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2021/04/20 Richard Lopez Construction, Inc.---111 AIC40R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 04/27/2021 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 endorsements . PRODUCER I Mg TACT Anaelica Jensen Baccarella Insurance Services, Inc. 3610 Central Ave. Suite #200 Riverside CA 92506- INSURED Richard Lopez Construction, Inc. Richard Lopez & Richard Lopez Constructi 250 E. Rincon, Suite 106 Corona CA 92879- FAX Angelica@bacins.com INSURER(SI AFFO IN C C INSURER A Kinsale Insurance Company 38920 COVERAGES CFRTIFICATF NIIMRFR• QFFWlQrnhr du IalIOCD. 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 TYPE OF INSURANCE Si) POLICY EFF Nam) LIMITS A X COMMERCIAL GENERAL LIABILITY X CLAIMS -MADE OCCUR Deductible: $5,000 X X 10100065568-3 )4/20/2021 04/20/2022 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 100,000 X MEDFXP jAny one arson S Excluded BI/PD/PI combined PERSONAL&ADVINJURY $ 1,000,000 GENLAGGR LIMIT APPLIES PER: POLICY�jECT D LOC GEN AGGREGATE $ 2,000,000 PRODUCTS - COMP/DPAGG $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Fa a-idi-0 $ BODILY INJURY (Per person) $ ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS $ BODILY INJURY Per accident) ( ) - HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per ar,FjQ,. _ $ A UMBRELLA LIAR X OCCUR 10100065572-3 04/20/2021 )4/20/2022 EACH OCCURRENCE $ 4,000,000 X EXCESS LIAB -MAD $ 4,000,000 -AGGREGATE S WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY'LITE ANY PROPRIETOR/PARTNER/EXECUTIVE_ OFFICERIMEMBER EXCLUDED? NIA E.L EACH i ACCIDENT E L DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, describe &gRAT)ONS below El DISEASE -PICY LIMIT DESCRIPTION OF OPrRATIONS I LOCATIONS I VEHICLES (ACORD 101, Addnivnzl RamarBS Schedulo, may be attached if more space is required) RE:. City of Menifee. its officers, employees and agents are hereby rim',ed as Additional Insured as their interest may appear. per blanket Al form #CG2010 1219 & CG2037 1219 for ongoing & completed operations. Insurance is Primary & non-contributory per form #CAS 5003 0717. Waiver applies per blanket form #CG 2453 1219. Forms attached. vcr• a wnrc rry cucrc L,ANt,tLLA I tVrV ni vitiaav City of Menifee 29714 Haun Road Menifee, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CA 92586- AUTHORIZED REPRESENTATIVE @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION Attached To and Forming Part of Policy 0100065568-3 Additional Premium: Effective Date of Endorsement . Named Insured 04/20/2021 12:01AM at the Named Insured Richard Lopez Construction Inc address shown on the Declarations Return Premium: $o I This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s) Location(s) of Covered Operations Blanket, as required by written contract, executed prior to Locations as required and specified by written contract, the start of work on the project. executed prior to the start of work on the project. 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the 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. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" 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. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS Attached To and Forming Part of Policy 0100065568-3 .I Additional Premium: $0 Effective Date of Endorsement 04/20/2021 12:01AM at the Named Insured address shown on the Declarations Return Premium: $o This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Named Insured Richard Lopez Construction Inc Name of Additional Insured Person(s) or Organization(s) Location and Description of Completed Operations Blanket, as required by written contract, executed prior to the start of work on the project. Locations as required and specified by written contract, executed prior to the start of work on the project. 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the 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. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100065568-3 04/20/2021 12:01AM at the Named Insured Richard Lopez Construction Inc address shown on the Declarations Additional Premium: Return Premium: $0 $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE ENVIRONMENTAL CONTRACTING AND PROFESSIONAL SERVICES LIABILITY COVERAGE PRODUCTS POLLUTION LIABILITY COVERAGE PREMISES ENVIRONMENTAL LIABILITY INSURANCE COVERAGE ENVIRONMENTAL COMBINED LIABILITY POLICY - ALL COVERAGE PARTS The insurance provided to Additional Insureds shall be excess with respect to any other valid and collectible insurance available to the Additional Insured unless the written contract specifically requires that this insurance apply on a primary and non-contributory basis, in which case this insurance shall be primary and non-contributory. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS5003 0717 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC Attached To and Forming Part of Policy i Effective Date of Endorsement Named Insured 0100065568-3 04/20/2021 12:01AM at the Named Insured Richard Lopez Construction Inc address shown on the Declarations Additional Premium: Return Premium.- 0 $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV— Conditions: We waive any right of recovery against any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to lass. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CG 24 53 12 19 0 Insurance Services Office, Inc, 2018 Page 1 of 1