2021/12/01 Charles E. Thomas Company, Inc.o.Ro"
COVEBAGES
CERTIFICATE OF LIABILIW INSURANCE
CERTIFICATE NUMBER: 82l es09c3 BEVISION NUMgER: 1
oATE (XX/OOrV YYY)
1212nO21
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOBMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTEN THE COVEFAGE AFFOBDED BY THE POLICIES
BELOW. THIS CEBTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETU/EEN THE ISSUING INSURER(S), AUTHOBIZED
REPRESENTATIVE ON PNODUCER, AND THE CEBTIFICATE HOLDEB.
IUPORTANT: ll the cerllllcate holder l! an ADOITIONAL INSUREO, the policy(les) must have ADDITIONAL INSUHED prqvlelona or be endorsed.
It SUBnOGATION lS WAIVEO, eublect lo lho terms and condltlon3 of the pollcy, canaln pollcles may rsqulre an endorsem€nt. A statemenl on
thls cartltlcaie dols nol confcr rights to lha crrtlflcltc holder ln lleu ot such €ndor!emcnt(!).
Pf,OOUCEB
And16ini & Company-San Mat€o
220 West 20th Ave
San Matoo CA 94403
It{tuFEo
Charles E. Thomas Compsny. lnc
13701 So Alma Avlnuo
Gardena CA 90249
fi8E-rEelqdrlgc-FEffi*.,, e-s-onza-a36r
iBSiLse, leatciccta@andrcinr com
COVEAAGE
INSUREF A: CIUM &FOTSIET S ec lns Co 44524
ttsunen a: Fedet4 l!!!I9[cj!ojr]pany ?i?91
43753ll€uEac: R.public lndcmnity Co of Calil
uauaEF o :
ITSUBEN E:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED EELOW HAVE BEEN ISSUEO TO THE INSUREO NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANOING ANY REOUIREMENT. TERM OR CONOITION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OF MAY PERTAIN. THE INSUFANCE AFFOBDED BY THE POLICIES DESCRIBED HEREIN IS SUAJECT TO ALL THE TEBMS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REOUCED BY PAIO CLAIMS,tt{6x rypE oF rNsun^NcE i"""t}i*,f poucy MJ'.EF ' ,ffits8}frrt, ,ffitsB[iI&, urrTs
X COMUERCIAI GETIEFAL LIA'IUIY
cLArMs.MAoE T *"u,
EPK137916 1211t2021 12112022 E\CHoCcURBENcE $2.000.000
PFEM SES iEa 6orironc.l $100.000
,t{Egqfr4rysgrgloll -0 000
PEFSONAL & ADV TNJUAY t2.000.000
GEN'L AGOBEGATE LIM I APPLIES PEF GENEBTAGGREGAIE , I2 OOO OOO
PFOOUCTS COMP,OP AGG t2 000.000PoucY, X fSi LOC
QTHEB s2.000.000
ts AUTOI'OBILE LIABILITY 73612365 12t1t2021 1211n022 fcOM BIN Eo s INGLE I-IMI I| (Ea acdd.nl)
I mo,rr ,uun" r"r, p.oon1
$ 1 000.000
IX ANY AUIO_ J owlreoI auros oruYHNED
____..t AUTOS oriLY
. SCHEOULED
AUTOSi- No{ owNEDAIITOS Oa,lLYfi- .or ' o*
EOOILY lM.lUFY lPd a@dd.n t
5
X comp s1 ooo $
Uf,BBELLALIAB
X EXCES9 UAB
X occua
CLAli,lS.l'rADE
oEo x neteruttor,r$ 6
EFX1l0335 t4 000 000
AGCBEGATE t4 000.000
$
c YI,oAKEBa COUPIT{ SATK)r{
AI{D ET'PLOYEAS' LIAAIUTY
ANVPROPBIETOE.PAFTIIERiEXECIJTIVE
OFFICERMEM9ENEXCLUO€O?
otscArPTtoN * oPEHArroNs b.b*
25532202 12t1n021 121n022 x PER
iSIATUTE
orB
EFY/N ELEAcHAccToENT -11000.000
EL DISEASE EAEMPTOYEE T1 OOO,OOO
E,!, OISEASE . POLICY LIMIT 31.000 000
EPK137916 M12021 12h|2022 o@w.n.c 0
0
00
00
0
0
00
00
oEttcFtmot of oPlnAno&t / Loc^Trotls / vEHtctES {A@io r0r. addrdolrt F. rr. !kh.duh, ,r[y b. tr.rrd I mor..!.c. r. rrquhd)
C[y ol Monrfc€ and tE otfcral6 oftcars rmploya66 and voluntalrE ar€ rncludrd as Addrtional lnsurad wth rr6pccts to Goncral Ltability whara raquirod by
wntion contract per the atlEched blanket endorsem6nt
CEBTIFICATE HOLDER CANCELLANON
City of l\4enifee
29844 Haun Road
Menifee CA 92586
STIOULD At{Y OF THE ABOVE DESCRIBED POUCIES AE CAI{CELLEO BEFORETHE EXPINATOI{ DATE THENEOF. NOTICE wlLL BE OELIVEBED IN
ACCOROANCE wllH THE POLICY PBOVISIOT{S.
AuTTi('FIZED FEPFESEI{'ANVE
fAmAau-tat^/
@ 198&2015 ACORD CORPORAION. All rlghE rs$rvod.
Tho ACOBD name end logo are regllterod marks ol ACORO
2 ol3 6653
ACOHD 25 (2015/03)
PFOPEFIYOAMAOE
1211D021 1212022 EtcncccUFR€NCE
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - STATE OR GOVERNMENTAL
AGENCY OR SUBDIVISION OR POL!TICAL
SUBDIVISION - PERMlTS OR AUTHORIZATIONS
This endorsement modifres insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
CONTRACTORS POLLUTION LIABILITY COVERAGE PART
ERRORS AND OIVIISSIONS LIABILIry COVERAGE PART
THIRD PARTY POLLUTION LIABILIry COVER PART
ONSITE CLEANUP COVERAGE PART
SCHEDULE
Statc Or Governmental Agency Or Subdivision or Political Subdivision:
Where Required By Written Contract
lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations.
Under the Common Provisions, Section lll -Who ls An lneured is amended to include as an
insured any stat€ or governmental agency or
subdivision or political subdivision shown in the
Schedule, subject to the following provisions:
1. This insurance applies only with respect to
operations performed by you or on your be-half for which the stat€ or governmental
agency or subdivision or political subdivision
has issued a permit or authorization.
2. This insurance does not apply to:
a. "Bodily injury", "property damage" "per-
sonal and advertising injuM, a "pollution
condition" or a "wrongful act" arising out of
op€rations performed for the federal gw-
ernment, state or municipality; or
b. "Bodily injury" or 'property damage' in-
cluded within the "producb-completed op-
erations hazard".
ENo145-1'1 1 1 Page I of 1
3 ol3 6653
lncludeg copyrighted material of lnsurance Service Office, lnc with its permi66ion.