Loading...
2019/12/01 R I C Construction Co. Inc. Certificate of Liability Insurance (3) r 7 DATE(MMIDD/YYYY) ,alco�a� CERTIFICATE OF LIABILITY INSURANCE 121312019 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 Patriot Risk& Insurance Services r+A_tE: 2415 Campus Drive, Suite#200 WANENo. 949. 486-7900 FAX N 949 486 7950 Irvine, CA 92612 E-MAIL INSURER(S)AFFORDING COVERAGE _ NAIC# www.patrisk.com OK07568 JNSURERA: Middlesex Insurance Company 23434 INSURED INSURER B: R I C Construction Co. Inc. 10675 E Avenue, Suite#1 INSURERC; Hesperia CA 92345 INSURERD: INSURER E; INSURER F: COVERAGES CERTIFICATE NUMBER: 52691730 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. _ MSR LTR TYPE OF INSURANCE ADDL$ VD POLICY NUMBER MMIDOPoucy EFF MMtD Y�Y LIMITS A VCOMMERCIAL GENERAL LIABILITY �/ A0114746004 12/1/2019 12/1/2020 EACH OCCURRENCE $] 00 000 CLAIMS-MADE OCCUR P emilSES{ r - $500000 MED EXP(Any oneperson) $5 000 PERSONAL&ADV INJURY $1 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY E]SECT LOC PRODUCTS-COMP/OP AGG $3 00O 000 OTHER: Em to ee Benfits 1,000,000 A AUTOMOBILE LIABILITY A0114746001 12/1/2019 12/1/2020 (FAAhn $1000000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY P A UMBRELLA LIAB OCCUR A0114746006 12/1/2019 12/1/2020 EACH OCCURRENCE $5000000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5 000 000 DED I I RETENTION $ A WORKERS COMPENSATION A0114746005 12/1/2019 12/1/2020 PER OTH- AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE � EL.EACH ACCIDENT $1 000 000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) EL.DISEASE-EA EMPLOYEE $ If yes,des�be under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $1 000 000 A (Leased/Rented&Contractors Eqpt A0114746003 12/1/2019 12/1/2020 Contractor's Equipment:$1,404,917 Leased/Rented Equipment:$50,000 Deductible:$2,500 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) City of Menifee and its elected officials,officers,employers,agents,representatives,consultants,contract employees and volunteers are named as additional insured with respecls to General Liability on a primary and noncontributory basis per attached endorsement and named insured with respects to Auto Liability per attached endorsement. Waiver of Subrogatinns apply to General Liability,Auto Liability and Workers Compensation per attached endorsements. 30 days notice of cancellation,10 days for non-payment of premium. 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 Attn:Gina Gonzalez, Project Manager ACCORDANCE WITH THE POLICY PROVISIONS. Cityy Hall 26"M Haun Road AUTHORIZED REPRESENTATIVE Menifee CA 92586 Dave Jacobson ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 730 119/20 GLAD/UHB/WC/IM J AMOUe Romero i 1c/:1/2019 9:04:52 AM I .+.,ye 1 of 5 ':"his certificate cancels and euperaedea ALL previously issued certificates. R I C Construction Co.Inc. POLICY NUMBER: Ao114746004 COMMERCIAL GENERAL LIABILITY CG20370413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ R 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) Location And Description Of Completed Or Organization(s) Operations 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 B. With respect to the insurance afforded to these include as an addltional Insured the person(s) or additional insureds, the following Is added to organization(s) shown in the Schedule, but only Section III-Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage"caused,in whole or In part, by required by a contract or agreement, the most we your work at the location designated and will pay on behalf of the additional Insured is the described In the Schedule of this endorsement amount of insurance: performed for that additional insured and Included In the"products-completed operations hazard". 1. Required by the contract or agreement;or However. 2. Available under the applicable Limits of 1. The insurance afforded to such additional Insurance shown In the Declarations; whichever is less. Insured only applies to the extent permitted by law;and This endorsement shall not Increase the 2. If coverage provided to the additional insured applicable Limits of Insurance shown in the Is required by a contract or agreement, the Declarations. 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 0413 ®Insurance Services Office, Inc.,2012 Page 1 of 1 52691730 1 19�20 GLAU/UMB/WC/IM I AnaerLe Romero 1 12/7/2019 9:04:52 AM IPST) I Page 2 of 5 This certificate cancels and supersedes ALL previously issued certi ScBtes. POLICY NUMBER: AOI I4746001 COMMERCIAL AUTO CA 76 010615 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED - PRIMARY AND NONCONTRIBUTORY - COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM With reaped to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s)or organizadon(s)who are"insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage iForm. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated. Named Insured:R I C Construction Co.Inc. Endorsement Effective Date: I2/01/20I9 SCHEDULE Name Of Person(s)Or Organization(s): Any person or organization you are required to add as an additional insured under a written contract or agreement In effect prior to any accident,injury,loss or damage. Information required to complete this Schedule,if not shown above,will be shown In the Declarations. A. Each person or organization shown in the B. Primary And Noncontributory Insurance Schedule is an "insured" for Covered Autos This insurance is primary to and will not seek Liability Coverage, but only to the extent that contribution from any other auto insurance issued person or organization qualifies as an "insured" to the person or organization in the schedule under the Who Is An Insured provision contained under your policy provided that: in: (1) Paragraph A.1. of Seaton II-Covered Autos (t) The person or organization is a Named Insured Liability Coverage in the Business Auto and under such other Insurance;and Motor Carrier Coverage Forms;or (2) Prior to the 'accident you have agreed in (2) Paragraph 0.2.of Section I - Covered Autos writing in a contract or agreement that this Coverages of the Auto Dealers Coverage insurance would be primary and would not seek contribution from any other insurance Form. available to the person or organization. CA 76 01 0615 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. 52691730 19120 GLAUJUMB/WC/IM Annette Romero 112/3/2019 9:01:52 AM {PST page 3 of 5 This certificate cancels and supersedes ALL previously issued certificates. POLICY NUMBER: AOI I4746001 COMMERCIAL AUTO CA04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is Indicated below. Named Insured: R I C Construction Co.Inc. Endorsement Effective Date: I2/01/2019 SCHEDULE Name(s)Of Person(s)Or Organization(s): Any person or organization you are required to add as an additional Insured under a written contract or agreement In effect prior to any acclden%Injury,loss or damage. Information required to complete this Schedule,if not shown above,will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person(s)or organizations) shown In the Schedule, but only to the extent that subrogation is waived prior to the"accident"or the"loss"under a contract with that person or organization. CA 04 441013 0 Insurance Services Office, Inc.,2011 Page 1 of 1 52"2 730 19/20 GLAU/UMB/WC/IM Annette RfWearo �12/3/2019 9:04:52 AM 1?9V page 4 of 5 This certificate cancels an supersedes AL previously issued certificates. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule.(This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly,or indirectly to benefit anyone not.,named in the Schedule. 'Schedule Name Any person or organization from whom you are required to waive your right to recover under a written contract or agreement in effect prior to any loss or damage Address: 10675 E Ave Ste 1 Hesperia, CA 92345-5120 Description of Waiver: Any person or organization from whom you are required to aive your right to recover under a written contract or agreement in effect prior to any loss or damage JobID: City of Menifee and its elected officials,officers,employers,agents,representatives,consultants,contract employees and volunteers This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.i Endorsement Effective 12/01/2019 Policy No. A011474600az,� 5 Endorsement No. Insured R I C Construction Co.Inc. Premitam Insurance Company Countersigned by Middlesex Insurance Company WC 00 03 13 (Ed.4-84) 0 1983 National Council on Compensation Insurance. Page 1 of 1 5269173a 19120 GLAU/(1Ma/WC/IM J Annette Bamero 12/3/2019 9:04:52 AM (PST) PaSe 5 of 5 This certificate cancels and supersedes ALL previously issued certificates.