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2021/02/18 L.C. Paving & Sealing, Inc. (6)12/04/2021 HARTLEY CYLKE PACIFIC-#0574253 INSURANCE SERVICES, INC. 2747 UNIVERSITY AVENUE SAN DIEGO CA 92104-4068 JANA CLARK (619) 295-5155 (619) 291-0912 jana@hcpacinsurance.com L.C. Paving & Sealing, Inc. 620 Alpine Way Escondido CA 92029 TRAVELERS PROPERTY & CASUALTY CO OF AMERICA 25674 CL2191071210 A Y DT22CO0S13576ATIL21 02/18/2021 02/18/2022 1,000,000 300,000 5,000 1,000,000 2,000,000 2,000,000 A Y 8100S0955232126G 02/18/2021 02/18/2022 1,000,000 Medical payments 5,000 A CUP0S1373832126 02/18/2021 02/18/2022 4,000,000 4,000,000 A UB8S6221012126G 09/12/2021 09/12/2022 1,000,000 1,000,000 1,000,000 A INLAND MARINE QT6300S106923TIL21 02/18/2021 02/18/2022 LEASED/RENTED $100,000 SCHEDULED EQUIP $714,100 DEDUCTIBLE $1,000 *10 day notice of cancellation for non-payment of premium shall apply. 30 day notice of cancellation for all other reasons. *City of Menifee, its officers, agents and employees shall be named Additional Insured. RE: CIP 21-09: Murrieta Road and Sun City Blvd. Traffic Signal Improvement Project City of Menifee 29714 Haun Rd. Menifee 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. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY DocuSign Envelope ID: E50D00B5-C379-4137-82AD-E77EEF107BC8 DocuSign Envelope ID: E50D00B5-C379-4137-82AD-E77EEF107BC8 DocuSign Envelope ID: E50D00B5-C379-4137-82AD-E77EEF107BC8 DocuSign Envelope ID: E50D00B5-C379-4137-82AD-E77EEF107BC8 DocuSign Envelope ID: E50D00B5-C379-4137-82AD-E77EEF107BC8 DocuSign Envelope ID: E50D00B5-C379-4137-82AD-E77EEF107BC8 DocuSign Envelope ID: E50D00B5-C379-4137-82AD-E77EEF107BC8 DocuSign Envelope ID: E50D00B5-C379-4137-82AD-E77EEF107BC8