2020/07/01 Aqua Patch Road Materials Certificate of Liability InsuranceACQRO> CERTIFICATE OF LIABILITY INSURANCE
DATE //2020 Y)
06/30/30020
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
COAME:AC Asako Tourville
N
Seven Corners Insurance Solutions Inc.
(310) 347-3100 FAXNe1; (310) 388-5996
AICNN
Ext :
21241 S Western Ave
e- AI tourville.a@sevencorners-is.com
ADDRESS:
Suite 250
INSURER(S) AFFORDING COVERAGE
NAIC #
Torrance CA 90501
INSURERA: Tokio Marine America Insurance Company
10945
INSURED
INSURER B :
Jalux Americas, Inc. d.b.a. Aqua Patch Road Materials
INSURER C :
390 N. Pacific Coast Highway Suite 2000
INSURER D :
PO Box 910
INSURER E
ElSegundo CA 90245
INSURER F :
COVERAGES CERTIFICATE NUMRER- 20-21 AquaPatch RFVICInN NIIMRFR-
THIS IS TO CERTIFYTHAT 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.
LTR
TYPE OF INSURANCE
IN D
WVD
POLICY NUMBER
MMIDDY EFF
MM/LDIGDYEXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE Fx_] OCCUR
CPP6403488-10
07/01/2020
07/01/2021
EACH OCCURRENCE
$ 1,000,000
PREMISES Q occurrence
$ 1,000,000
MED EXP (Any one person)
$ 10,000
PERSONAL &ADV INJURY
$ 1,000,000
GGEEN'LAGGREGATE LIMITAPPLIES PER:
POLICY ❑ JECT LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS -COMP/pP AGG
$ 2,000,000
Employee Benefits
$ 1,000,000
A
AUTOMOBILE LIABILITY
ANYAUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
CPP6403488-10
07/01/2020
07/01/2021
GOMacddenl $31NGLELIMIT
Ba
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per aocldonl
$
Uninsured motorist
$ 1,000,000
A
UMBRELLALIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
I
CU6403490-10
07/01/2020
07/01/2021
EACH OCCURRENCE
"•""•""•"' y'•"""'•
$ 4,0001000
AGGREGATE
$ 4,000,000
DED RETENTION $ 10,000
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
PER OTH-
STATUTE ER
E L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L, DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
Evidence of Insurance
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Menifee and its officers, employees, agents ACCORDANCE WITH THE POLICY PROVISIONS.
and authorized volunteers
29844 Haun Road AUTHORIZED REPRESENTATIVE
Menifee CA 92586
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