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2018/03/01 Hill Crane Service, Inc. Certificate of Liability Insurance10/22/2018 10:08 AM FROM: Tolman & Wiker TO: +19516793843 Gregory C. Anderson Shawn E. Carson Steven W. Carter Raymond M Clem Ronald F TOLMAN & W I�iER Jefrrey G. Dannann JefFrey T. Dodds INSURANCE SERVICES, LLC Bryce W. Eddy John A. Feliciano TW INNOVATIVE RISK ADVICE SINCE r9z3— Kipton Keller Shaun M. Kelly Date/Time Monday, October 22, 2018 Date: Monday, October 22, 2018 Attention: Insurance Certificates Company: City of Menifee From: Kathy Stutts Fax Number: (805) 585-6256 9:13:43 AM 1-951-679-3843 Phone Number: (805) 585-6156 Regarding Hill Crane Service, Inc. I Certificate of Insurance Pages 10 Including Cover a Joan M. Kirchhof Mark D. Lyon David L_ Rucker David R. Shore Denise D. Sutton Vance Taylor Richard W. Toohey Gregory W. Van Ness Barbara J. Ward Marcus A. Wilson Please find attached the Certificate of Insurance on behalf of Hill Crane Service, Inc. with regards to their upcoming policy renewal. Please be advised that the attached certificate is for the Workers' Compensation renewal only. If you have any questions, please let me know. Thank you! Thank you, Kathy Stutts I Commercial Account Assistant TOLMAN & WIKER INSURANCE SERVICES, LLC (p): 805.585.6156 17 ft 805.585.6256 * (e): kstutts@tol manandwi ker. com < mai Ito: kstutts@tolmanandwi ker. com> www.tolmanandwiker.com<http://www.tolmanandwiker.com/> 196 S. Fir St. Ventura, CA 93001 1 CDI License: OE52073 [cid:image005.jpg@Ol D3CBEF.AB2B4BCO][bestplacesmall] This facsimile transmission and any documents contained within are legally protected and only for the use of the intended recipient(s). If you are not an Intended recipient of this facsimile, you are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on the contents of this facsimile information is strictly prohibited. If you have received this transmission in error, please immediately notify us by return facsimile and destroy the original transmission and Its attachments without reading or saving It in any manner. Thank you. 196 South Fir Street, PO Box 1388, Ventura, CA 93002-1388 Offices in: Bakersfield, Salinas, Santa Maria, Ventura www.tohnanandwiker.com CDI Lic: oE59.o79 10/22/2018 10:08 AM FROM: Tolman & Wiker TO: +19516793843 P. 2 TOLMAN I W I KE R INNOJA FIVE 0151: ADVICE. SINCE ItI21 10/22/2018 10:08 AM FROM: Tolman & Wiker TO: +19516793843 P TOLMAN'WIKER 1 IY IF ti'YX i1V1 BI'it hbvKv Owto kfl'9 10/22/2018 fi�.L'T �"e.ldCES To WORK 46 10:08 AM FROM: Tolman & Wiker TO: +19516793843 10/22/2018 10:08 AM FROM: Tolman & Wiker TO: +19516793843 K 10/22/2018 10:08 AM FROM: Tolman &. Wiker TO: +19516793843 P. 6 ACIORV� DATE (MMlD DIYYYY) CERTIFICATE OF LIABILITY INSURANCE 10/17/2018 THIS CERTIFICATE IS ISSUED AS AMATTER 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 Kathy Slutts NAME: Tolman 8 Wiker Insurance Services LLC #OE52073 PHONE Eat (805) 585-6256 r0.c Nc} (805) 585 6256 ADDRESS: kstulls@tolmanandwiker com 196 S. Fir Street PO Box 1388 INSURER(S) AFFORDING COVERAGE NAIC If INSURERA: International Ins Co of Hannover SE 86486 Ventura CA 93002-1388 INSURED INSURER B: American Alternative Ins Corp 19720 INSURER C: Westchester Surplus Lines Ins 10172 INSURER D: Zurich American 16535 Hill Crane Service, Inc INSURER E: Indian Harbor Ins Co 36940 3333 Cherry Avenue Long Beach CA 90807 INSURER F : COVERAGES CERTIFICATE NUMBER: 18/19 GL/AUIWC/XS/XS 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 OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN LS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DDIYYV MM DDIYVYY LIMITS X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 2'DDD'000 � 300,000 CLAIMS -MADE OCCUR PRFMISES JEa occurrence $ MED EXP (Any one person) $ Excluded On -Honk X Over the Road 2,DD0,00D A Y IICHMPP-0003024-00 03/01/2018 03/01/2019 PERSONAL B ADV INJURY $ CENTACORECATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000 PIOLlCY ❑ACTT ❑LOC PRODUCTS-COMPIOPAGG $ 4,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acciden $ 1,000,000 BODILY INJURY (Per person) $ ANYAUTO B OWNED SCHEDULED 6LA2CA0000006-00 03/01/2018 03/01/2019 BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS PROPERTY ❑AMAGI= $ HIRED HNON-OWNED AUTOS ONLY AUTOS ONLY POr acodont UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,OOD,D00 X AGGREGATE $ 5,000,000 C EXCESS LIAB CLAIMS -MADE G46605962002 03101/2018 03/01/2019 DIED I I RETENTION $ $ WORKERS COMPENSATION PF AND EMPLOYERS' LIABILITY YIN /\ STATUTE ER EL EACH ACCIDENT $ 1,ODO,OOD D ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA WC5084565-07 11/01/2018 11/01/2019 1,000,000 BE EXCLUDED? OFFICERry (Mandatory in NH) EL DISEASE -EA EMPLOYEE $ If yes, describe under 1,D00,000 DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $ EACH OCCURENCE $3,000,000 Excess Liability E SXS004531203 03/01/2018 03/01/2019 AGGREGATE $3000000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) RE: 1.2 GL: Certificate Holder is Additional Insured as respects Operations of the Named Insured per form GLM20330315 Endorsement applies only as required by current written contract on file CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Menifee ACCORDANCE WITH THE POLICY PROVISIONS. 29714 Haun Road AUTHORIZED REPRESENTATIVE Menifee CA 92586 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 10/22/2018 10:08 AM FROM: Tolman &, Wiker TO: +19516793843 P. 7 Policy NumberFcHMPP-0003024-00 Insured Name: Hill Crane Service, Inc THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL, INSURED - ONGOING OPERATIONS OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION II — WHO IS AN INSURED is amended to include as an additional insured any person or organization that the Named Insured has agreed to name as an Additional Insured on its policy. However, such additional insured status shall be granted only If such agreement was evidenced "in writing" or by a written contract executed by the Named Insured before the "occurrence" took place. Furthermore, the conditions triggering such additlonal insured status are governed as follows: A. Such person or organization is an Additional Insured only with respect to liability for "bodily Injury" or "property damage" that is directly caused by the Named insured's performance of "ongoing operations" for at least one of the Additional Insureds. B. However, where the Named Insured has agreed in a written contract to specific editions of ISO additional insured endorsements or to specific language as delineated in those ISO additional insured endorsements, Paragraph A above is deleted and replaced with either paragraph BA or B.2 below. 1. caused in Whole or In Part — Where the Named Insured is required by a written contract to make a person or organization an Additional Insured using the language from LSD Additional Insured forms CG2033 or CG2010 with edition dates of July 2004 (07/04), or April 2013 (04/13) such person or organization is an Additional Insured only with respect to liability for "bodily injury" or "property - __- damage' that is caused in whole or in .---..._.. -_- --- part by the Named Insured's performance of "ongoing operations" for at least one of the Additional Insureds; OR 2. Arising Out Of — wl�ere the Named Insured is required by a written contract to make a person or organization an Additional Insured using the language from ISO Additional Insured forms CG2033 or CG2010 with edition dates of 2001,1993 or 1985, such person or organization is an Additional Insured only with respect to liability for "bodily injury" or "property damage' arising out of the Named Insured's performance of "ongoing operations" far at least one of the Additional Insureds, Additionally: 1. The insurance afforded to any Additional insured only apples to the extent permitted by law; and If coverage provided to the Additional Insured is required by contract or agreement an in writing, the insurance afforded to such additional Insured will not be broader than that which the Named insured Is required by the contractor agreement to provide for such Additional Insured. Exclusions With respect to the insurance afforded to the Additional Insureds: A. This endorsement does not eliminate any other exclusions in this policy or the CG0001(10/Ol) policy form. B. This Additional insured Endorsement apply k 1. Any damages arising from the "products completed operations hazard"; Page 1 of 2 GLM 2033 0315 10/22/2018 10:08 AM FROM: Tolman & Wiker TO: +19516793843 P. 8 2. "Bodily injury" or "Property damage" arising out of the rendering of or failure to render any piofessional architectural, engineering or surveying services, including: The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, filed orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural, or engineering activities; 3. "Bodily injury" or "property damage" occurring after: a. All the work on the project to be performed by Named Insured on behalf of the Additional Insured has been completed; or b. That portion of the work performed by he Named Insured, 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; or c. The Named Insured completes delivery, and/or assembly of equipment at the project site pursuant to the terms of the bare lease agreement; or d. The Named Insured;s equipment has been assembled at the project site, if the work to be performed by the Named insured on behalf of the Additional Insured is limited to the rental of equipment that must be set up or assembled at the project site. This exclusion does not apply to liability caused by the Named Insured's acts or omissions during the disassembly or the equipment. Definitions As used in this Endorsement, the following definitions apply: A. "Ongoing operations" shall mean that period of time in which any insured is actively performing work or operations on a project or in preparation for work on a project. That period of time commences when the insured actively begins work to fulfill its contractual obligations, and ends when their contractual obligations have been fulfilled. ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED. Authorized Representative Includes copyrighted material of Insurance Services Office, Inc., GLM 2033 0315 with its permission. Page 2 of 2 10/22/2018 10:08 AM FROM: Tolman & Wiker TO: +19516793843 P. 9 Policy Number:IICHMPP-0003024-00 Insured Name: Hill Crane Service, Inc THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED EXCLUSION - DESIGNATED OPERATIONS UNDER A CONSOLIDATED INSURANCE PROGRAM This endorsement mGdiflesinsurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM It is agreed that SECTION I —COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILTY, Z. Exclusions Is amended to Include the following: This Insurance does not provide coverage for 'bodily Injury" or "property damage" arising out of the acts or omissions of any Insured if: A. The accident occurred at or incidental to a project that is insured by a "consolidate Insurance program", and 'S. The insured has enrolled in and or participated in that "consolidated insurance program.' This exclusion applies regardless If the "consolidated Insurance program" provides coverage Identical to that provided by the above referenced coverage part, or If It remains In effect, If die Named Insured Is enrolled in a "consolidated insurance program" covering a project with a minimum of $10,000,000 In limits of coverage, and the Named Insured Is performing work at the project or In furtherance of or incidental to Its work on the project, the above exclusion does not apply to: a. "property damage" that occurs to real or personal property of others In the care, custody or control of the Named Insured ifsuch property damage occurs while that property Is In the possession of, or Is being raised, hoisted, lowered, or moved by "mobile equipment" operated by, owned by, or loaned to the Named Insured or any of its Subcontractors; OR b. That portion of "bodily injury" or "property damage" for which the Named Insured Is not provided coverage under the "consolidated Insurance program", OR c. Any portion of damages resulting from "bodily injury" or "property damage" that it nxcass of the limits available to the Named Insured under the "consolidated Insurance program". However, none ofthe above exceptions, a., b., c. applies to any or all Additional Insureds It Is agreed that SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4.Other Insurance b. Excess Insurance Is amended to Include the following: If at least one of the above exceptions, 9, b., or c., applies to the Named Insured, the coverage available under this liability policy Is excess to. A. The coverage provided to the Named Insured by the"consolidated Insurance program," B. Any deductibles owed by the Named Insured under this liability policy or under any "consolidated Insurance program," C. The Named Insured's self -insured retention. Definitions For the purpose of this limited exclusion endorsement: A. "Consolidated Insurance Program" means: Any Wrap -Up, OCIP, CCIP, or any other Insurance policy purchased to cover a specific construction project or Jobsite for an Indefinite term of construction. - B, "Ongoing Operations" means that period of time in which any insured is actively performing work or operations on the construction project, in preparation for or Incidental to work on the construction project. That period of time commences when the insured begins work to fulfill its contractual obligations, and ends when their contractual obligations have been fulfilled. GLM 2154 0511 Page'1 of 1 10/22/2018 10:08 AM FROM: Tolman & Wiker TO: +19516793843 P. 10 AC6,1?i Ee CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 0/ 12/2018 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 KathyStulls Tolman & Wiker Insurance Services LLC #OE52073 PHONE (805) 695.6156 (805) 585-6256 C Na Eaet: N.):196 IL kstuits lolmanandwiker cam ADDRESS: S. Fir Street PO BOX 1388 INSURER(S) AFFORDING COVERAGE NAIL S INSURERA: Western World Ins Co 13196 Ventura CA 93002-1388 INSURED INSURERS: INSURER C : Hill Crane Service, Inc. INSURERD: 3333 Cherry Avenue INSURER E : Long Beach CA 90807 INSURER F : COVERAGES CERTIFICATE NUMBER: 1B/19XS over AU REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- LTR TYPEOF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYY (MMDDIYYVY) LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ AMA N PREMISES Ea occurrence MED EXP (Any one person) $ PERSONAL B ADV INJURY $ GEN'L AGGREGATE LIMITAPPLIES PER ❑ PFCROT ❑ LOC POLICY J OTHER GENERAL AGGREGATE $ PRODUCTS - COMP/OPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMB SINGLELrMrr Ea acciden $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per eccidon! $ $ A X UMBRELLA LAB X OCCUR EXCESSLIA9 CLAIMS -MADE GLX1000256-00 03101/201B 03/01/2019 EACH OCCURRENCE $ 1 D00 D00 AGGREGATE $ 1,000,000 DED I I RETENTION $ $ 'WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUD ED? (Mandatory In NH) byes, describe under DESCRIPTION OF OPERATIONS below NIA PER OTH- STATUTE F.R EL EACHACCIDENT $ EL DISEASE - EA EMPLOYEE $ EL DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ll�� > .C+--az ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD FAX RX Result Report CC KYOIERB 2018/10/22 10:21 Firmware Version 2N42000.007.106 2018.05.25 [2N41000.005.0011 [2N41100.001.0021 [2N47000.007 1041 AIAR22 I Job No.: 095967 Total Time: 0'02'22" Page: 010 Complete Document: WestScan...095967 No. Date and Time Destination Times Type Result Resolution/ECM 001 18/10/22 10:18 0'02'22" FAX OK 200x200 Fine/On 1 [ L8D5706310 1