2018/02/20 Integrated Project Services, Inc. Certificate of Liability InsuranceACCOR& CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
11 /30/2018
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 Cora Lim
NAME!
SelectSolutions Insurance Services
PHONN (866) 500-6359 F (925) 951-0077
Tt VX
c Nc :
1107 Investment Blvd
ADDR1ESS,. coral@selectsolutionsins.com
Suite 100
INSURER(S) AFFORDING COVERAGE
NAIC #
El Dorado Hills CA 95762
INSURERA: Beazley Insurance Company, Inc.
37540
INSURED
INSURER B
Integrated Project Services, Inc., DBA: Pettit
INSURER C:
1787 Pomona Road, Suites D & E
INSURER D :
INSURER E :
Corona CA 92880
INSURER F
COVERAGES CERTIFICATE NUMBER: CL1821225694 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.
LTR
TYPE OF INSURANCE
NSD
WVD
POLICY NUMBER
O 1CICY
MMIDD
L EXP
MM/DD
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
PREMISES Ea occurrence
$
CLAIMS -MADE 0 OCCUR
MED EXP (Any one person)
$
PERSONAL& ADV INJURY
$
GEN'L AGGREGATE LIMITAPPLIES PER:
PRO-
POLICY ❑ JECT LOC
GENERALAGGREGATE
$
PRODUCTS-COMP/OPAGG
$
$
OTHFR:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accWenl
$
BODILY INJURY (Per person)
$
ANY AUTO
OWNEDAUTOS ONLY AUTOS SCHEDULED
BODILY INJURY (Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
HUMBRELLA
PROPERTY DAMAGE
Per accident
$
LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB IH
CLAIMS -MADE
DE I RETENTION $
$
WORKERS COMPENSATION
PER OTH-
AND EMPLOYERS' LIABILITY y / N
STATUTE ER
E.L. EACH ACCIDENT
$
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
NIA
E.L DISEASE - EA EMPLOYEE
$
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS below
PROFESSIONAL LIABILITY
A
V15RDP181201
02/20/2018
02/20/2019
PER CLAIM
$1,000,000
AGGREGATE
$2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
Re: As Per Contract or Agreement on File with the Insured.
Professional Liability contain a 30 day notice provision for cancellation/non-renewal endorsement to follow from
carrier.
liGr� l Ir IV/'11 G rl VLLJCR
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 Rd.
AUTHORIZED REPRESENTATIVE
Menifee CA 92586 ;— 0—
v 1988-2075 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
Effective date of this Endorsement: 30-Nov-2018
This Endorsement is attached to and forms a part of Policy Number: V15RDP181201
Beazley Insurance Company, Inc. Referred to in this endorsement as either the "Insurer" or the
"Underwriters"
NOTICE OF CANCELLATION TO CERTIFICATE HOLDER
This endorsement modifies insurance provided under the following:
AFB A&E MEDIA TECH@ POLICY
In consideration of the premium charged for the Policy, it is hereby understood and agreed that in addition
to the provisions of Clause XVI. CANCELLATION AND NONRENEWAL B., if this policy is cancelled by
the Underwriters, other than for non-payment of premium, the Underwriters will provide 30 days
written notice to the following party(ies):
City of Corona
Public Works Department
400 S Vicentia Avenue
Corona, CA 92882
City of Corona
Department of Water & Power
755 Corporation Yard Way
Corona, CA 92882
City of Corona
400 S Vicentia Avnue
Corona, CA 92882
City of Menifee
29714 Haun Road.
Menifee, CA 92586
All other terms and conditions of this Policy remain unchanged.
r
Authoriz6d Representative
E01414 Page 1 of 1
082009 ed.