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2021/10/25 Reliable Concrete Accessories (7)o.Ro' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS I]PON 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), AUTHORIZEO REPRESENIATIVE OR PRODUCER, ANO THE CERTIFICATE HOLDER, IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSUREO provisions or be endorsed- lf SUBROGAIION lS WAIVED, subject to the terms and condilions ol lhe policy, ce.tain polici* may rcquire an endorsement. A statement on this certificate does not confer riqhts to th€ certiricate holdor in liou of such endorsement(s)- PRoorJcER Edoewood Partners lnsurance Center {EPIC)'lgdOO MacArthur Blvd. PH Floorlrvine. CA 92612 www edqewoodins com 263 0606 I 263 0906 INSURER(A) AF FORDINC COVERAGE rNsuRERAi Ponnsylvania Lumbermens l\,'lulual lnsurance Co 14974 Reliable Concrete Accessories 7600 Redondo CircleHuntington Beach CA 92648 rNsuRERB, Securily Nalional lnsurance Coanpany 19879 rNsuRERc, Great Amencan lnsurance Company r6691 CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE tIUMBER: 64666912 CANCELLATION COVERAGES REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIS]ED BELOW HA\,€ EEEN ISSUED TO THE TNSUREO MMED AAOVE FOR THE FOLICY PERIOD INOICATED NOTWTHSTANOING ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO !'!tIICH THIS CERTIFICATE MAY BE ISSUEO OR MAY PERTAIN. THE INSURANCE AFFORDED AY THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES, LIMITS SHOV\N MAY HAVE BEEN REDUCEO 8Y PAIO CLAIMS 1 COM M € RCIAL GENERAL LIABILIIY GEN'L AGGREGAT E LIM]I APPL ES PER 04-R013-01 21 10t2512021 10125t2022 i 1,000,000 PREMISES rE. ocoirencer s 100,000 MEOExP (Any on6p.6on)!5.000 PERSONAL A ADVlNJURY s1 000 000 GENERAL ACGREGATE s2.000,000 PROOUCTS COMP/OP AGO 000 000 04-R013-02,21 1a/2512021 1012512022 COMBINEO S NCLE LIMIT r1 000 000 aoollY INJURY {P./ p.6on) BOOILY TNJURY (Pd &c'd.no t 10.000 04-R0r 3 03 21 10t25t2021 10t2512022 r5.000 000 s5,000.000 B AND EMPLOYERS' LIABILITY ANYPROPR ETOR/PARTNER/EXECUTVE OFF CER/MEMAEREXCLUDEO? DEs.RlPrroN oFoPFRAloNs eN st^,c1361650 1011t2021 10t1t2022 s 1,000,000 E L D]SEASE . EA EM PLOYEE s 1 000 000 EL DSEASE POL1CYLMI 31,000,000 c lnland Marine' Scheduled Equipment Excess Lrability $5[,,1M Excess of $sMI\i 04"R013-01-21 TAU95OO '1o12512021 10t2512021 '1o125t2022 10125t2022 $3,807,441 73 S2,500 Deductrble, ACV $5,000,000 Each Occunence 55 000 0oo Aooreoale Limit D€SCRTPTION Of OPERAITONS / LOCATIONS / VEH|CtES (ACORO r 01 Ad.fin6..r F.mrfi. S.h.dur., my 6. rirch.d ir mor. rp.c. i. nqlidd) The Crty of Menrfee The City of Menifee Communily SerMces. lhe Menrlee Housing Aulhority and each oftherr officers, ofllcals employees agenls and volunteers are included as Additional lnsureds as rospecls General Llabrhty and Automobrle Lrabrhty rnsurance per attached endorsemenls Pnmary and Non-Conlnbutory Il/brdrng apples per anached endorsemenl (s) \ brv€r of Subrogaron on \ lrrkers Compens3lron and Employers Llaorllty rnsu.arce as respecls lo lhe Cly ol Men'be the Crty ol Menrlee Communrty S€rvrces Drslrct lhe Mrnibe Housrng Aulhonty and eech of ther officers employees agents aod lolunteels per attached endorsemenl CERTIFICATE HOLOER AUIHORIZEO REPRESENTAIIVE WYsu- ACORO 2s (2016/03) o 1988"2015 AcORD CORPORATION. Allrighls rsserved The ACORD namo and logo aro registered marks of ACORD rr , rLear e ,ran.€ls and supersedes ALL pr€\iiouily issued c€rtrfi.ates I EgoMosrLEUABruw I t |7 Ielr'er.:ro IF 1 omro fl s.HFn!,FD II lAUrosoNLY lr'lAUTos lI lHrREo I lNoNow[EDLl l ^urosorrlY L! l AUTos oNLYl, ooc I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE]HE EXPIRATION DATE TBEREOF, NOTICE WLL BE DELIVERED IN ACCOROANCE WTH THE POLICY PROVISIONS, Cilv of Menifee 29844 Haun Road Menifee CA 92583 Rcl iahlc (i)ncrctc Acccssories t0l22l2{t2t {).1-lt0ll{)t-21 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROAD FORM ADDITIONAL INSURED This endorsement modifies insurance provided under the following COIMMERCIAL GENERAL LIABILITY COVERAGE PART 1. Broad Form Additional lnsured Paragraph 2. of Section ll - who ls An lnsured of Commercial General Liability Coverage Form cG 00 01 is amended to add the following: e. Additional lnsured by Writlen Contract or Written Agreem€nt The following are insureds under the policy when you have agreed in a written contract or agreement to provide them coverage as additional insureds under your policy: (1) Lessors of Leased Equipment: person(s) or organization(s) r,vho lease equipment to you, but only with respect to their liability lor "bodily injury", "property damage' or'personal and advertising injury" arising out of or caused, in whole or in part, by the maintenance, operation or use of such equipment by you, your 'employees", 'temporary workers'or "volunteer workers". Wilh resped to the insurance afforded to hese additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. l2l Owners, Managers or Lessors of Premises or Land: any owner, manager or lessor of premises or land, but only wilh respect to their liability arising out ot or caused, in whole or in part, by ownership, mainlenance or use ofthat part of such premises or land leased to you. This insurance does not apply to: (a) Any "occurrence" which lakes place after you cease to be a tenant or lessee of such premises or land, or (b) Struclural alterations, new construction or demolition operations performed by or on behalf oI the owner, manager or lessor of such premises or lard. (3) Mortgagees, Assignees or Receivers: any person(s) or organization(s) with respect to their liabilily as your mortgagee, assignee or receiver and arising out of their ownership, maintenance or use of your premises. This insurance does not apply to: Any structural alteralions, new construction or demolition operations pedormed by you or others for such person or organization. (4) Any person or organization, other than a joint venture, for whom you have agreed by written contract to provide "bodily injury' or "property damage' liability insurance, but only for liability arising out of or caused, in whole or in part, by operation(s) performed by you or on your behalf, provided that: (a) This Subparagraph (4) does not apply to any agreement to provide insurance to: (i) Any'employee", association of'employees" or labor union, except wilh respect to work performed by or for you or for such "employee", associalion of'employees" or labor union under direct contracl between you as contractor and such "employee", association of "employees" or labor union as owners, Pennsylvania Lumbermens Mutual lnsurance Company Philadelphia. Pennsytuania COMMERCIAL GENERAL LIABILITY LUM-145 02 06 Younabrrq I r0/?2/2021an-els dnd supersedes ALL prpviously issued certrfrcates. LUM-145 02 06 Page 1 of3 (ii) Any railroad company except with respect to work performed by you or for you for such railroad company under direct contract or agreement between you and such railroad company; (iii) Any person or organization whose profession, business or occupation is that of an architect, surveyor or engineer with respect to liability arising out of preparation or approval of maps, drawings, opinions, reports, surveys, change orders, designs or specifications; giving direclions or instructionsi failing to give directions or instructions; or the performance of any other professional services by such person or organization, (iv) Any of your contractors or subcontractors or any partner, ofticer, agent or "employee" of such contractors or subcontractorst and (v) Anyone described in Paragraphs e.(1) through (3) above. (b) lf a vendor of "your products" is an additional insured under this Coverage Form, such insurance as provided to lhe additaonal insured applies only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business and subject to the following additional exclusions. This insurance does not apply to: (i) "Eodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of assumption of liability in a contract or agreement. This exclusion does not apply to liability lhat the vendor would have in the absence of the contract or agreement, (ii) Any expressed warranty ofyour "products' unauthorized by you; (iii) Any physicalor chemical change in "your products" made intentionally by such vendor; (iv) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from you or the manufacturer, and then such parts are repackaged in the original container; (v) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make, or normally undertakes lo make in the normal course of business, in connection with the distribution or sale ol "your prodrcts"; (vi) Demonstration, installation, servicing or repair operations except such operalions performed at the vendor's premises in cmnection with the sale of'your products"; or (vii) Any of'your producls" which, afrer distribution or sale by you, have been labeled or relabeled or used as a container, parl or ingredient of any other item or substance by or for the vendor. This insurance afforded to the vendors in (4Xb) above does not apply to any person or organization from whom you have acquired such products, ingredients, parts or containers entering into, acconpanying or containing "your products". No insurance is provided under this vendor's coverage in (4Xb) if "bodily injury' or "property damage'under the "products-completed operations hazard" is excluded by any exclusions or provrsions ofthis Coverage Form or by any endorsement. (c) The insurance afforded to any person or organizaiion as an insured under Paragraph 2.e.(l) lhrough (4) above: (i) Shall include only that insurance required to be provided by the terms of such agreement, and then only to the extent that such insurance is induded within the terms of this policy, and lhat person's or organization's status as an additional insured under this endorsement ends: (a) when your operations for that additional insured are completed or (b) when any written contract or agreement with such person or organization is terminated or expires. Pennsylvania Lumbermens Mutual lnsurance Company Philadelphra. PennsylvaniaLUM-145 02 06 , 'trb, .c r!nnlr.r yornqberq ,0/r2lr0)r_r '. .r" ir''r c 'drc-14 dnd supars.lcs ALL pre;.ol's y rssJed carLrfrcares, Page 2 of 3 (ii) Does not apply to'bodily injury" or "prope(y damage" included within lhe "products- completed operations hazard" unless such coverage is required by an 'insured contract" between you and the additional insured. (iii) ls subject to all applicable exclusions of Paragraph 2. Exclusions, Coverage A (Section l). (iv) Does nol include any person or organization induded as an insured under the provisions of Section ll - Who ls An lnsued or included as an additional insured by any other endorsemenl lo this policy. (d) The limits of insurance afforded to such additional insureds shall be the lesser of the limits required by any contract or agreement between the parties or provided by this pdicy. (e) The insurance afforded to any person or organization as an additional insured under this Paragraph 2.e.(1) through (4) does not apply to "bodily injury" or "property damage" which o@urs prior to the date of your contract or written agreemenl with such person or organization. 2. Other lnsurance The insurance afforded to any additional insured under Paragraph 2.e.(l) through (4) will be primary and non- contributory iI requlred by such contEct or agreement with you. 3. Waiver of Right of Recovery by Written Contract or Agreement We waive any right of recovery lo payments we make for iniury or damages arising oul ot your ongoing operations or'your work" included in the "products-completed operalions hazard". This applies to any person or organization with whom you have agreed in a written contract or agreement made prior to the date of the "occurrence" to waive your rights of recovery from such person or organization, but only for payments made under this insurance as a consequence ofsuch contract or agreernent. LUM.'145 02 06 Pennsylvania Lumbermens Mutual lnsura)ce Company Philadelphra, Pennsylvanra rnd rupersedps Att prev.orsly lsqued rerrrflcdres. Page 3 of 3 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY wc 00 03 13 (Ed.04-84) WAIVER OF OUR RIGHT TO RECOVER FROI\,I OTHERS ENDORSEI\,IENT Schedule Any person or organization as required by written contract This endorsement changes the policy to which it is allached and is efiective on the date issued unless otheMise staled. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effectiuefin1no2.t Policy No. sr c13616so Endorsement No. lnsured p"|1"61" 6sn6reteAccessories lnsurance Company Security National lnsuranc€ Company Countersigned by wc 00 03 '13 (Ed 04-84) 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 agreemenl applies only to the extent that you perform work under a written contracl that requires you to obtain this agreement kom us.) This agreement shall not operate direclly or indirectly lo beneflt anyone not named in the Schedule. Wyg'"*-- .a'r .'on'el. -nd sLpp,p-dps AIL prpv oJs-y lrsued .errlficates, Rcliablc ('oncrclc Acccssorics POLICY NUMBER: 0.1-R0ll-02-2 I COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FoRM NAME: COMMERCIAL AUTOMOBILE EXTENSTION ENDORSEMENT This endorsemenl modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM A. Any person or organization whom you are required by contract to name as additional insured is an "insured" for LIABILITY COVERAGE but only to the extent that person or organization qualifies as an "insured'under the WHO lS AN INSURED provision of Section ll- LIABILITY COVERAGE. B, For any person or organization for whom you are required by contract to provide a waiver of subrogation, the Loss Condition- TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US is not applicable. C. The insurance afforded to any additional insured whom you are required by contract to name as an additional insured will be PRIMARY AND NON-CONTRIBUTORY by such contract or agreement with you. , hb, E r.nnit.r y6unq6..q I 10/22l?021 3:03:50 N (po,r)thrs ..r''r drp Jn.cls dnd superseoes ALL prcvrousty rssupd cerrrticdres.