The URL can be used to link to this page

2021/08/16 Road Works, Inc.3/3/2022 Manale Insurance Services 817 W. Beverly Blvd. Suite 107 Montebello CA 90640 Andy Manale (323)581-4846 (323)581-4844 certificates@manaleins.com Road Works, Inc. 303 Short Street Pomona CA 91768 Financial Pacific Insurance Company 31453 Insurance Company of the West 27847 A X X X Primary & Non-Contributory X X Y 60477177 8/16/2021 8/16/2022 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 A X X Y 60477177 8/16/2021 8/16/2022 1,000,000 UNINSURED MOTORISTS - BI 1,000,000 A X X X X 60477177 8/16/2021 8/16/2022 2,000,000 2,000,000 B Y WSA 5052134 02 12/1/2021 12/1/2022 X 1,000,000 1,000,000 1,000,000 A Business Personal Property 60477177 8/16/2021 8/16/2022 Limit (Bldgs 1&2)$736,600 A Inland Marine 60477177 8/16/2021 8/16/2022 Limit $115,144 Job: PMP 22-02 Potomac & Meadows Resurfacing for Crack Sealing Svcs. The City of Menifee, its Officers, Officials, Agents, Employees & Volunteers are named Additional Insureds with regards to General Liability, Excess (follows suit) and Business Auto. Insurance is Primary & Non-Contributory. Waiver of Subrogation in favor of Additional Insureds applies to General Liability, Business Auto & Worker's Compensation. City of Menifee Attn: Maritsa Ramirez 29844 Haun Road Menifee, CA 92586 (951)679-2568 mramirez@cityofmenifee.us Andy Manale/VH Y The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person)$ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PER STATUTE OTH- ER E.L.EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes,describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S)AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INS025 (201401) DocuSign Envelope ID: 74A21D81-AA6D-4505-B43D-9654F25A9ADBDocuSign Envelope ID: 7B54A251-1776-41DE-B129-0361F27D0B45 60477177 DocuSign Envelope ID: 74A21D81-AA6D-4505-B43D-9654F25A9ADBDocuSign Envelope ID: 7B54A251-1776-41DE-B129-0361F27D0B45 POLICY NUMBER: 60477177 DocuSign Envelope ID: 74A21D81-AA6D-4505-B43D-9654F25A9ADBDocuSign Envelope ID: 7B54A251-1776-41DE-B129-0361F27D0B45 DocuSign Envelope ID: 74A21D81-AA6D-4505-B43D-9654F25A9ADBDocuSign Envelope ID: 7B54A251-1776-41DE-B129-0361F27D0B45 DocuSign Envelope ID: 74A21D81-AA6D-4505-B43D-9654F25A9ADBDocuSign Envelope ID: 7B54A251-1776-41DE-B129-0361F27D0B45 DocuSign Envelope ID: 74A21D81-AA6D-4505-B43D-9654F25A9ADBDocuSign Envelope ID: 7B54A251-1776-41DE-B129-0361F27D0B45 DocuSign Envelope ID: 74A21D81-AA6D-4505-B43D-9654F25A9ADBDocuSign Envelope ID: 7B54A251-1776-41DE-B129-0361F27D0B45 DocuSign Envelope ID: 74A21D81-AA6D-4505-B43D-9654F25A9ADBDocuSign Envelope ID: 7B54A251-1776-41DE-B129-0361F27D0B45 DocuSign Envelope ID: 74A21D81-AA6D-4505-B43D-9654F25A9ADBDocuSign Envelope ID: 7B54A251-1776-41DE-B129-0361F27D0B45 INSURED This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned By WSA 5052134 02 12/01/2021 INSURANCE COMPANY OF THE WEST ROAD WORKS INC INCL. WC 99 06 34 (Ed. 8-00) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to t he extent that you perform work under a written contract that requires you to obtain this agreement from us). The additional premium for this endorsement shall be % of the total California Workers’ Compensation premium otherwise due. Schedule Person or Organization Job Description 2 ANY ALL CALIFORNIA PERSON/ORGANIZATION OPERATIONS WHEN REQUIRED BY WRITTEN CONTRACT DocuSign Envelope ID: 74A21D81-AA6D-4505-B43D-9654F25A9ADBDocuSign Envelope ID: 7B54A251-1776-41DE-B129-0361F27D0B45