2021/08/13 Cal West Underground, Inc.page 2 of 2
Clienl#:1265801 3OSCALWESACORD, CERTIFICATE OF LIABILITY INSUBANCE
COVERAGES CERTIFICATE NUMBER FEVISION NUMBEB
811312021
THIS CEFTIFICATE IS ISSUEO AS A MATTEB OF INFONMATION ONLY AND CONFEBS NO RIGHTS UPON THE CEBTIFICATE HOLDER, THIS
CEFTIFICATE OOES NOT AFFIFMATIVELY OR NEGATIVELY AMENO, EXTEND OB ALTEB THE COVEBAGE AFFONDEO BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE OOES NOT CONSTITUTE A CONTBACT BETWEET{ THE ISSUING INSUFER(S). AUTHORIZED
BEPFESENTATIVE OR PROOUCEB. ANO THE CEBTIFICATE HOLDER,
IMPOBTANT: ll tho ccrtlllc.t. hold.r i8 .n AoDITIONAL INSUBED, lhe policy(ies) must h.ve ADDITIoNAL lNsuBEO provi6ion6 or b. €ndors€d
It SUBBOGATION lS WAIVED, subiect to the lerms and conditlon6 of the policy. con.ln pollcle3 m.y requiro an endoro.mant. A rtatement on
lhia co ltlcat6 d@B not confar rny righla to the certlllclte holdar ln ll.u ol 6uch endoraamant(s)
$!l!fcr sonta MEris
lcqc '!o enl 714 941-2800McGrlf, lnsuranc6 Sorvicas
24m E Katella Ave Suite 1100
Anaholm, CA 92806
714 941-2800
gonla.morrls@mcgrifl.com
rN6lrBE B(S) A FFO FOrNC COVERAGE
. A!uoclal.d lnduetrlcs lns Company
. Travala.s Propcrty Casualty Co ol Amcr
. AGCS Marlnc lnsurancc Company
TIISIJFEF E
23140
25674
22A37Cal West Underground lnc.
P.O. Box 6286
Norco, CA 92860
THIS IS IO CEBTIFY THAI THE POUCI€S Of IIEWIANCE LISTED BELOW HAVE BEEN ISSUED TO IHE INSURED NAMED ABOVE FON THE POLICY PERIODINDICATED, NOTWIIHSTANDING ANY REOUIREMEM. IERM OF CONDITION OF AN/ CONTFACI OFI OT|]EB DOCUMENT WITH RESPECI TO WHICH THIS
CEBTIFICATE MAY BE ISSUED OB MAY PEFTAIN. THE INSURANCE AFFOFIDED BY THE POLICIES DESCFIEED HEBEIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONOITIONS OF StrcH POLICIES. LIMITS SI]OWN MAY HAVE BEEN BEDUCED AY PAID CLAIMS-
A
TYPE OFINSUFANCE
x coMMEFCIAL GENEFAL LtABtLllY
cra us.vaor X occun
X BYPD Ded:5,000
i PoLiaY EFI I policY Eip
I(Mm/D6ryiyyl (Mrr/oryivq LlMlrs
pgl3l2O21 Osloll2O22 EAc. occL qRLN!r
I DAMAcE !O BEN lLO
, o BEVjSES (tJ at, r_.n!.
AESl'194s180r s'l,000,000
s100,000
s0
s1,000,000
s2,00O,000
s2,00O,000
GEN'L AGGAEGAIE LIMITAPPLIES PERI ,o.,"" J 5P3; l r,o"
iOIHEB
AUIOi'OEILE LAEILI
MEO EXP (Aiyon. F&n)
PEFsONAL A AOV INJ.JFY
GENEFAL AgGFEGATE
PB@UCTS . COI!,IP/OP AGG
B 81 03 N3233s521 26G 312021 o't 01 t2o22 :8Y:lt:R,"'"n.. .,,$1,qqo,000xSOOILY INJUFY(Por p..on)
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SCHEOULED
lPaacc'dq,!
312021 OSlOll2On EACN occuFRENcE
AGGREGATE
$
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$s.0(n.@q
r5,000,000
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EXA120871600
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ANOETPLOYEB6 LIABILITY
ANY PFOPFIETOF]PAFTNEB/EXECUTIVEOFFTCEE/MEMBEF EXc!UDE0,
DESCFIPTIOiI OF OPERATIONS b.lo*
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RentodrLoasod
u86N3228492126G 12021 0510112022 X STAIUTE EF
E L EACH acoDENr s1,OOO,0O0
EL orsEAsE EAEMproyrt s't,000,0o0
. E L DrsEAsE PoL cY L rvrr sl,O0O,0O0
O5/o1l2022 $1 ,0OO D€ductiblo
$1s0,mo Mar Por lr.m
u2021
oEscnrPrrot oF oPEF^Tlolls/ Loc^Tlol{s /vEnlcLE6 (acoFo 10r, addluomr F.m.rt. s.h.d!t.. ,n.y b. .n..h.d n mor.p.c. b r.qurr.d)
Evldonco ol Coverags.
CEFTIFICATE CANCELLATION
STIOULD ANY OF THE ASOVE DESCRlaED POLICIES BE CANCELLEO BEFOFETHE EXPIEATIOI{ OATE THEBEOF. NOTICE WILL AE OELIVERED III
ACCOROANCE WITH THE POLICY PBOVISIONS.
Clty ol Meniree
29714 Haun Rd
Sun Clty, CA 92586
AIJTHOFZED FEFF€SENTAIIVE
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The ACORO name and logo !re rogirterod marka ot ACOBD
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