2021/05/01 Cal West Underground, Inc. Certificate of Liability Insurancepage 2 of 2
Client#: 1265801 305CALWES
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY)
4/29/209/2021
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(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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER NA E: Sonia Morris
McGriff Insurance Services PHONE rAX
(wc, No, ExtL714-941-2900 F ;A/c, Noy
2400 E Katella Ave Suite 1100 noD 140.E sonla.morrise.mcgYlff cpm
Anaheim, CA 92806 - - f -
714 941-2800 INSURER(S) AFFORDING COVERAGE NAIC #
_ INSURER A: Travelers Property Casualty Co of Amer :25674
INSURED
INSURER R
Cal West Underground Inc.
P.O. Box 6286
Norco, CA 92860
COVERAGES
CERTIFICATE NUMBER:
INSURER C :
INSURER D:
INSURER E :
INSURER F
RFVISIt)N 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.
ADDi.$Illmn
TYPE OF INSURANCE INSR •WVO
COMMERCIAL GENERAL LIABILITY
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICYEFF POL[CYEXP
POLICY NUMBER _ (MM/DD/YYYY� ilA1W{1WYYYY],. _ _ _ LIMITS
EACH OCCURRENCE $
1NSR
LTR
CLAIMS -MADE 71 OCCUR
p5�Eau
$
MED EXP (Any one person)
$
_
PERSONAL & ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
FI
POLICY Ll JECT LOC
PRODUCTS - COMP/OP AGG
$
u
OTHER;
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
jp_%Q�
$
ANY AUTO
BODILY INJURY (Per person)
$
OWNED SCHEDULED
AUTOSONLY AUTOS
BODILY INJURY (Per accident)
$
HIRED NON -OWNED
PROPERTY DAMAGE
$
AUTOS ONLY AUTOS ONLY
„(Per accid. ,
$
UMBRELLA LIAB
OCCUR
HCLAIMS-MADE
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
J- RETENTION $
$
A
WORKERS COMPENSATION
UB6N3228492126G
D5/01/2021 05/01/2022
X IPER OTH-
AND EMPLOYRAW LIABILITY Y / N
E.L. EACH ACCIDENT
$.1 000 000
ANY PROPRIETOWPARTINCR/EXECUTIVE
OF FICERJM EMS ER EXCLUDED?
N / A
E.L. DISEASE - EA EMPLOYEE
$1. 00),000
(Mandal" In NH)
If yes, describe under
E.L. DISEASE- POLICY LIMIT
-"
$1 000 000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required)
This certificate is for the work comp renewal
only. All other coverages, certificates and forms will be
issued once those renew in August.
Evidence of Coverage.
L:LH.I I)-'IUA I t HOLLIEH CANCELLAT(ON
City of Menifee
29714 Haun Rd
Sun City, 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
ACORD 25 (2016/03) 1 of 1
8729 #S27850533/M27849699
01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SOMOR
EN.
page 1 of 2
05/03/2021
McGriff Insurance Services
PO Box 819
Wilson NC 27894-0819
5400 H
City of Menifee
29714 Haun Rd
Sun City, CA 92586
V28