2022/10/11 Custom Concrete Services Corp2t17p023
THIS CEBTIFICATE IS ISSUEO AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON T}IE CEBTIFICATE HOLOER. THIS
CEBTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVEBAGE AFFOROED BY THE POLICIES
BELOW. TH|S CERTTFTCATE OF TNSURANCE OOES NOT CONSTTTUTE A CONTFACT BETWEEN THE TSSUTNG TNSUBEB(S), AUTHOBTZED
REPRESENTATIVE OR PRODUCER, AND THE CEFTIFICATE HOLDEB.
IMPORTANT: lf the cortilicate holder iB an ADOITIONAL INSURED, tho policy(i€s) muEt have AODITIONAL INSUBED proviaiona or bo endoraed,
It SUBROGATION lS WAIVEO, subl.ct to th6 te,ma and condillona of lhe policy, c6rtain policlea m6y .oqui.. an endoraement. A alatsnont on
this certiticale does not confor righl. to tho certillcate holdor in li6u ol auch 6ndor6emenl(a),
PFODUCEB
Arlhur J. Gallagher Risk Management Services, LLC
21820 Burbank Boulevard
Suite 30'l
Woodland Hills CA 91367
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rNsuREFls) AFFOR OrN6 COVEFAGE
L cense# 0D69293 l suhER a: Everest Premier lnsurance company
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16045
20443INSURED
Custom Concrete Services Corp
24648 Chalone Dr.
Murrieta CA 92562
sunER E : Continental Casualtv fumpany
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IN6URER E:
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COVERAGES
CERTIFICATE HOLOEF
Crty of Menifee
29844 Haun Rd
Menifee CA 92586
SHOULDAiIY OFT}IE ASOVE OESCAIaED POLICIES BE CANCELLEO AEFOBE
THE EXPIRATION DATE THEREOF, I{OTICE WILL BE DELIVEREO It.I
ACCOBDANCE WITH THE POLICY PROVISIONS.
CERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE NUMBER: 867007971 REVISION NUMBER
CANCELLATION
@ 198E"2015 ACOBD CORPORATIoN. All rights resetved
Th€ ACORO namc and logo are rogi8tercd marks ol ACORO
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED AELOW HAVE BEEN ISSUED TO THE INSUFED NAMED ABOVE FOR IHE POLICY PEBIOD
INDICATED, NOTWITHSTANOING ANY FEOUIREMENI, TEBM OB CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CEFTIFICATE MAY BE ISSUEO OF MAY PEBTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCBIBEO XEREIN IS SUBJECT TO ALL THE IEAMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE AEEN BEOUCED BY PAID CLAIMS
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GEN LAGGBEGATE LIM T APPLIES PEF
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c6979920942 223t2023 212y2021 EACHOCCUAFENCEDAIIAGETOHEflTET
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GE NEFAL AGGFEGATE
PEOOUCTS ' COMP/OP AGG
31,000,000
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s 1,000,000
$ 2.9!!,q-0q
$2,000,000
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AIJTOM O AILE LIAAILITY
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AUTOS ONLY
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AUTOS ONIY
SCHEOULED
AUTOS
NON.OWNEO
AUTOS ONI.Y
COMBINEO SINGLE LIMIT1E!,!sspgd_
EOOTLY I|UUAY (Pu pe6on)
aoDlLY INJUBY (P6l ac.rdont)
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UMBRELLALIAB H occuF I
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;;;T_T FETENTONS
EACH OCCURFENCE _
AGOAEGAIE s
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A WOFKERSCO{tlPENSAlrON
ANO EMPLOYE HS' TIA6ILITY
ANYPROPB!ETOR/PAFINEF/EXECUTIVE
OFFICER]M€MBEREXCLUOEO2(M.n.L!oryin H)
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OESCR PTION OFOPEBATIONS b€low
1011112022 10111t2023 v IPER lOTli-^ ISTATUTE ] IEF
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OISEASE . EA EMPLOYEE
OISEASE. POLICY LIMIT
s 1,000,00q
_L]rq09,_090
t 1,000,000
oEscFtPTtoN oF oPERATTo S / LOCATToLS / vElllctEa lAcono l ol, Arldidon.r R.'n.rt. S.h.drl., o.y b..tt ch.d n hor .p.4 i. r.qul l)
City of Menite€ is included as an additional insursd in regards to the general liability covarage.
ACORD 25 (2016/03)
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Arthur J. Gallagher Risk l,4anagement Services, LLC
21820 Burbank Boulevard, Suite 301
Woodland Hills CA 9'1367
[40G2023 00002677 01
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City of Menifee
29844 Haun Rd
Menifee, CA 92586
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We are providing you with a Certificate of lnsurance confirming our client's coverage.
Want to get certificates of insurance faster? "Go Green with Gallagher" by receiving
digital copies of certificates via e-mail in the future. Or, do you no longer require a
certificate of insurance for our client? Please contact us at
COl.UpdateMyEmail@AJG.com and provide the following information for processing:
Confirmation that a certificate of insurance is no longer required; or
E-mail address to send future certificates of insurance in lieu of U.S. Mail delivery
lnsured Code: CUSTCON-05
This Certificate Number: 867007971
To learn more about the lnsurance and Risk Management Services offered by Gallagher,
please visit us at www.ajg.comius/about-us/how-we-work/core-360.
Gallagher does not share your e-mail as detailed in our privacy policy found at https://
www. ajg.com/us/privacy-policy/.
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CTIA
BEST CHOICE CONTRACTOR PROGRAM
Blanket Addltional lnsured - Owners, Lessees or
Contractors
This endorsement modifies insurance provided under the following
COI\,,IMERCIAL GENERAL LIABILITY COVERAGE PART
Poricy Number: C697 9920942 Endorsement Effective. 2/2312023 al 12:01 a. m
Authorized Representative
SCHEDULE
Name of Additional lnsured Person(s)
or Organization(s): (Blanket)(Specitic)
Any person or organizalion that the Named lnsured is
obligated by virtue ot a writtsn contracl or written
agroomenl to mak6 an additional insured on this
Coverago Part, provided such contract or agroomont;
. ls currently in sfiect or becomes offoctive during
th6 policy period; and. Was €xecuted prior to:
a. the "bodily injury," or "property damage"; or
b. the offense that caused the "per3onal and
advertising iniury";
for which the additional insured 6ssks covorage.
Localion(s) of Covered Oporalions:
Any location in th€ "coverago torritory" that is subject
to the contract or agr€oment specified abov6.
A. Ssction ll - Who 18 An lnsured is amended to include as an insured the person or organizalion shown in the
Schedule, but only to lhe exlent that the person or organizalion shown in the Schedule is held liable ,or your
acts or omissions arising out of your ongoing operalions performed for thal insured.
B. With respect to lhe insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to "bodily injury" or "propety damage" occuning after:
L All work, including materials, parts or equipment furnishBd in connection with such work, on the project
(other than service, maintenance or repairs) to be performed by or on behalf of the addilional 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 contraclor or subcontractor engaged in performing
operations for a principal as part of the same pmject.
C. with respect to the insurance atforded to these additional insureds, this insurance also does not apply to
"bodlly iniury", "proparty damage" or "Personal and adver sing inlury" arising out of the rendering of, or
the failure to render, any professional architectural, engineering or surveying services, includingl
1. The preparing, approving, or failing to prspare or approve, maps, shop drawings, opinions, reports,
surveys, fi€ld orders, change orders or drawings and specifications; or
2, Supervisory, inspection, architectural or engineering activities.
D. Primary and Noncontributory lnsutance
lf so required by a written contracl or written agreement, this insurance will be primary to, and will not seek
contribution from. other insurance under which the additional insured isa named insured. Butinall other
CNA97587xx (4-2020) Policy No: C6g7gg26942
Page 1 of 2 Effective Date: 2t2312023
Copyighr CNA All Rlghts RBsoryod. lnclude3 copydghted met6nalof lnsuram€ Ss.vic€s Oflics, lnc. wed with psrmrssion
Ih$tffi
Ilissffi
Named lnsured:
CUSTOM CONCRETE SEHVICES COHP, DBA:
CUSTOM CONCBETE SEHVICES COBP
CNA
BEST CHOICE CONTRACTOR PROGRAM
Blanket Addltlonal lnsured - Owners, Lessees or
Contractors
instances, and notwithstanding anything to the contrary in tho condition entitled Other lnsurance, this
insurance will be excess of any other insurance available to the additional insured.
E. Solely with respect to the insurance granted by this endorsemenl, the seclion entitled COMMERCIAL
GENERAL LIABILITY CONDITIONS is amended to add the following to the condition entitled Dutios ln Ths
Event of Occurrence, Offen3e, Claim or Suit;
Any additional insured pursuant to this Coverage Part will, as soon as possible:
1. Give us writlen notice of any claim, or of any "occurrenco" or offense that may result in a claimi
2. Send us copies of all legal papers received and otherwise cooperate with us in the invesligation, defense or
settlement of the claimi and
3. l\rake availabb any other insurance and tender the defense and indemnity of any claim lo any other insurer
or self-insurer whose policy or program applies to a loss thal we cover under this Coverage Part. However,
if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not
apply to insurance on which the additional insured is a named insured.
F. Solely with respect to the insurance granted by this endorsement:
1 . The words "you" and "your" refer to the Named lnsured shown in the Declaralions.
2. "Your work" means work or operations performed by you or on your behalf, and materials parts or
equipment furnished in connection with such work or operations.
G. Blanket Waiver of Subrogation
We waive any right of recovery we may have against an entity that is an additional insured under the terms of
lhis endorsemenl with respecl to payments we make for injury or damage arising out of ,,your work', done
under a written conlracl or writlen agreement wilh that person or organizalion, provided such contracl or
agreemenl:
1. Requires such a waiver of our rights;
2. ls currently in effecl or becomes effective during the policy period; and
3. Was executed prior the "bodily lniury", "property damage" or "personal and advsrtising injury', that
gave rise to the claim.
All other terms and conditiom of the Policy remain unchanged
This endorsement, which forms a part of and is for attachment to the Policy issued by the designated lnsurers,
takes effect on the eftective date of said Policy at the hour stated in said Policy, unleis anothei effective date is
shown below, and expires concurre with said Poli
cNA97587XX (4-2020)Policy No: Q$$79920942
Page2ol2 Effective Date: 2/23/2023
Copyrlghl CNA All Rights R€serv6d, lncludos copyright€d mateial of lnsuEnc€ Ssrvic€6 Omc€, lnc, used wtth permission