2022/07/01 Blackmore Co, LLC'-^A(:()Rt)-
07to112022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRIVIATIVELY 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), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IiIPORTANt lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed
lf SUBROGATION lS WAIVEO, subject to the terms and conditions of the policy, certain policies may require an endorsement- Astatementon
this certificate does not confer rights to the certificate holder in lieu of such €ndorsement(s).
PROOUCEF
James G. Parker lnsurance
Licenso #0554959
P O Bor 3S47
Ca(ie Stubble,leld CISR
(559) 222-7722 l5s9) 222-1724
CarieStubblefield@j9park6r.com
INSUR€AFFOROING COVERAGE
Evanston lnsulance Company
Oregon Mutual lns Co
Blackmore Co LLC
Blackmore Equipment Co LLC
41571 Date St
Murrieta
XL Specialty lnsurance Company
cA s2562
CERTIFICATE OF LIABILITY INSURANCE
CERTTFTCATE NUMBER: 22-23 GL BA l[4 UMBCOVERAGES REVISION NUI\4BER
TH S IS TO CERT]FY THAT THE POL CIES OF INSURANCE LISTED BELOW HAVE BEEN ]SSUED TO THE NSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQU RE]\,IENT TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WIIH RESPECT TO WIIICH THIS
CERIIFICA]E MAY BE ISSUED OR IVAY PERTAIN, THE INSURANCE AFFORDED BY THE POL CIES DESCRIBED HEREIN ]S SUBJECT TO ALLTHE TERMS
EXCLUS]ONS AND CONDITIONS OF SUCH POLIC ES LIMITS SHOI^A MAY HAVE BEEN REDUCED BY PAID CLA MS
TYPE OF INSURANC€LIMITS
E:ACH OCCTJRRENCE ! 't,000,000
PREM SES (Ea occlre.ce). 300,000
ME0 D(P {Anv on. eBon)$ 5,000
PERSONAL A ADV INJURY s 1,000,000
GENERALAGGREGATE $ 2,000,000
PROOUCTS. COMP/OPAGG $ 2,000,000
COMMERC IA L G EN EF AL LIAAILIry
LAGGREGATE LIMIT APPLIES PER
PoLrcY E 5E& E roc
oTu€R
I o..u"
MKLV5PBCOO4SO5 07t01t2022 07to1t2o23
Per Project Agg regate $ 10,000,0m
OOM€INEDSINGLELIMIT s 1,000,000
BOD LY NJLJRY(Per p.6on)s
BOOTLY TNJURY (P.. a.cd.nt)s
s
B OWNEO
AI]TOS ONLYHIRED
SCHEDULEO
NON.OWNED
AUIOMOAILE LIABILITY
cMo921413 07to1t2022 07 to1Da23
sxEACIi OCCURRENCE $ 4,000,00oxUMBRELLA LIAB
EXCESS LIAB
OCCUR
AGGREGATE $ 4,000,00o
DEO RETENTION S
MKLV5EUL1O4290 o't 1o112022 07to1t2023
$
STATIJIE or8
E L EACHACCIO€NT s
EL OJSEASE EA EMPLOYEE s
U/O RKEiS COMPENSATION
AI{O EMPLOYERS' LIABILITY
ANY PROPRI€TOR/PARTN ER/EXECW VE
OFFICER/MEMBER EXCLUOED'
OESCR PTION OF OPERATIoNS b.l@ E L DISEASE , POLICY LIMIT
c Rented/Leased Equipment
Schoduled Equipment Ul\r100089059M4224 07to.v2022 071o1t2023
$ I ,0O0 Deductible
ll,00O Oeductibl€
$58s,m0
Per Schedule
DESCRIPTIONoFOPERATIONS/LOCATIONS/VEHlCLES(ACOR01Or,AddlilonalicmarksSch.dul.,m.yb.at.ch.dfmor..pac.l.r.qukd)
xIII
xIEII
CERTIFICATE HOLDER CANCELLATION
City of M€nifeo
297'!4 Haun Rd
I
SIIOULDANY OF THEAAOVE OESCRIAED POLICIES BE CAT{CELLED BEFORE
THE EXPIRATION OATE THEREOF. NOTICE WLL BE OELIVERED IN
ACCORDAI{CE wlTH THE POLICY PROVISIONS.
AU-THORIZED REPRESENTATIVEa{*6fu^t
ACORO 25 (2016/03)
I
I 14so7
| 3788s
tr
cA 92586
@ 1988-2015ACORO CORPORATION. All righls rese ed.
The ACORO name and logo are register€d marks ofACORO