The URL can be used to link to this page

2019/10/01 Robertson's Ready Mix, Ltd. Certificate of Liability Insurancer� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 09/25/2019 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 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 Marsh Risk & Insurance Services CA License #0437153 633 W. Fifth Street, Suite 1200 Los Angeles, CA 90071 Attn: E: LosAngeles certrequest@marsh.com1F:212 948.0535 CN 103156079-RRM-GA-19-20 INSURED Robertson's Ready Mix Ltd. Robertson's Transport, Ltd. 200 S Main Street Corona, CA 92882-2212 COVERAGES CERTIFICATE NUMBER: America Ins. Co. INSURER E: INSURER F : LOS-002259077-18 REVISION NUMBER: 4 10945 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. LN8R CY EFF POLICY EXP TYPE OF INSURANCE ADDL BR POLICY NUMBER MMLdofYYYY MM DVfyY y LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I " I OCCUR GLS 6407783-05 10/01/2019 10/0112020 EACH OCCURRENCE $ 1,000,000 PREMISES a $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 SIR Value $ 100.000 A AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY CAS6407782-05 10/01/2019 10/01/2020 COMBINED SINGLE LIMIT Ea accident) $ 2,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE ecGden! $ SIR Value: $ 500,000 UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE r��--ry:--t� OFFICER/MEMBER EXCLUDED? DI (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- STATUTE I ER E-L EACH ACCIDENT $ EL DISEASE -EA EMPLOYE $ E L" DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Workers Compensation I Employers' Liability is Self -Insured per attached certificate issued by the State of California CERTIFICATE HOLDER 1;ItydfMeffifee, 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 of Marsh Risk & Insurance Services Lutti Smith ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD STATE OF CALIFQRNIA Edmund G. Brown Jr., Governor DEPARTMENT OF INDUSTRIAL RELATIONS OFFICE OF SELF-INSURANCE PLANS 11050 Olson Drive, Suite 230 , Rancho Cordova,CA 95670 Phone No. (916) 464-7000 FAX (916) 464-7007 CERTIFICATION OF SELF-INSURANCE OF WORKERS' COMPENSATION TO WHOM IT MAY CONCERN: This certifies that Certificate of Consent to Self -Insure No. 2173 was. issued by the Director of Industrial Relations to: Robertson's Ready Mix, Ltd. under the provisions of Section 3700, Labor Code of California with an effective date of December 1, 1991. The certificate is currently in full force and effective. Dated at Sacramento, California This day the 30th of October 2017 Lyn Asio Booz, Chief ORIG: Steven Walthers Robertson'S Ready Mix, Ltd. 200 South Main Street, Ste 200 Corona, Ca 92882-2212 STATE OF GALIFORNIA Edmund G. Brown Jr., Governor DEPARTMENT OF INDUSTRIAL RELATIONS OFFICE OF SELF-INSURANCE PLANS 11050 Olson Drive, Suite 230 Rancho Cordova,CA 95670 Phone No. (91 G) 464-7000 FAX (91 6) 464-7007 CERTIFICATION OF SELF-INSURANCE OF WORKERS' COMPENSATION TO WHOM 1T MAY CONCERN: This certifies that Certificate of Consent to Self -Insure No. 2173-ZB was issued by the Director of Industrial Relations to: Robertson's Transport, Ltd. under the provisions of Section 3700, Labor Code of California with an effective date of October 1, 2002. The certificate is currently in full force and effective. Dated at Sacramento, California This day the 30th of October 2017. Lyn Asio Booz, Chief ORIG: Steven Walthers Robertson'S Ready Mix, Ltd. 200 South Main Street, Ste 200 Corona, Ca 92882-2212