In The Event Of Accident, Claim, Suit Or, Loss, a. is.changed by adding the following: If you report an injury to an "employee" to your workers' compensation carrier and if it is subsequently determined that the injury is one to which this insurance may apply, any failure to comply with this condition will be waived if you provide us with the required notice as soon thereafter as practicable after you know or reasonably should have known that this insurance may apply. 2. Waiver Of Subrogation Section 5. Transfer Of Rights Of Recovery Against Others To Us is changed by adding the following: However, this Condition does not apply to any person(s) or organization(s) with whom you have a written contract, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under such contract with that person or organization. XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 5 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission.