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2018/03/18 T Maus Grading & Paving, Inc. Certificate of Liability InsuranceP5201[e21AN12 ACp1LIPI3 DATE CERTIFICATE OF LIABILITY INSURANCE I 01/0 M/2019 Y) L 1 f/oa/o19 1 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 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 LIC #011179377 1-949-222-0444 CONTACT ISO Insurance Services - ERM Insurance Brokers NAME: (BI.C.No.Ex* 949-222-0444 FAC 949-222-0445 E•MA" 3000 W. MacArthur Blvd., Suite #120 AOORESS: _ INSURERS AFFORDING COVERAGE NAIC # Santa Ana, CA 92704 INSURERA: COLONY INS CO 39993 INSURED INSURER B: EMPLOYERS MUT CAS CO 21415 T Maus Grading & Paving, Inc. INSURER C: NATIONAL UNION FIRE INS CO OF PITTS 19445 31900 Mission Trail #205 INSURERD: Falls.Lake Fire & Casualty Co 15884 INSURER E : Lake Elsinore, CA 92530 INSURER F: ' COVERAGES CERTIFICATE Nl1MRFR* 55037433 RFVISIAN NIIu112F112• 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 A-ou SITBR POLECY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVO POLICY NUMBER 111111KITIDATM (MMMOWAY1 LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X X 103 GL 0023229-00 04/15/18 04/15/19 EACHOCCURRENCE 'bAW&FTO RENTS PREMISES IE,I $ 1,000,000 $ 100,000 X MED EXP (Any oneperson) $ 5,000 Deductible $5, 000 PERSONAL & ADV INJURY $ 1,000,000 POLICY JET LOC F1GEN'POLICY GATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY 5ES0189 12/15/18 12/15/19 COMBINED IN ELIMIT (Ea Wgjal)$ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( 1 $ NON -OWNED HIRED AUTOS AUTOS P9b0ERTY DAMAGE celden $ $ C UMBRELLA LIAB X OCCUR BE069966380 06/14/18 04/05/19 EACHOCCURRENCE S 2,000,000 AGGREGATE $ 2,000,000 X EXCESS LIAR CLAIMS -MADE $ DED RETENTION D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I k ANY PROPRIETOR/PARTNERIEXECUTIVE � OFFICER/MEMBER EXCLUDED? N / A FLA00868a-00 03/18/1e 03/18/19 X PER 7 ER $ 1,000,000 - EL EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS belowI DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) The certificate holder is additional insured per CG2010 0704/CG2037 0704; general liability waiver of subrogation per CG 2404 0509; primary/non-contributory wording per CG2001 0413 I,Ar1L r_LLA1IUM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 29714 Haun Rd. AUTHORIZED REPRESENTATIVE Menifee, CA 92586 — I USA -• 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Debraerm 55037433 P52"12191U2 ISU Insurance Services - ERM Insurance Brokers 3000 W. MacArthur Blvd., Suite # 120 Santa Ana, CA 92704 Electronic Service Requested ALL FOR AADC 923 1568 0.9555 AB 0.405 ulu�llilhlllllll�li�u��llllilul�llr�l��l�rluhl�ll�,lil Cityy of Menifee 6 29714 HAUN RD MENIFEE, CA 92566-6540 EBIX BPO This document was brought to you by CertificatesNow. - If you have questions regarding the content of this document, please contact - the Producer/Agent listed on the certificate of insurance or the Insured listed - on the notice of cancellation/reinstatement.- To find out how you can send and receive all of your certificates of insurance - either by email, high speed fax or standard mail, email customer.caretslebix.com- or visit our website at www.confirmnet.cem:- cc: The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. 0, 0 z w Certificate Delivery by CertificatesNow - www.ConfirmNot.com - 877.669.6600 Policy Number: 103 GL 0023229-00 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ- z lons : Locations Of Covered Operations As required by written contract ecuted prior to the date of Construction project sites at which you performed occurrence but only to the extent work for such additional insured. permitted by law and 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. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I 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. 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 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 0 00 z w Policy Number: 103 GL 0023229-00 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of 1 0 00 w