2011/01/24 Dennis Janda, Inc. OP ID:VW
s►`��ry CERTIFICATE OF LIABILITY INSURANCE rw EddwO°IYYYY)
07/05/11
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: M the ceffcate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. R SUBROGATION M WANED, subject to
the terms and CondMlons of the polity, certain policies may require an endorsement. A statement on tbls certRl°ate does not confer rights to the
certificate holder In lieu of such andarsement s.
PRODUCER 951-676-2229
Skachota Insurance Agency Inc 951-676-7391 PIN. xo:
California License nN9673WSW
3500 Ridge Park Drive N203 ADOArae:
Temecula, CA 92590
Robert L.Hamm. c Tau JANDDEI
INSURHNa)AFFORDING COVERAGE .0
esu ED Dennis Janda Inc. NSIIRERA:Golden Eagle Insurance 10836
42164 Remington Avenue WILandmark American Ins Co
Temecula,CA 92590 wsuRBee:
IxsuREao:
IIRUIa:RE:
COVERAGES CERTIFICATE NUMBER: 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 REOUIREMENT, 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 CI MIS.
WeR IMLII III
TYPE OF INSURANCE pOLICINlIM6ER LIMIB
DENERALLwBI1lIY EACH OCCDFRENCE f 1,000,00
A % DadMEricwLCENERxuneam % CBP9927889 0126H7 01f1dH2 PREMISES Eamamrl�e a 100,00
CIAINB MACE a]OCCUR MEDE Amore FBI 1 5,00
PERSd aPOV NA S 1,000,00
IUsPP L..RE.ATE a Z000,04
GEHL.OGGPEWTE LIMITPN•t1E5PEA: HtCCVCr` OM`1CPMQ S 1,000,00
PIXICY PRo LOC f
AUTOMOBLEIYBIIIry X COMINEDSINGLE LIMIT
(Ee a<ne„nn f 1,000,00
A adr ALR1 BA8728887 11I08H0 11l06/17 DODILY WAY(P.0..) f
ALL MhTEDMRGe. BODILY lx Y(Per IOP I S
% BOBECLLEDAUI05 PROPEm DAMAGE
% HIREDA.RCS 1Pore 4r* $
x NONONPEDAl1I05 3
f
uMaIaELA LA. DccuR races OCCUPRENCE f
EXCEDIUM GPIMSuaCE AGQREBYB f
DEDUCTIBLE f
NTI
COMPENBATpN
ANDENPL4YErt9'LwBWIT TIN
ANY PRWREICPIPPRINE(dENECUINE ❑ NIA EL EACN ACCIDENT S
FFOBBMEER
(MmdeeenrinlH LUCFDp ELDISEIME-EADFfLOY f
II B9.tleeVllM WWr EL DISEASE-P0.ICYLIMIT
B ezr.n 18180 OSI08/ii 05108112Li1,000,
.I LiabilityDed: 10.00
DE9CRIPTDN OF OPERATIONSI L°CATON31 VEHICLES MWM ACOR°1.1,Adds.R—II,..dub Amore vpece B •q'v l,eJl
eriifcate Holder is an additional insured and Wintery with re.pecta to the
enerel Liability per the attached GECG 602(O>I.04)endorsement.Also an
dditional insured with respects to the Commercial Automobile.
CITYMEN
.MOULD MY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE PALL BE DELIVERED IN
CRY Dr Months ACCORDANCETNTH THE POLICY PROVISIONS.
29714 Haw Rd
Ph nNae,CA 92586 AUTHORREDREPRESENDImvE
M 1988-2009 ACORD CORPORATION. All right.reserved.
ACORD 25(2009109) The ACORD name and logo are registered mark.of ACORD
The following Provisions are also added to this Coverage Part:
A. ADDITIONAL INSUREDS—BY CONTRACT,AGREEMENT OR PERMIT
1. Paragraph 2. under SECTION II—WHO IS AN INSURED is amended to include as an insured any person
or organization when you and such person or organization have agreed in writing in a contract, agreement
or permit that such person or organization be added as an additional insured on your policy to provide
Insurance such as Is afforded under this Coverage Part. Such person or organization is not entitled to any
notices that we are required to send to the Named Insured and is an additional insured only with respect
to liability arising out of:
a. Your ongoing operations performed for that person or organization; or
b. Premises or facilities owned or used by you.
With respect to provision t.a. above, a person's or organization's status as an insured under this
endorsement ends when your operations for that person or organization are completed.
With respect to provision 1.b. above, a person's or organization's status as an insured under this
endorsement ends when their contract or agreement with you for such premises or facilities ends.
2. This endorsement provision A.does not apply:
a. Unless the written contract or agreement has been executed, or permit has been issued, prior to the
"bodily injury", "property damage"or"personal and advertising injury";
b. To"bodily injury"or"property damage"occurring after:
(1) All work, including materials, parts or equipment furnished in connection with such work, In the
project (other than service, maintenance or repairs) to be performed by or on behalf of the
additional insured(s)at the site 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;
c. To the rendering of or failure to render any professional services including, but not limited to, any
professional architectural,engineering or surveying services such as:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions,
reports,surveys,field orders,change orders or drawings and specifications;and
(2) Supervisory, Inspection, architectural or engineering activities;
d. To"bodily injury","property damage"or"personal and advertising Injury"arising out of any act, error or
omission that results from the additional insureds sole negligence or wrongdoing;
e. To any person or organization included as an insured under provision B.of this endorsement;
I. To any person or organization included as an insured by a separate add'rlional insured endorsement
issued by us and made a part of this policy.
B. ADDITIONAL INSURED—VENDORS
Paragraph 2.under SECTION II—WHO IS AN INSURED is amended to include as an insured any person or
organization (referred to below as "vendor") with whom you agreed, in a written contract or agreement to
provide insurance such as is afforded under this policy, but only with respect to "bodily injury" or "property
damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's
business,subject to the following additional exclusions:
1. The insurance afforded the vendor does not apply to:
a. "Bodily Injury"or"property damage"for which the vendor is obligated to pay damages by reason of the
assumption of liability In a contract or agreement. This exclusion does not apply to liability for
damages that the vendor would have in the absence of the contract or agreement;
b. Any express warranty unauthorized by your
c. Any physical or chemical change in the product made intentionally by the vendor;
Includes copyrighted malarial of Insurance services Offices Inc.wl lh Its permission.
GECG 602(09104) Page 4 of 5
Otn4=5 sweet) NEUMPGMI AGENT COPY ornruwnn corms rrenooni rm�na,n anon sn
d. Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or
substitution of parts under Instructions from the manufacturer, and then repackaged in the original
container;
e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to
make or normally undertakes to make in the course of business, in connection with the distribution or
sale of the products;
f. Demonstration, installation, servicing or repair operations, except such operations performed at the
vendor's premises in connection with the sale of the product;
g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a
container, part or ingredient of any other thing or substance by or for the vendor;or
h. To "bodily injury' or "property damage" arising out of any act, error or omission that results from the
additional insured's sole negligence or wrongdoing.
2. This insurance does not apply to any insured person or organization, from whom you have acquired such
products, or any ingredient, part or container, entering into, accompanying or containing such products.
Includes copyrighted material of Insurance services Offices Inc.with its permission.
GECG 602(09104) Page 5 of 5
01714f2g05 9927089 NEUSXJPC2901 AGENT COPY
PGDMOSW J01875 GCAOPPN Wg14215 Page 95
WELLS FARGO INS INC/PAC NEP
PO BOX 330J 5
SAN ANTONIO TX,78255
City Of Menifee
29714 HAUN RD
SUN CITY, CA 92586
ACORD 25 (2009/09)