2019/01/16 Valley Pipeline Services, Inc. Certificate of Liability Insurance (5)_ 1 ®
ACORO CERTIFICATE OF LIABILITY INSURANCE
`�.
DATE (MMIDDIYYYY)
12I03I2019
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 �i:
Temecula Insurance Services Ci�� 0' E
@fi ••
NAME: rlITAOI Cynthia Cadenhead
PHONE (951) 694-5200 x (951) 302-0470
AIC No Ex A,.,,):
ApoRIESS: Cynthia@temeculainsuranceservices.com
41923 Second Street �@a
Suite 201 E� :.9 +1
INSURER(S) AFFORDING COVERAGE
NAIC#
INSURER A : Kinsale Insurance Company14027
Temecula `jt� CA 92590
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INSURED [[}} rr
INSURER B : WestAmerican Insurance Company
44393
INSURER C : State Compensation Ins. Fund
35076
Valley Pipeline Services, Tric L 111JJJ
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INSURER D : Ohio Security Insurance Company
24082
47-110 Washington St
INSURER E :
Ste. 201
INSURER F:
La Quinta CA 92253
COVERAGES CERTIFICATE NUMBER: CL1911002254 REVISION NUMBER:
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.
INSIR
LTR
TYPE OF INSURANCE
I
p
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY X
MMIDD/YYVY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE � OCCUR
PREMISES JEa occurrence
$ 100,000
MED EXP (Any oneperson)
$ Excluded
PERSONAL &ADV INJURY
$ 1,000,000
A
Y
0100049221-2
03/31/2019
03/31/2020
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 21000,000
PRODUCTS-COMP/OPAGG
$ 2,000,000
POLICY F PRO ❑ LOC
JECT
Deductible
$ 5,000
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accldenl
$ 1,000.000
BODILY INJURY (Per person)
$
ANYAUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
BAW56619091
12/06/2019
12/05/2020
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accldaM
$
Deductible
$ 1,000
UMBRELLA LAB
X
OCCUR
EACH OCCURRENCE
$ 2,000,000
x
AGGREGATE
$ 2,000,000
A
EXCESS LIAB
CLAIMS -MADE
0100049292-2
03/31/2019
03/31/2020
DED RETENTION $
Deductible
$ 0
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE �
OFFICER/MEMBER EXCLUDED?
(M andatory in NH)
NIA
9086042
01/16/2019
01/16/2020
X STATUTE ER
EL EACH ACCIDENT
$ 1,000,000
E. L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
S 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
Scheduled Limit
1,111,353
D
Contractors EquipmenGBPP
Deductible $1,000
BKS56619091
03/31/2019
03/31/2020
Rent/Leased Equipment
$300,000
BPP Limit
$28,136
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re Project: Menifee Elementary School #14
Derby Hill Drive & Stagecoach Read
Menifee, CA 92596.
City of Menifee and it's elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers are hereby added as
additional insures but only as respects work done by, for, or on behalf of the named insured. The Umbrella Liability follows the General Liability and Auto
Liability.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Menifee ACCORDANCE WITH THE POLICY PROVISIONS.
29714 Haun Road
AUTHORIZED REPRESENTATIVE
Menifee CA 92586
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD