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2019/09/15 Superior Ready Mix Concrete, LP Certificate of Liability InsuranceANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD SUPER-1 OP ID: ED 01/08/2020 Jack Brouwer, CIC Brouwer Insurance Agency License # 0454226 725 E. Valley Parkway Escondido, CA 92025 Jack Brouwer, CIC 760-745-5151 760-741-9308 Tokio Marine America Insurance Safety National Casualty Corp. Superior Ready Mix Concrete, L.P. 1508 W. Mission Road Escondido, CA 92029 National Fire and Marine A X 1,000,000 X X X GLD6404241-09 09/15/2019 09/15/2020 100,000 5,000 1,000,000 2,000,000 X 2,000,000 100,000 2,000,000A X CAD6404239-09 09/15/2019 09/15/2020 X X XX 4,000,000C 42-UMO-302903-04 09/15/2019 09/15/2020 4,000,000 XB SP 4061506 11/01/2019 11/01/2020 1,000,000 EMPLOYERS LIABILITY ONLY 1,000,000 1,000,000 Re: TBD The City of Menifee and its officers, employees, agents and authorized volunteers are named as additional insured per attached endorsements >>>>>>>>>>>>>>>>see next page>>>>>>>>>>>>> CITY-04 City of Menifee 29844 Haun Road Menifee, CA 92586 760-745-5151 10945 15105 20079 Ded Date HOLDER CODE INSURED'S NAME PAGENOTEPAD: Re: TBD The City of Menifee and its officers, employees, agents and authorized volunteers are named as additional insured per attached endorsements CG 2010 04 13 Additional insured Owners Lessees or Contractors CG 3027 04 13 Additional insure Products Completed Operations CA9 04 004 10 06 Auto liability additional insured CG 20 01 04 13 Primary Non Contributory Endorsement CA 00 01 03 10 Auto liability primary CG 2404 05 09 Waiver of subrogation general liability Certificate of consent to self insure Letter of waiver of subrogation provided by insured workers compensation CITY-04 2 Superior Ready Mix 01/08/2020 SUPER-1 OP ID: ED Policy # CAD6404239-09 Policy Number: GLD6404241-09 Policy # CAD6404239-09