2022/12/01 CMB Structures, Inc.@.anstate.Y&t'i!6dh.^d:
Conificete Holdor:
CITY OF MENIEEE
2 9 7 14 IIAUN RD
MENIEEE, CA USA 925866540
Named lndrld:
CMB STRUCTURES, INC
?211 HAVEN AVE * E287
ALTA LOMA CA 91? 01.5 O 54
ct cw A(E 10 11
CERTIFICATE OF I NSURANCE
This cerlificaE is issued for inlomnlimal purposes only. lt cerlifies that the policils lisbd in thts docrirltnt ha\re been issued
to the Naned lnsured. lt dcs not grant any rights to any party ns can it be used, in any uay, to modify coverage provk ed
by such polic*s. Altsralion ot this cedificaE des not ctange lhe tsnns, exclusions or cmditms ol such pdicies. Corerage
is sublect to lhe provisions of the policies, including any exclusions or conditiorc, r€gardlesg ol the povisions of any olher
contact such as bet!\Een fte cerlificaE holder and the NarEd lnsured. The lirdts shown belo{v are the limits pro/kled at
the policy inceplion. Subsequent paid dains may rcduce these lhits.
Automotile LiaUlitv
ln$lgr Name: Allstate lnsurance Company
PolicyNumber: 048285011
x 1 - Any Auto 2 - Owned Autos Only 3 - Owned Priv. Pass. Aulos Only
4 - Owned Autos Other Than Priv
Pass. Autos Only
5 - Owned Autos Subject to
No Fault
6 - Owned Autos Sublect to a Compulsory UM Law
7 - Sp6cilicallV D€scribsd Autos 8 - Hired Autos Only 9 - Nonowned Autos Only
Policy E Lcdv. Oale 2 72-a7-2a22 Policy Exdretion lhlei 12- 01-2a23
Limits ol
lnsurance
s2,000,000 Combined Single Limit (each accid€nt)
Bl Per Person Bl Per Accident PD Per Accident
DascriBio{r ol OperEtions/Locations/Vehiies/Endorsomonts/Special Prcvidorls
hle]€sbd Party TtDe: Addi.tional Insured - Municipality
THIS CERTIFICA]E DOES NOT GRANT ANY COVEBAGE OR FIGHTS TO THE CEFNHCATE HOLDER.
IF 'IHIS CEHTIFICATE INDICATES'IHAT THE CERTIFICATE HOLDER IS AN ADDINONAL INSUHED, IHE POLICY(IES) MUST
EI'THEB BE ENDORSEO OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WIH ADDITIONAL
INSURED STATUS, IHE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EX"TENT INOICATED IN SUCH
POLICY LANGUAGE OR ENDOBSEMENT.
Producrr:
DOUG MOORE AGENCY
Dato:09-19-22
Authorized Re Fssenlathre;
L9t...riffi lncludes copyrighted material of lnsurance Services Oftic€, lnc., with its permission
Alhirts lnsurance Cqrpdry Pry I ol IBrr14.l cl cw Am 1011
Addilronal lnsu€d Copy
@q1'mm
L9i-.rliffi
POLICY NUMBER: 04 82 860 11 COMMERCIAL AUTO
cA 20 48 10 13
THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ IT CAREFULLY.
DESIGNATED INSUHED FOR
COVERED AUTOS LIABILITY COVERAGE
This endorsernent modifies insurance provided under the lollowing:
With respect to coverage provided by this endorsernent, the provisions ol the Coverage Form apply unless
modilied by this endorserEnt,
This endorsernent identifies person(s) or organization(s) who are "insureds" lor Covered Autos Liability Coverage
under the l4/ho ls An lnsurod provision of the Coverage Form. This endorsernenl does not aller coverage
provided in lhe Coverage Form.
This endorsernent changes the policy effective on the inception date ol the policy unless another date is indicaled
below.
Nanld Insured: CMB STRUCTURES, INC
Endors€nEntEfbctiveDab: L2-0l-2022
SCHEDULE
NerD Of PeBon(s) Or Organizator(s):
CITY OF MENIFEE
2 9 7 14 HAI]N RD
MEN]FEE, CA USA 925855540
lnlormalion required to complete this Schedule, il not shown above.lrylll be shown in lhe Dec laratio n s
Each person or organization shown in the Schedule is
an "insured" lor Covered Autos Liability Coverage, but
only lo the extent that person or organization qualilies
as an "insurod" under the vvho ls An lnsured
provision conlalned in Paragraph A1. of Section ll -
Covered Autos Liability Coverage in lhe Business
Auto and Molor Carrier Coverage Forms and
Paragraph O.2 ol Section I - Covered Autos
Coverages of the Auto Dealers Coverage Form.
O lnsurance Services Ottice, lnc., 2011
ldditional L$rad Copy
8!J1r4-3 ca 20 /a 10 13 PagE 1 ol 1
AUTO DEALEBS COVEBAGE FORM
BUSINESS AUTO CO\ERAGE FORM
MOTOB CABRIER COVEBAGE FORM
@4lqkls
CUSTOMER NUMBER: 67875 RIIN DATE: 09 - 19 -22
DOUG MOORE AGENCY
?27 O VICTORIA PK {3C
RANCHO CUCA}.'ONGA, CA 91739
l.li:il.riffi
CITY OF MENIFEE
2 9 7 ].4 HAI]N RD
MENIFEE, CA 92585.6540
BIlI4.3
1 000022091 904828601 '1 01 1 5001 33000'1003 Additonrl hs!€d Copy