Loading...
2019/02/18 L.C. Paving & Sealing, Inc. Certificate of Liability Insurance (3)CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) F�. 2/19/2019 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 CONTACT JANA CLARK NAME: HARTLEY CYLKE PACIFIC—#0574253 AHONN (619)295-5155 7fC Noy (619)291-0912 INSURANCE SERVICES, INC. E•MIL jana@hcpacinsurance.com ADDRESS! 2747 UNIVERSITY AVENUE INSURERIS) AFFORDING COVERAGE NAIC # INSURERA:UNITED SPECIALTY INSURANCE CO. SAN DIEGO CA 92104-4068 INSURED INSURER B: Nationwide Insurance CO. 23787 L.C. Paving S Sealing, Inc. INSURERC:TOPA INSURANCE COMPANY 330 Rancheros Drive #208 INSURER D: STARNET INSURANCE COMPANY INSURER E : INSURER F: San Marcos CA 92069 COVERAGES CERTIFICATE NUMBER:19/20 ALL COVERAGES; 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. INSLTR TYPE OF INSURANCE I g POLICY NUMBER MM DD/YYYY MM DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE FTOCCUR DAVAMTO RENTED PREMISES fEa occurrence $ 50,000 MED EXP (Any one person) $ 5,000 X ATNSF1924018 2/18/2019 2/10/2020 PERSONAL & ADV INJURY $ 1,000,000 GENI AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO-JECT F—] LOC X POLICY PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBIN D L LI Ea acddernt $ 1,000,000 BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS ACP7803877894 2/18/2019 2/18/2020 BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS COMP DED: $250 PROPERTY DAMAGE Par aE.ldenl $ '1 Medical payments $ 5,000 LOLL DED: $500 X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 C EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ XL0020024202 2/18/2019 2/10/2020 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N X PER - STATUTE 1EIR111 E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE D OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) N / A BNUWC0138038 9/12/2018 9/12/2019 E L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below EL. DISEASE -POLICY LIMIT $ 1,000,000 B COMMERCIAL PROPERTY ACP7803877894 2/18/2019 2/18/2020 BPP: $16,200 00 DED: $500 INLAND MARINE LEASEDIRENTED EQUIPMENT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) City of Menifee and its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers are hearby added as additional insured but only as respects work done by, for, or on behalf of the named insured. *10 day notice of cancellation for non-payment of premium shall apply. RE: Quail Valley Goetz Road Pedestrian Sidewalk Improvements Project CIP 16-10 CERTIFICATE HOLDER CANCELLATION City of Menifee 29714 Haun Rd. Menifee, CA 92586 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 CHAEL HARTLEY/KARI ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) INS025 (201401) The ACORD name and logo are registered marks of ACORD AC�RL70 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 2/19/2019 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(les) 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 UUNTACT NAME: JANA CLARK HARTLEY CYLKE PACIFIC—#0574253 PHONE (619) 295-5155 FAX (619)291-0912 AIC o ! • 771AIC. Noy ADDRESS:jana@hcpacinsurance.com INSURANCE SERVICES, INC. 2747 UNIVERSITY AVENUE INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:UNITED SPECIALTY INSURANCE CO. SAN DIEGO CA 92104-4068 INSURED INSURER B: Nationwide Insurance Co. 23787 INSURERC:TOPA INSURANCE COMPANY L.C. Paving & Sealing, Inc. 330 Rancheros Drive #208 INSURER D: STARNET INSURANCE COMPANY INSURER E INSURER F: San Marcos CA 92069 COVERAGES CERTIFICATE NUMBER:19/20 ALL COVERAGES; 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. �INSR LTR TYPE OF INSURANCE ADDL SUOR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [i] OCCUR EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ so, 000 MED EXP(Any one person) $ 5,000 X ATNSF1924018 2/18/2019 2/18/2020 PERSONAL & ADV INJURY $ 1,000,000 GENIAGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $ 2,000,000 X POLICY JEa LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Es acclden! $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X ACP7803877894 2/18/2019 2/18/2020 BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS COMP DED: $250 PROPERTY DAMAGE Faracdde I $ Medlcel payments $ 5,000 COLL DED: $500 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 HCLAIMS-MADE AGGREGATE $ 4,000,000 C EXCESS LIAB DED I RETENTION $ $ XL0020024202 2/18/2019 2/18/2020 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X H- STATUTE ER E.L. EACH ACCIDENT $ 11000,000 D ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) NIA BNUWC0138038 9/12/2018 9/12/2019 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below I I I B COMMERCIAL PROPERTY ACP7803877894 2/18/2019 2/18/2020 BPP:$16,200.00 DED: $500 INLAND MARINE LEASED/RENTED EQUIPMENT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) City of Menifee and its elected officials, officers, employees, agents, representatives, consultants, contract employees and voluteers are hearby added as additional insured but only as respects work done by, for, or on behalf of the named insured. *10 day notice of cancellation for non-payment of premium shall apply. RE: CIP No. 15-05, Holland Road Missing Sidewalk CERTIFICATE HOLDER CANCELLATION City of Menifee 29714 Haun Rd. Menifee, CA 92586 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 ICHAEL HARTLEY/KARI 19RR ni& A{'nRn r0RP0RATInN All rinints racarvad ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) A� Rpm CERTIFICATE OF LIABILITY INSURANCE ) FDA2E19/2I 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 UONTAUT JANA CLARK !NAME: HARTLEY CYLKE PACIFIC—#0574253 PHONE (619) 295-5155 A/C No; (619)291-0912 INSURANCE SERVICES, INC. h-MAiL5:7ana@hcpacinsurance.com ADDRES 2747 UNIVERSITY AVENUE INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:UNITED SPECIALTY INSURANCE CO. SAN DIEGO CA 92104-4068 INSURED INSURER B: Nationwide Insurance Co. 23787 L.C. Paving & Sealing, Inc. INSURERC:TOPA INSURANCE COMPANY 330 Rancheros Drive #208 INSURER D: STARNET INSURANCE COMPANY INSURER E: San Marcos CA 92069 INSURER F: COVERAGES CERTIFICATE NUMBER:19/20 ALL COVERAGES; 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. IiLTSR RWk TYPE OF INSURANCE L POLICY NUMBER MMIDDY/YYYY EXP MMIDDY /YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 A CLAIMS -MADE � OCCUR MED EXP (Any one person) $ 5,000 X ATNSF1924018 2/18/2019 2/18/2020 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 X PRO- POLICY JECT LOC PRODUCTS -COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLELIMIT Ea aant ccM $ 1,000,000 BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS ACP7803877894 2/18/2019 2/18/2020 BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS COMP DED: $250 PROPERTYDAMAGE Per aoddeni $ 'I Medical payments $ 5,000 COLL DED; $500 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 C EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ XL0020024202 2/18/2019 2/18/2020 WORKERS COMPENSATION - X VERIM AND EMPLOYERS' LIABILITY Y / N STATUTE E L EACH ACCIDENT $ 11000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE D OFFICER/MEMBER EXCLUDED? ❑ N / A E L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) BNUWC0138038 9/12/201B 9/12/2019 If yes, describe under E. L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below B COMMERCIAL PROPERTY ACP7803B77894 2/18/2019 2/18/2020 BPP: $16,200.00 DED: $500 INLAND MARINE LEASEDIRENTED EQUIPMENT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Menifee and its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers are hearby added as additional insured but only as respects work done by, for, or on behalf of the named insured. *10 day notice of cancellation for non-payment of premium shall apply. RE: PW 17-02 ON CALL CONCRETE MAINTENANCE SERVICES CERTIFICATE HOLDER CANCELLATION City of Menifee 29714 Haun Rd. Menifee, CA 92586 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 CHAEL HARTLEY/KARI IJ 19BB-2014 rye'/ rinhtq rpSprvprl ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) �Ce DATE(MMIDD/YYYY) 161�CC CERTIFICATE OF LIABILITY INSURANCE 2/19/2019 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 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 CUNTACT JANA CLARK NAME: HARTLEY CYLKE PACIFIC-#0574253 PHONE (619) 295-5155 FAX (619)291-0912 C E 1 ' iAIC, N.: INSURANCE SERVICES, INC. F-MAILS:jana@hcpacinsurance.com ADDRES 2747 UNIVERSITY AVENUE INSURER(S) AFFORDING COVERAGE 1 NAIC # SAN DIEGO CA 92104-4068 INSURERA:UNITED SPECIALTY INSURANCE CO. INSURED INSURER B: Nationwide Insurance Co. 123787 L.C. Paving & Sealing, Inc. INSURERC:TOPA INSURANCE COMPANY 330 Rancheros Drive #208 INSURER D: STARNET INSURANCE COMPANY INSURER E : San Marcos CA 92069 INSURER F: COVERAGES CERTIFICATE NUMRFR-19/20 ALL COVERAGES; RFVIRInNI NIIMRFR• 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. LTR TYPE OF INSURANCE POLICY NUMBER MMIDDYIYYYY EXP MM/DDY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ 1,000,000 PREMISES Eaoccurresus $ 50,000 MED EXP (Any one person) $ 5,000 X ATNSF1924018 2/18/2019 2/18/2020 PERSONAL & ADV INJURY $ 1, 000,000 GENL AGGREGATE LIMIT APPLIES PER: X POLICY 71 Pella LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SIMILELIMIT Ea acddent $ 1,000,000 X BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X 1117803877894 2/18/2019 2/18/2020 BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS COMP DED: $250 PROPERTY DAMAGE Peracclden4 $ Medical payments $ 5,000 COLL DED: $500 X UMBRELLA LIAB OCCUR HCLAIMS-MADE EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 C EXCESS LIAB DIED I I RETENTION $ $ XL0020024202 2/18/2019 2/18/2020 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YI N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) IN A BNMC0138038 9/12/2018 9/12/2019 - X STATUTE ER E L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE $ 11000,000 If yes, describe under E.L DISEASE -POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS below B COMMERCIAL PROPERTY ACP7B03B77894 2/18/2019 2/18/2020 BPP:$16,200.00 DED: $500 INLAND MARINE LEASED/RENTED EQUIPMENT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) City of Menifee and its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers are hearby added as additional insured but only as respects work done by, for, or on behalf of the named insured. *10 day notice of cancellation for non-payment of premium shall apply. RE: CIP No. 18-06 & Newport Road and Menifee Road Street Improvements project CERTIFICATE HOLDER CANCELLATION City of Menifee 29714 Haun Road Menifee, CA 92586 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 CHAEL HARTLEY/KARI X� TIC)N_ All rinhts rpsprvprl ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD ) 2 19 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 NAME: r JANA CLARK HARTLEY CYLKE PACIFIC-#0574253 PAHONNIGE (619)295-5155 "AX C He: (619)291-0912 INSURANCE SERVICES, INC. A -MAIL S:Jana@hcpacinsurance.com 2747 UNIVERSITY AVENUE INSURERIS AFFORDING COVERAGE NAIC # SAN DIEGO CA 92104-4068 INSURERA:UNITED SPECIALTY INSURANCE CO. INSURED INSURER B: Nationwide Insurance Co. 23787 L.C. Paving & Sealing, Inc. INSURERC:TOPA INSURANCE COMPANY 330 Rancheros Drive #208 INSURER D: STARNET INSURANCE COMPANY INSURER E: San Marcos CA 92069 INSURERF: COVERAGES CERTIFICATE NUMBER:19/20 ALL COVERAGES; 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 IINSR LTR TYPE OF INSURANCE ADDL SURR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 157MAGE TO RENT Er7 PREMISES Ea occurrence $ 50,000 A CLAIMS -MADE ❑X OCCUR MED EXP (Any one person) $ 5,000 X ATNSF1924018 2/18/2019 2/18/2020 PERSONAL & ADV INJURY $ 1,000,000 GENIAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ ❑ JPERCOT LOC PRODUCTS $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea aoddom $ 1,000,000 X BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X ACP7803871894 2/18/2019 2/18/2020 BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS COMP DED: $250 ZOPIdl16 AMAGE Per apcidanf $ Medical payments $ 5,000 COLL DED: $500 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 C EXCESSLIAB CLAIMS -MADE DED RETENTION $ $ XL0020024202 2/18/2019 2/18/2020 WORKERS COMPENSATION X PER AND EMPLOYERS' LIABILITY YIN STATUTE ER E L EACH ACCIDENT $ 11000,000 ANY PROPRIETOR/PARTNERIEXECUTIVE D OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) ENUWC013803B 9/12/2018 9/12/2019 If yes, describe under E L DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below B COMMERCIAL PROPERTY ACP7803B77894 2/18/2019 2/18/2020 BPP: $16,200 00 DED: $500 INLAND MARINE LEASEDIRENTED EQUIPMENT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Menifee and its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers are hearby added as additional insured but only as respects work done by, for, or on behalf of the named insured. *10 day notice of cancellation for non-payment of premium shall apply. RE: Sun City Blvd. ADA Improvements - CIP 18-04 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 29714 Haun Road ACCORDANCE WITH THE POLICY PROVISIONS. Menifee, CA 92586 AUTHORIZED REPRESENTATIVE MICHAEL HARTLEY/KARI $d ©1988-2014 ACORD CORPORATION. All rights reser ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) TE CERTIFICATE OF LIABILITY INSURANCE DA2E19/20 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 NAME; JANA CLARK HARTLEY CYLKE PACIFIC—#0574253 PHONE (619) 295-5155 FAX (619)291-0912 E N t MCNoI ADDRESS: Jana@hcpacinsurance.com INSURANCE SERVICES, INC. 2747 UNIVERSITY AVENUE INSURER(S) AFFORDING COVERAGE NAIC # SAN DIEGO CA 92104-4068 INSURERA:UNITED SPECIALTY INSURANCE CO. INSURED INSURER B: Nationwide Insurance Co. 23787 L.C. Paving & Sealing, Inc. INSURERC:TOPA INSURANCE COMPANY 330 Rancheros Drive #208 INSURER D: STARNET INSURANCE COMPANY INSURER E : San Marcos CA 92069 _ INSURERF: COVERAGES CERTIFICATE NUMBER:19/20 ALL COVERAGES; 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. INSR LTR TYPE OF INSURANCE � L SUER POLICY NUMBER EFF MMJDDYNYYY EXP MMIDDYIYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGETORENTED PREMISES Ea occurrence $ 50,000 A CLAIMS -MADE OCCUR MED EXP (Any one person) $ 5,000 X ATNSF192401B 2/18/2019 2/1B/2020 PERSONAL & ADV INJURY $ 1,000,000 GENI AGGREGATE LIMIT APPLIES PER: X POLICY JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY rOMSINLELIMIT Ea accident)$ 1,000,000 X BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X ACP7803877894 2/18/2019 2/18/2020 BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS COMP DED: $250 PROPERTY DAMAGE Per a .dden4 $ Medical payments $ 5,000 LOLL DED: $500 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 [J AGGREGATE $ 4,000,000 C EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ .0020024202 2/18/2019 2/18/2020 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N X I..PSTEARTUTE I ER E.L. EACH ACCIDENT $ 1,000,000 D ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ /M OFFICEREMBER EXCLUDED? (Mandatory In NH) If yes, describe under N / A BNUWC013603B 9/12/2018 9/12/2019 El DISEASE -EA EMPLOYEE $ 1,000,000 E L. DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS below B COMMERCIAL PROPERTY ACP7803877894 2/18/2019 2/18/2020 BPP:$16,200.00 DED: $500 INLAND MARINE LEASEDIRENTED EQUIPMENT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of Menifee and its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers are hearby added as additional insured but only as respects work done by, for, or on behalf of the named insured. *10 day notice of cancellation for non-payment of premium shall apply. RE: CIP 18-04 - Sun City ADA CERTIFICATE HOLDER CANCELLATION City of Menifee 29714 Haun Road Menifee, CA 92586 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 ICHAEL HARTLEY/KAKI © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) INS025 (201401) The ACORD name and logo are registered marks of ACORD