2021/10/01 Hillcrest Contracting, Inc.; Ros Mar Equipment Co., Inc. (3)ACC)RD-HILLCREST.
CERTIFICATE OF LIABILITY INSURANCE 9t23t2021
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 POLICIESBELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTR,ACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEO
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lf the certificate holder is an AOOITIONAL INSURED, the policy(ies) must have ADOITIONAL INSURED provisions or be endorsed.
It SUBROGATION lS wAlVED, subiect to the terms and conditions of the policy, certain policies may requiie an endorcement. A statement onthis certilicate does not confer rights to the certificate holder in lieu ot such endorsement(s).
Hillcrest Contracling, lnc.; Ros Mar Equipment Co., lnc
'1467 Circie City Drive
Corona, CA 92879
INSURED
pany lnsurance Serylces, lnc
400
The Wooditch Com'l Park Plaza, Suite
lrvine, CA 92614
tNsuRER c : lndian Harbor lnsurance com
A,Executive Risk lndemnity, lnc.
. N"),(949) 553.0670
n
l.I3.n^i, .,0, ts+sl 553-9800
INSURER(S}AFFORDING COVERAGE
Federal lnsurance Com
COVERAGES ION NUMBER:
THIS IS TO CERT]FY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ]SSUED TO THE INSURED NAA,IED ABOVE FOR THE POLICY PERIODINDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDIT]ON OF ANY CONTRACTOR OTHER DOCUMENTWITH RESPECTTOWHICH THIS
CERTIFICATE I\4AY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERIVS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAII[,IS,
UMITSryPE OF INSURANCE
xA $
$
$
$
$
COMMERCIAI. GENERAL LIABILITY EACH OCCURRENCE
X 54310295 10t1t202'l rorvzozz ffiffi ffi El)1fiD.,".,
GENERAL AGGREGAIE
Deductible
x
PROOUCTS. COMP/OP AGG $
CLA MS.MADE X occuR
GEN'L AGGREGA'TE LI[I TAPPLIES PER
1,000,000
5,000
100,000
1,000,000
10,000
2,000,000
2,000,000
MEo ExP [Any on€ pe6on)
PERSONAL & ADV INJURY
"o.,"" f 55"o; [ ,o"
OTHER
B
X 54310294
2,000,000
BODILY INJURY {Per accide.t) $
S
s
s
'tot'12021 101'v2022 BODILY INJURY (Per pe6on) $
COMBINEDSINGLEL MIT
UMBRELLA LIAB
EXCESS LIAB
OED RETENTON $
OCCUR
CLAIMS-MAOE
s
$
$
EACH OCCURRENCE
A6GREGAIE
x
ANY PROPRIETOR/PARTNEFYEXECUTIVE
OFFICEFI/MEIVgER EXCLUOEO?
DESCRIPTION OF OPERATiONS below
X 543'10296 E L EACH ACCIDENT
EL OISEAi]E- EA EI\IPLOYEE S
1,000,000
B
N
S10t't2021 101'12022 1,000,000
1,000,000
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
c
c
Pollution Liability
Pollution Liability
PEC004859s-0s
PEC0048595-05
101112021
10t112021
101'12022
101'12022
x Per Claim/Agg,
stR
1,000,000
10,000
OESCRIPTION OF OPERATIONS / LOCATIONS / VEHICIES (ACORD 101 , Additional R.marts Sch.dul., may b6 .tt.ch.d il moE !p.c. i. roquned)RE: All operations performed by tho Named lnsured during the current policy period. glaipwv/auai/wcwv/pollai
City of Menifee and its officers, employees, agents and authodzed volunteers are included as Additional lnsureds as respects General Liability, Auto Llability
and Pollution Liability per attached endorsements,
This insurance shallapply as P.imary and Non-Contributory per attached endorsement.
Waiver of Subrogation for General Llabllily and Workers' Compensation: See Atrached Endorsements.
City ot Menifee and its office.s, employees, agents
and aulhorized volunteets
29844 Haun Road
Sun City, CA 92586
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, T{OTICE WILL 8E OELIVERED IN
ACCORDANCE wlTH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE@--
CERTIFICATE HOLDER
ACORD 2s (2016/03)
35181
2028'l
36940
I INSURER D I
II INSURER E :
cPl
D('- o""o,,-.]ow"Eo - scHFDrn Fo
AUIOS ONLY AUTOSX !1fi%0. o*,,, x lSia'"t*,t?
c iRTIFICATE NUMBE
O'1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo arc registered marks ofACORD
AGENCY CUSTOMER ID. HILLCREST.
LOC #: 1
ADDITIONAL REMARKS SCHEDU LE
CPALMER
ACORD'
Hlllcresl Contracting, lnc.i Ros Mar Equipment Co., lnc1467 Circle Citv DriveCorona, cA 92879
SEE PAGE 1
NAIC CODE
SEE PAGE 1 SEEPl EFFECIVE DArE sEE PAGE 1
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORO FORM,
FORM NUMBER: acoRD 25 FORM TITLE:Certificaie of Liabilitv lnsurance
Cancellation*Except 10 Days Notice of Cancellation for Non-Payment of Premium.*Should this policy be cancelled before the expiration date, The Wooditch Company will mail 30 (thirty) days written notice to those
Certificate Holders which require such action per contracl ot agreement.*
@ 2008 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered ma.ks of ACORD
ACORD 101 (2008/01)
Page 1 ol 1
POLICY NUMBER: 54370294
COMMERCIAL AUTOMOBILE
THIS ENDORSEMEI{T CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
GOMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT
BUSINESS AUTO COVERAGE FORM
This endorsement modifies the Business Auto Coverage FormI. EXTENDEDCANCELLATIONCONDITION
Paragraph 4.2.b. - CANCELLATION - of the
COMMON POLICY CONDITIONS form lL 00 17 is
deleted and replaced with the following:b. 60 days before the effective date of cancellation if
we cancel for any other reason.2, BROAD FORM I SUREDA Subsidiaries and Newly Acquired or Formed
Organizations As lnsureds
The Named lnsured shown in the Declarations is
amended to include:
1. Any legally incorporated subsidiary in which
you own more than 50% of the voting stock on
the effective date of lhe Coverage Form.
However, the Named lnsured does not include
any subsidiary that is an "insured" under any
other automobile policy or would be an
"insured" under such a policy but for its
termination or the exhaustion of its Limit of
lnsurance.
2. Any organization that is acquired or formed by
you and over which you maintain majority
ownership. However, the Named lnsured
does not include any newly formed or acquired
organization:
(a) That is an "insured" under any other
automobile policy.
(b) That has exhausted its Limit of Insurance
under any other policy; or
(c) 180 days or more atter its acquisition or
formation by you, unless you have given
us written notice of the acquisition or
formation.
Coverage does not apply to "bodily injury" or
"property damage" that results from an "accident"
that occurred before you formed or acquired the
organization.
B. Employees as lnsureds
Paragraph 4.1 . WHO lS AN INSURED - of
SECTION ll - LIABILITY COVERAGE is amended to
add the following:d. Any "employee" of yours while using a
covered "auto" you don't own, hire or
borrow in your business or your personal
affairs.
G, Lessors as lnsuleds
Paragraph 4.1. - WHO lS AN INSURED - of
SECTION ll - LIABILITY COVERAGE is
amended to add the following:e. The lessor of a covered "auto" while the
"auto'is leased to you under a written
agreement if:
('l) The agreement requires you to
provide direct primary insurance for
the lessor; and
(2) The'auto" is leased without a driver.
Such leased "auto" will be considered a
covered "auto" you own and not a covered
"auto" you hire.
However, the lessor is an "insured" only
for "bodily injury" or "property damage"
resulting from the acts or omissions by:
'l . You;2. Any of your "employees" or agents;
or3. Any person, except the lessor or
any "employee" or agent of the
lessor, operating an'auto" with the
permission of any of 1. and/or 2.
above.D. Persons And Organlzations As lnsureds
Under A Writlen lnsuled ContIact
Paragraph A. l - WHO lS AN INSURED - of
SECTION ll - LIABILITY COVERAGE is
amended to add the following:f. Any person or organization with respect to
the operation, maintenance or use of a
covered "auto", provided that you and
such person or organization have agreed
under an express provision in a written
"insured contract", written agreement or a
written permit issued to you by a
governmental or public authority to add
such person or organization to this policy
as an "insured".
However, such person or organization is
an "insured" only:
Form: 16-02-0292 (Rev. 11-16) Page '1 of 3
"lncludes copyrighted material of lnsurance Services Office, lnc. with its permission"
This endorsement modifies insurance provided under the following:
(1) with respect to the operation,
maintenance or use of a covered
"auto"; and
(2) for "bodily injury" or "property damage"
caused by an "accident" which takes
place after:
(a) You executed the "insured
contract" or written agreement; or(b) The permit has been issued to
you.3. FELIOW EMPLOYEE COVERAGE
EXCLUSION 8,5. - FELLOW EI\,4PLOYEE , Of
SECTION ll - LIABILITY COVERAGE does not apply.4. PHYSICAL DAMAGE - ADDITIONAL TEIUPORARY
TRANSPORTATION EXPENSE COVERAGE
Paragraph A.4.a. - TRANSPORTATION EXPENSES
- Of SECTION III _ PHYSICAL DAMAGE
COVERAGE is amended to provide a limit of $50 per
day for temporary transportation expense, subject to a
maximum limit of $1,000.5. AUTO LOAN/LEASE GAP COVERAGE
Paragraph A. 4. - COVERAGE EXTENSIONS - of
SECTION III _ PHYSICAL DAI,IAGE COVERAGE iS
amended to add the following:
c. Unpaid Loan or Lease Amounts
ln the event of a total "loss" to a covered "auto", we will
pay any unpaid amount due on the loan or lease for a
covered "auto" minus:1. The amount paid under the Physical Damage
Coverage Section of the policy; and2. Any:a. Overdue loan/lease payments at the time of
the "loss";b. Financial penalties imposed under a lease for
excessive use, abnormal wear and tear or
high mileage;c. Security deposits not returned by the lessor:d. Costs for extended warranties, Credit Life
lnsurance, Health, Accident or Disability
lnsurance purchased with the loan or lease;
ande. Carry-over balances from previous loans or
leases.
We will pay for any unpaid amount due on the loan or
lease if caused by:1. Other than Collision Coverage only if the
Declarations indicate that Comprehensive
Coverage is provided for any covered "auto";2. Specified Causes of Loss Coverage only if the
Declarations indicate that Specified Causes ol
Loss Coverage is provided for any covered "auto";
or3. Collision Coverage only if the Declarations indicate
that Collision Coverage is provided for any
covered "auto.
6. REiITAL AGENCY EXPENSE
Paragraph A. 4. - COVERAGE EXTENSIONS - of
SECTION III_ PHYSICAL DAMAGE COVERAGE
is amended to add the following:
d. Rental Expense
We will pay the following expenses that you or
any of your "employees" are legally obligated
to pay because of a written contract or
agreement entered into for use of a rental
vehicle in the conduct of your business:
MAXIMUM WE WILL PAY FOR ANY ONE
CONTRACT OR AGREEMENT:'1. $2,500 for loss of income incurred by the
rental agency during the period of time that
vehicle is out of use because of actual
damage to, or "loss" of, that vehicle, including
income lost due to absence of that vehicle for
use as a replacementl2. $2,500 for decrease in trade-in value of the
rental vehicle because of actual damage to
that vehicle arising out of a covered "loss'; and3. $2,500 for administrative expenses incuned
by the rental agency, as stated in the contract
or agreement.4. $7,500 maximum lotal amount for paragraphs
1., 2. and 3. combined.7. EXTRA EXPENSE - BROADEI{ED GOVERAGE
Paragraph A.4. - COVERAGE EXTENSIONS - of
SECTION lll - PHYSICAL DAI\iIAGE COVERAGE
is amended to add the following:e. Recovery Expense
We will pay for the expense of returning a
stolen covered "auto" to you.
8. AIRBAG COVERAGE
Paragraph 8.3.a. - EXCLUSIONS - of SECTION
lll - PHYSICAL DAMAGE COVERAGE does not
apply to the accidental or unintended discharge of
an airbag. Coverage is excess over any other
collectible insurance or warranty specifically
designed to provide this coverage.9. AUD|O, VTSUAL AND DATA ELECTRONTC
EqUIPMENT - BROADENED COVERAGE
Parasraph C.1.b. - Lll\4lT OF INSURANCE - of
SECTION lll - PHYSICAL DAMAGE is deleted
and replaced with the following:
b. $2,000 is the most we will pay for "loss" in any
one "accident" lo all electronic equipment that
reproduces, receives or lransmits audio, visual
or data signals which, at the time of "loss", is:
(1) Permanently inslalled in or upon the
covered "auto" in a housing, opening or
other location that is not normally used by
the "auto" manufacturer for the installation
of such equipment;
(2) Removable from a permanently installed
housing unit as described in Paragraph
2.a. above or is an integral part of that
equipmenl; or
(3) An integral part of such equipment.
10. GLASS REPAIR - WAIVER OF DEDUCTIBLE
Form: 16-02-0292 (Rev. 11-16) Page 2 of 3
"lncludes copyrighted material of lnsurance Services Offlce, lnc. with its permission"
Under Paragraph D. - DEDUCTIBLE of
SECTION III _ PHYSICAL DAMAGE COVERAGE
the following is added:
No deduclible applies to glass damage if the glass
is repaired rather than replaced.
11. TWO OR MORE DEDUCTIBLES
Paragraph D.- DEDUCTIBLE - of SECTION lll -PHYSICAL DAMAGE COVERAGE is amended to
add the following:
lf this Coverage Form and any other Coverage
Form or policy issued to you by us that is not an
automobile policy or Coverage Form applies to the
same "accident", the following applies:1. lf the deductible under this Business Auto
Coverage Form is the smaller (or smallest)
deductible, it will be waived; or2. lf the deductible under this Business Auto
Coverage Form is not the smaller (or smallest)
deductible, it will be reduced by the amount of
the smaller (or smallest) deductible.
12. AMEI{DED DUTIES IN THE EVEI{T OF
acctDEltT, GLAIV|, SUtr OR LOSS
Paragraph 4.2.a. - DUTIES lN THE EVENT OF
AN ACCIDENT, CLAIM, SUIT OR LOSS Of
SECTION lV - BUSINESS AUTO CONDITIONS is
deleted and replaced with the following:a. ln the event of'accident", claim, "suit" or
"loss", you must promptly notify us when the
"accident" is known to:
(1) You or your aulhorized representative, if
you are an individual:
(2) A partner, or any authorized
representalive, if you are a partnershipi
(3) A member, if you are a limited liability
company; or
(4) An executive officer, insurance manager,
or authorized representative, if you are an
organization other than a partnership or
limited liability company.
Knowledge of an "accident", claim, "suit" or
"loss" by other persons does not imply that the
persons listed above have such knowledge.
Notice to us should include:
(1) How, when and where the "accident" or
"loss" occurred;
(2) The "insured's'name and address; and
(3) To the extent possible, the names and
addresses of any injured persons or
witnesses.
,3. WAUEN OF SUBROGATION
Paragraph A.5. - TRANSFER OF RIGHTS OF
RECOVERY AGAINST OTHERS TO US of
SECTION lV - BUSINESS AUTO CONDITIONS is
deleted and replaced with the following:5. We will waive the righl of recovery we would
otherwise have against another person or
organization for "loss" to which this insurance
applies, provided the "insured" has waived
their rights of recovery against such person or
organization under a contract or agreement
that is entered into before such "loss".
To the extent that the "insured's" rights to
recover damages for all or part of any
payment made under this insurance has not
been waived, those rights are transferred to
us. That person or organization must do
eveMhing necessary to secure our rights and
must do nothing after "accident" or "loss" to
impair them. At our request, the insured will
bring suil or kansfer those rights to us and
help us enforce them.
14. UNINTENTIONAL FALURE TO DISCLOSE
HAZARDS
Paragraph 8.2. - CONCEALMENT,
MISREPRESENTATION or FRAUD of SECTION
lV - BUSINESS AUTO CONDITIONS - is deleted
and replaced with the following:
lf you unintentionally fail to disclose any hazards
existing at the inception date of your policy, we will
nol void coverage under lhis Coverage Form
because of such failure.
I5. AUTOS REI{TED BY EMPLOYEES
Paragraph 8.5. - OTHER INSURANCE of
SECTION IV _ BUSINESS AUTO CONDITIONS -
is amended to add the following:e. Any "auto" hired or rented by your "employee"
on your behalf and at your direction will be
considered an "auto" you hire. lf an
"employee's" personal insurance also applies
on an excess basis to a covered .auto" hired
or rented by your "employee" on your behalf
and at your direction, this insurance will be
primary to the "employee's" personal
insurance.
16. HIRED AUTO - COVERAGE TERRITORY
Paragraph 8.7.b.(5). - POLICY PERIOD,
COVERAGE TERRITORY of SECTION lV
BUSINESS AUTO CONDITIONS is deleted and
replaced with the following:
(5) A covered "auto" of the private passenger
type is Ieased, hired, rented or borrowed
without a driver for a period of 45 days or
less; and
17- RESULTANT MENTAL ANGUISH COVERAGE
Paragraph C. of - SECTION V - DEFINITIONS is
deleted and replaced by the following:
"Bodily injury" means bodily injury, sickness or
disease sustained by any person, including
mental anguish or death as a result of the "bodily
injury" sustained by lhat person.
Form: 16-02-0292 (Rev. 11-16) Page 3 of 3
"lncludes copyrighted material of lnsurance Services Offlce, lnc. with its permission"
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following
COI\,,tI\,4ERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
A. Seclion ll - Who ls An lnsured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury" or
"properly damage" caused, in whole or in part, by
"your work" at the location designated and
described in the Schedule of this endorsement
performed for that additional insured and
included in the "products-completed operations
hazatd" .
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
2. lf coverage provided to the additional insured
is required by a contract or agreement, the
insurance afforded lo such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
COMMERCIAL GENERAL LIABILITY
cG 20 37 12 19
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section lll - Limits Of lnsurance:
lf coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
lnsurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable
Limits of lnsurance shown in the Declarations.
Name Of Additional lnsured Person(s)
Or Organization(s)Location And Description Of Completed Operations
WITERE REQUIRED BY WRITTEN CONTRACT, BUT
ONLY WIIEN TTIE CONTRACT SPECIFIES COVERAGE
FOR COMPLETED OPERATIONS
A],L LOCATIONS I{IIERE REQUIRED BY WRITTEN
CONTAACT
lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations.
cG 20 37 12 19 O lnsurance Services Office, lnc.,2012
POLICY NUMBER: 54310295
Page 1 of I
POLICYNUMBER: 5431029iI
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional lnsured Person(s)
Or Organization(s)Location(s) Of Covered Operations
9|HERE REQUIRED BY WRITTEN CONTRACT AIL LOCATIONS }IHERE RTQUIRED BY WRITTEN
CONTRACT
lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations
A. Section ll - Who ls An lnsured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf;
in the performance of your ongoing operations forthe additional insured(s) at the location(s)
designated above.
However:
l. The insurance afforded to such additional
insured only applies to lhe extent permitted by
law; and
2. lf coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to'bodily injury" or
"property damage" occurring after:
'1. All work, including materials, parts or
equipment furnished in connection with such
work, on the prolect (other than service,
maintenance or repairs) to be performed by or
on behalf of the additional insured(s) at the
location of the covered operations has been
completed; or
2. That portion of "your work" out of which the
iniury or damage arises has been put to its
intended use by any person or organization
other than another contractor or subcontractor
engaged in performing operations for a
principal as a part of the same project.
cG 20 10 12 19 @ lnsurance Services Office, |nc.,2018 Page 'l of 2
COMMERCIAL GENERAL LIABILITY
cG 20 10 12 19
C. With respecl to the insurance afforded to these
additional insureds, the following is added to
Section lll - Limits Of lnsurance:
lf coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amounl of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of
insurance;
whichever is less.
This endorsement shall not increase the
applicable limits of insurance.
Page 2 ol 2 @ lnsurance Services Office, lnc., 20'18 cG 20 101219
POLTCYNUMBER. s4310295 COMMERCIAL GENERAL LIABILITY
10-02-2461 (Ed. 7-15)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY INSURANCE FOR
SCHEDULED ADDITIONAL INSURED
This endorsement modifles insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Additional lnsured:
SCHEDULE
Location Of Covered Operations:
Where required by written contract
(lf no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
With respect only to the Additional lnsured and at the
Location Of Covered Operations shown in the
Schedule, the following is added to SECTION lV -
COMMERCIAL GENERAL LIABILITY CONDITIONS,
Paragraph 4. Other lnsurance and supersedes any
provision to the contrary:
Primary And Noncontributory lnsurance
This insurance is primary to and will not seek
conlribution from any other insurance available to
the Additional lnsured with respect to the Location
Of Covered Operations shown in the Schedule
under this policy provided that:
(1) The Additional lnsured is a named insured
under such other insurance: and
(2) You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution fromany other insurance available to the
Additional lnsured.
10-02-246'l (Ed.7-15) lncludes copyrighted material of Insurance Services Office, lnc.,
with its permission.
Page 1 of 1
Policy No. 54310295
c. Method Of Sharing
lf all of the other insurance permits contribution
by equal shares, we will follow this method al-
so. Under this approach each insurer contrib-
utes equal amounts until it has paid its appli-
cable limit of insurance or none of lhe loss
remains, whichever comes first.
lf any of the other insurance does not permit
contribution by equal shares, we will contribute
by limits. Under this method, each insurer's
share is based on the ratio of its applicable lim-
it of insurance to the total applicable limits of
insurance of all insurers.
5. Premium Audit
a. We will compute all premiums for this Cover-
age Part in accordance with our rules and
rates.
b. We may audit your books and records as they
relate to this insurance at any time during the
term of this policy and up to three years after-
wards.
c, The first Named lnsured must keep records of
the information we need for premium computa-
tion, and send us copies at such times as we
may request.
6. Representations
By accepting this policy, you agree:
a. The statements in the Declarations are accu-
rate and complete;
b. Those statements are based upon representa-
tions you made to us; and
c. We have issued this policy in reliance upon
your rePresentations.
7. Soparation Of lnsureds
Except with respect to the Limits of lnsurance, and
any rights or duties specifically assigned in this
Coverage Part to the first Named lnsured, this in-
surance applies:
a. As if each Named lnsured were the only
Named lnsured; and
b. Separately to each insured against whom
claim is made or "suit" is brought.
L Transfer Or Waiver Ot Rights Of Recovery
Against Others To Us
We will waive the\- erwise have had a
right of recovery we would oth-
gainst another person or organ-/ izalion, for loss to which this insurance applies,
provided the insured has waived their rights of re-
covery against such person or organization in a
contract or agreement that is executed before
such loss.
To the extent that the insured's rights to recover
all or part of any payment made under this Cover-
age Part have not been waived, those rights are
transferred to us. The insured must do nothing af-
ter loss to impair them. At our request, the insured
will bring "suit" or lransfer lhose rights to us and
help us enforce them.
This condition does not apply to Coverage C.
9. When We Do Not Renew
lf we decide not to renew this Coverage Part, we
will mail or deliver to the first Named lnsured
shown in the Declarations written notice of the
nonrenewal not less than 30 days before the expi-
ration date.
lf notice is mailed, proof of mailing will be sufficient
proof of notice.
SECTION V - DEFINITIONS
'1. "Advertisement" means an electronic, oral, written
or other notice, about goods, products or services,
designed for the specific purpose of attracting the
general public or a specific market segment to use
such goods, products or services.
"Advertisement" does not include any e-mail ad-
dress, lnternet domain name or other electronic
address or metalanguage.
2. "Advertising injury" means injury, other than "bodi-
ly injunf, "property damage" or "personal injury',
sustained by a person or organization and caused
by an offense of infringing, in that particular part of
your "advertisement" about your goods, products
or services, upon lheir:
a. Copyrighted "advertisement"; or
b. Registered collective mark, registered service
mark or other registered trademarked name,
slogan, symbol or title.
3. "Asbestos" means asbestos in any form, including
its presence or use in any alloy, by-product, com-
pound or other material or "waste".
4. "Auto" means:
a. A land motor vehicle, trailer or semitrailer de-
signed for travel on public roads, including any
attached machinery or equipment; or
b. Any other land vehicle that is subject to a com-
pulsory or financial responsibility law or other
motor vehicle insurance law in the state where
it is licensed or principally garaged.
However, "auto" does not include "mobile equip-
ment".
5."Bodily injury" means physical:
a. lniury;
b. Sickness; or
c, Disease;
lncludes copyrighted material of ISO Properties,
lnc., with its permission
Page 12 of 16 Form 10-02-'1800 (Rev. 6-09)
Policy Number:
PEC004859504
lnsured to remove an action to the United States District Court, regardless of the jurisdiction in which, an
action is commenced.
G. Decla rations and Representations
By acceptance of this Policy, you agree that the statements, declarations and information contained in the
Application, submitted for this Policy and executed by you, and any other supplemental materials submitted
to us are:
2.such statements and information are material to our undeMriting of this Policy;
3. that this Policy has been issued by us in reliance upon the truth, correctness and completeness of
such statements, declarations and information, and
4.the Application, submitted for this Policy and executed by you, and any other supplemental
materials submitted to us are incorporated in and made part of this Policy.
H.Design Professional's lnsurance
You shall require that each Design Professional, with whom you enter into a written agreement, carry
professional liability insurance.
l. Headings
The descriptions in the headings of this Policy are solely for convenience and form no part of th e terms and
conditions of this Policy.
J.lnspection and Audit
We shall be permitted, but not obligated, to examine, audit, monitor and inspect on a continuing basis any
of your books, records, servces, properties and activities at any time, as far as they relate to the subject
matter of this Policy.
Neither our right to examine, audit, monitor and make inspections, or the actual undertaking thereol or any
report thereon, neither constitutes an undertaking to determine or warrant that property or operations are
safe, healthful, or conform to acceptable engineering practice, or are in compliance with any law, rule or
regulation. Any inspections shall be coordinated through the broker or agent of the First Named lnsured.
K. Other lnsura nce
Unless expressly stated to the contrary, this Policy is excess orer the Self-lnsured Retention Amount and
any other valid and collectible insurance whether such other insurance is stated to be primary, contributory,
excess, contingent or otherwise, unless such other insurance is written specifcally excess ofthis Policy by
reference in such other policy to this Policy Number in this Policy's Declarations. When any other
insurance has a duty to defend a Claim, we shall ha\E no duty to defend the Claim; ifthe other insurance
does not defend the Claim, we shall ha\e the right, but not the duty to defend the Claim.
With regard to SECTION I - INSURING AGREEIVENTS, B. Pollution Coverages, when you are required by
written agreement, executed prior to the first commencement of the Pollution Condition, to include any
person or entity as an additional lnsured, such co\,e rage shall be provided on a primary and non-
contributory basis to the extent required by the written agreement.
@ 2018 X.L. America, lnc. All Rights Reserved
May not be copied without permission.
EVPCPoCCP 06 '18
vsET'10/13/2019
Page 27 ol 28
L true, correct and complete;
Endorsement NumberNarned lnsured
Hillcrest Contracting, lnc Policy Number5431U296Symbol: Number:
Policy Period
1 0 I 0 I t2021 - 1 0 I 0 I t2022
Effective Date of Endorsement
10t01t2021
lssued By (Name of lnsurance Company)
Federal lnsurance Company
lnsen lhe pol cy number. The remainder of the lntormation s lo be completed only when this endorsemenl s ssued subsequent 1o lhe preparatron of the polLcy
Workers' Compensation and Employers' Liability Poli
CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because California is shown in ltem 3.A. of
the lnformation Page.
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, but this waiver applies only with respect
to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract
to obtain this waiver from us.
You must maintain payroll records accuralely segregating the remuneration of your employees while engaged in the
work described in the Schedule.
Schedule
( ) Specific Waiver
Name of person or organization
(X) Blanket Waiver
Any person or organization for whom the Named lnsured has agreed by written contract to furnish this
waiver.
2. Operations:
3. Premium:
The premium charge for this endorsement shall be 1.0 percent of the California premium developed
on payroll in conneclion with work performed for the above person(s) o. organization(s) arising out of lhe
operations described.
4. Ivlinimum Premium: $0
wc 90 03 75 (05/18)
Authorized Representative