2021/07/08 TR Design Group, Inc. (4)--,ACORD TRDESIG-01
CERTIFICATE OF LIABILITY INSURANCE '11t1812021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORTIATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENO, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHEPOLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S}, AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
It PORTANT: tf tho certificate holder is an ADOITIONAL INSURED, tho policy(iss) must have ADDITIONAL INSURED p.ovlslons or bo endorsed.
lf SUBROGATION lS WA|VED, subject to ths t6rms and conditions oI tho policy, cerlain policies may requirs an endoEomont. A statement on
this certificate does not confer aights to the co.tificate holder ln lieu of such endorsomonl(s).
rNsuRER(S) AFFOBpllqcOvERAGE
TNSUBEBA: Ohio Security lnsur4!e Comp4y
|NSIJRER a ;Property and Casualty lnsuranco company of Ha ord
rNsuEEE! ; Lexington lnsurancq lqompany
l fnl-.rrqqti?ltarz
INSURED
f
03469
1 7
pnooucen L nse # 0757776
rnational.com
TR Design Group, lnc.
2900 Adams St., Ste. A400
Riversido, CA 92504
HUB lnternational lnsulance Servicss lnc
PO Box 5345
Riversids, CA 92517
TNSURER D I
INSURER E:
fiRilElcr Kristie Koehre
COVERAG CERTIFICAT R N NUMBER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAi.4ED ABOVE FOR THE POLICY PERIOD
IIoiceTTo. NoTWTHsTANoING ANY REQUIREIMENT, TERM oR coNDITIoN OF ANY CONTRACIOROTHER DOCUMENTWTH RESPECTTO VVIiICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURAN
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOV\./N
CE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTOALL THETERMS,
MAY HAVE BEEN REDUCED BY PAID CLAIIT,'IS
L MITSlaoaLlauBRl
x
2,000,000
15,000
2,000,000
4,000,000
4,000,000
COMMERCIAL GENERAL TIABILITY
518t2022] cre us raeoe f4 ] occua Stat2021BZS (22) 56 41 41 9s
A RRENCE
x
x
2,000,000
GE N ERAL AGGR EGATE
DAMAGE fO RENTED
PSEMSES iEs occurencsl
UED EIe(Anv one p€6on)
PEEsq{A! !!qV !!lU8Y
LOCI 'ou"" I 3gg
r O!!NEDAUTOS ONLY
HIREDAUTOS ONLY i
2,000,000
BZS (22) s6 41 41 95
NON'WNEDAUTOS ONLY
x
AIJIOMOBIfE LIABIL'TY NLB 5D GL lr'
r)
SCHEOULEDAUTOS
AGGREGATE
EACH OCCURRENCE
OED REIENTION $
OCCUR
CLAIMS,MADEEXCESSLIAB
11122t2022
x TI.]TE
EL DS
'1,000,000
1,000,000
'1,000,000
OTH
EL DISEASE - EA EMPLOYE
woRKERS COiiPENSAnOiIANO EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVEOFF]CER/MEMBER EXCLUOED?
,11t22J2021B
X 72 wEc EV4335
Ded $25K./EAClaim Lmt
Aggregate
't,000,000
2,000,000
7 022
71at2022
7Professional Liab
7t8t2021
7't't'121
C Professional Liab.
oEscRtpTtoN OF opERATtoNs / LocAloN s / VEBTCLES {AcoRo 101, Addrrron.r R.m.rt! sch.dure, may be .tt.chod ra moE .p.co It EqulEd)
RE: AgreCment No. #2021-0214 and the corresponding Purchase Order (PO) *42975.
The C_ity of Menife€ and its officers, emptoyeei, agenG, authorized volunteers and all persons or€ntities are Additional lnaured with r€gard to Generaland
Auto Li;batity when required by written ioitraci $r the attached endoGement form 8i,7996 O9/16. Primary & Non_-Contributory wording applies with regard
to ceneral Liabitity wnin required by written co;tract per the attached endorsement form 8P1488 07/13. Walver of Subrogation with regard to Workers
Compensation applies when required by written contract per the attached endoEement foIm WC040306.
Should the poticies be cancetted before the expirataon date, Hub lnternational lnsurance Services lnc. (Hub), independent of any rights which may be afforded
SEE ATTACHED ACORD 101
The City of Mehilee
Attn: Paula Muratore
298i14 Haun Road
Menifee, CA 92586
SHOULO ANY OF THE ABOVE DESCRIBEO POLICIES BE CAI{CELLEO BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVEREO III
ACCORDANCE wlTH THE POLICY PROVISIONS.
AIJTHORIZED REPRESENTAT]VE
R CANCELLA
O 1988-2015 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks o, ACORD
ACORD 2s (2016/03)
PRODLJCTS COMP/OPAGG
I BoDTLY rNJlld 1eq!!9!9 1$
I PRoPERTY oAMAGE| (Perac.ld.nt) I $
51812021 5/8/2022 I BoD,Ly rNrucy €9:ls6on) , $
t
It---
Lr _-E L EACH ACCIOENT
03171112',1
*&ru,,-
acENcY cusToMER tD: TRDESIG-01
LOC #: I
ADDITIONAL REMARKS SCHEDULE
SGONZALEZ
ACoRD'
License # 0757776
HUB lnternational lnsurance Services lnc TR Dosidn Grouo. lnc.
29oo Adems sr., Ste. A400Riverslde, CA 92504
SEE PAGE 1
PAGE I EEPl EFFEcnvE DAIE: sEE PAGE 1
ADOITIONAL REIVIARKS
O 2008 ACORD coRPORATION. All rishts reserved
The ACORD name and logo are registered marks of ACORO
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
Certificate of LiabiliW lnsurancsFORM NUMBER: AcORp2s FORM TTTLE:
Description of Operations/Locationslvehicles:
within the policies to the certificate holder named below, will provide to such certificate holder notice of such cancellation within
thirty (30) days of the cancellation date, except in the event the cancellation is due to non-payment of premium, in which case Hub
will provide to such certificate holder notice of such cancellation within ten (10) days of the cancellation date.
ACORD 101 (2008/01)
Page 1 of I
BUSINESSOWNERS
BP 79 96 09 16
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESSOWNERS LIABILITYEXTENSION ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
Below is
summary
a summarization of the coverages provided by this endorsement. No coverages are given by this
Actual coverage descriptions are within this endorsement.
SUBJECTSECTION
A.
T
Supplementary Payments
Bail Bonds
Loss Of Earnings
Broadened Coverage For Damage To Premises Rented To You
lncidental l\redical Malpractice lnjury
Mobile Equipment
Blanket Additional lnsured (Owners, contractors Or Lessors)
Newly Formed Or Acquired Organizations
Aggregate Limits
Duties ln The Event Of Occurrence, Offense, Claim Or Suit
Liability And Medical Expenses Definitions
Bodily lnjury
lnsured Contracl
Personal And Advertising lnjury
Section ll - Liability is amended as follows:
A. Supplementary Payments
Section A.l. Business Liability is modified as follows:
1. The g25O limit shown in Paragraph A.1.f.(1Xb) Coverage Extension - Supplementary Payments for the
cost of bail bonds is replaced by a $3,000 limit
2. The $250 limit shown in Paragraph A.f .f.(lxd) Coverage Extension - Supplementary Payments for
reasonable expenses and loss of earnings is replaced by a $500 limit.
B. Broadened Coverage For Damage To Premises Rented To You
1. The last paragraph of Section E}.1. Exclusions - Applicable To Business Liability Coverage is replaced
by the following:
Wth respect to the premises which are rented to you or temporarily occupied by you with the permis-
sion of the owner, Exclusions c., d., e., g., h., k., 1., m., n. and o. do not apply to "property damage"'
B.
c.
D.
E.
F.
G.
H.
t.
@ 2016 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance Services Office, lnc., with its permissionBP 79 96 09 16 Page '1 of 4
2. Paragraph D.2. Liability And Medical Expenses Limits Of lnsurance is replaced by the following:
The most we will pay under thls endorsement for the sum of all damages because of all "property
damage" to premises while rented to you or temporarily occupied by you with the permission of the
owner is the Limit of lnsurance shown in the Declarations.
3. Paragraph D.3. Liability And Medical Expenses Limits Of lnsurance does not apply.
C. lncidental Medical Malpractice lniury
1. Paragraph (4) under Paragraph 8.1j. Exclusions - Applicable To Business Liability Coverage - Profes-
sional Services does not apply to "lncidental Medical Malpractice lnjury" coverage.
2. Wth respect to this endorsement, the following is added to Section F. Liability And Medical Expenses
Definitions:
a. "lncidental Medical Malpractice lnjury" means bodily injury arising out of the rendering of or
failure to render, during the policy period, the following services:
(1) Ivledical, surgical, dental, x-ray or nursing service or treatment or the furnishing of food or
beverages in connection therewith; or
(2) The furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances.
b. This coverage does not apply to:
(l) Expenses incurred by the insured for firslaid to others at the time of an accident and the
Duties in the Event of Occunence, Offense, Claim or Suit Condition is amended accordingly.
(2) Any insured engaged in the business or occupation of providing any of the services described
under a. above.
(3) lnjury caused by any indemnitee if such indemnitee is engaged in the business or occupation
of providing any of the services described under a. above.
D. Mobile Equipment
Section C. Who ls An lnsured is amended to include any person driving "mobile equipment" with your
permission.
E. Blanket Additional lnsured (Owners, Contractors Or Lessors)
l. Section C. Who ls An lnsured is amended to include as an insured any person or organization whom
you are required to name as an additional insured on this policy under a written contract or written
agreement. The written contract or agreement must be;
a. Currently in effect or becoming effective during the term of this policy; and
b. Executed prior to the "bodily injury", "property damage", or "personal and advertising injury".
2. The insurance afforded to the additional insured is limited as follows:
a. The person or organization is only an additional insured with respect to liability arising out of:
(1) Real property, as described in a written contract or written agreement, you own, rent, lease,
maintain or occupy, and
(2) Caused in whole or in part by your ongoing operations performed for that insured.
b. The Limit of lnsurance applicable to the additional insured are those specified in the written
contract or written agreement or the limits available under this policy, as stated in the Declara-
tions, whichever are less. These limits are inclusive of and not in addition to the Limit of lnsurance
available under this policy.
c. The insurance afforded to the additional insured does not apply to:
(1) Liabitity arising out ofthe sole negligence of the additional insured;
(2) "Bodily injury", "property damage", "personal and advertising injury", or defense coverage
under the Supplementary Payments section of the policy arising out of an architect's, en-
gineer's or surveyor's rendering of or failure to render any professional services including:
@ 2016 Liberty Mutual lnsurance
BP79 96 09 16 lncludes copyrighted material of lnsurance Services Office, lnc.,with its permission. Page 2 of4
i
(a) The preparing or approving of maps, shop drawings, opinions, reports, surveys, field
orders, change orders, or drawings and specifications; and
(b) Supervisory, inspection, architectural orengineering activities.
(3) Any "occurrence" that takes place after you cease to be a tenant in the premises described in
the Declarations; or
(4) Structural alterations, new construction or demolition operations performed by or for the
person or organization designated in the Declarations.
3. Any coverage provided hereunder shall be excess over any other valid and collectible insurance avail-
abie to the additional insured whether primary, excess, contingent or on any other basis unless a
contract specifically requires that this insurance be primary or you request that it apply on a primary
basis.
F. Newly Formed Or Acquired organizations
The following is added to Section c. who ls An lnsured:
Any business entity acquired by you or incorporated or organized by you under the laws of any individual
state of the United States of America over which you maintain majority ownership interest exceeding fifty
percent. Such acquired or newly formed organization will qualify as a Named lnsured if there is no similar
insurance available to that entity. However:
1. Coverage under this provision is afforded only until the 180th day after the entity was acquired or
incorporated or organized by you or the end of the policy period, whichever is earlier;
2. Section A.1. Business Liability does not apply to:
a. "Bodily injury" or "property damage" that occurred before the entity was acquired or incorporated
or organized by you; and
b. "personal and advertising injury" arising out of an offense committed before the entity was ac-
quired or incorporated or organized by you
3. Records and descriptions of operations must be maintained by the first Named lnsured.
No person or organization is an insured with respect to the conduct of any current or past partnership, joint
venture or limited liability company that is not shown as a Named lnsured in the Declarations.
G. Aggregate Limits
The following is added to Paragraph D.4. Aggregate Limits Liability and Medical Expenses Limits Of
lnsurance:
l. The Aggregate Limits apply separately to each of the "locations" owned by or rented to you or
temporarily occupied by you with the permission of the owner.
2. The Aggregate Limits also apply separately to each of your projects away from premises owned by or
rented to you.
For the purpose of this endorsement only, "location"
ing lots, or premises whose connection is interrupted
of-way of a railroad.
H. Duties ln The Event Of Occurrence, Offense, Claim Or Suit
means premises involving the same or connect-
only by a street, roadway, waterway or right-
1 paragraph E.2.a. Duties In The Event Of Occurrence, Offense, Claim Or Suit Liability And lvledical
Expenses General Condition applies only when the "occurrence" is known to any insured listed in
Paragraph c.1. who ls An lnsured or any "employee" authorized by you to give or receive notice of an
"occurrence" or claim.
paragraph E.2.b. Duties ln The Event Of Occurrencs, Offense, Claim Or Suit Liability And Niledical
Expenses General Condition will not be considered breached unless the breach occurs after such claim
or ,,suit,' is known to any insured listed under Paragraph c.1. who ls An lnsured or any "employee"
authorized by you to give or receive notice of an "occurrence" or claim.
2
BP 79 96 09 16
@ 2O16 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance Services Ofiice, lnc., with its permission Page 3 of 4
Section F. Liability And Medical Expenses Definitions is modified as follows
1. Paragraph F.3. is replaced by the following:
"Bodily lnjury" means bodily injury, sickness, disease, or incidental medical malpractice iniury
sustained by a person, and includes mental anguish resulting from any of these; and including
death resulting from any of these at any time.
Paragraph F.9. is replaced by the following
9. "lnsured contract" means:
a. A contract for a lease of premises. However, that portion of the contract for a lease of prem-
ises that indemnifies any person or organization for damage by fire to premises while rented
to you or temporarily occupied by you with permission of the owner is not an "insured
contract",
b. A sidetrack agreement,
c. Any easement or license agreement, except in connection with construction or demolition
operations on or within 50 feet of a railroad;
d. An obligation, as required by ordinance, to indemnify a municipality, except in connection
with work for a municipality:
e. An elevator maintenance agreement;
f. That part of any other contract or agreement pertaining to your business (including an indem-
niflcation of a municipality in conneclion with work performed for a municipality) under which
you assume the tort liability of another party to pay for "bodily injury" or "property damage"
to a third person or organization, provided the "bodily injury" or "property damage" is
caused, in whole or in part, by you or by those acting on your behalf. However, such part of a
contract or agreement shall only be considered an "insured contract" to the extent your
assumption of the tort liability is permitted by law. Tort liability means a liability that would be
imposed by law in the absence of any contract or agreement.
Paragraph f. does not include that part of any contract or agreement:
('l) That indemnifies a railroad for "bodily injury" or "property damage" arising out of con-
struction or demolition operations, within 50 feet of any railroad property and affecting
any railroad bridge or trestle, tracks, road-beds, tunnel, underpass or crossing;
(2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of:
(a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opin-
ions, reports, surveys, field orders, change orders or drawings and speciflcations; or
(b) Giving directions or inslructions, or failing to give them, if that is the primary cause of
the injury or damage; or
(3) Under which the insured, if an architect, engineer or surveyor, assumes liability for an
injury or damage arising out of the insured's rendering or failure to render professional
services, including those listed in (2) above and supervisory, inspection, architectural or
engineering activities.
Paragraph F.l4.b. Personal And Advertising lnjury is replaced by the following:
b. Malicious prosecution or abuse of process;
3
@ 2016 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance Services Otfice, lnc., with its permissionBP 79 96 09 16 Page 4 of 4
BUSINESSOWNERS
BP t4 88 07 't3
THIS ENDORSEMENT CHANGES THE POLICY. PLEASEREAD IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FOR|\tl
The following is added to Paragraph H. Other ln-
surance of Section lll - Common Policy Condi-
tions and supersedes any provision to the con-
tra ry:
Primary And Noncontributory lnsurance
This insurance is primary to and will not seek
contribution from any other insurance avail-
able to an additional insured under your poli-
cy provided that:
l. The additional insured is a Named ln-
sured under such other insurance: and
You have agreed in writing in a contract
or agreement that this insurance would
be primary and would not seek contribu-
tion from any other insurance available
to the additional insured.
,
BP t4 88 07 13 @ lnsurance Services Office, |nc.,2012 Page 1 of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT . CALIFORNIA
Policy Number: 72 WEC EV4335 Endorsement Number:
Effective Oate'. 11122121 Effective hour is the same as stated on the lnformation Page ofthe policy
Named lnsured and Address: TR DESIGN GROUP INC
29OO ADAMS ST UNIT A.4OO
RIVERSIDE CA 92504
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 agreement applies only to the extent that you
perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged an the work
described in the Schedule.
The additional premium for this endorsement shall be 2 % of the California workers' compensation premium othen ise due
on such remuneralion.
SCHEDULE
Person or Organization Job Description
Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from
US
Countersigned by
Authorized Representative
Policy Expiration Datet 1'1122122
.tr
Form wC 04 03 06 ('1) Printed in U.S.A.
Process Date: 10/07121