2022/01/31 CableCom, LLCo.Qo"CERTIFICATE OF LIABILITY INSURANCE DAIE(MMn)DIYYYY)
01143t2022
THIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CEBTIFICATE HOLOER. THIS
CEBTIFICATE OOES NOT AFFIBMATIVELY OR NEGATIVELY AMENO, EXTEND OR ALTEB THE COVERAGE AFFOROEO BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOBIZED
REPRESENTATIVE OB PBODUCER, AND THE CERTIFICATE HOLOER.
IMPORTANTT ll tho certillcale holdor ls an ADOITIONAL INSUBED, ths policy(les) must have AOOITIONAL INSI,JBED provisions or bo ondorsed.
ll SUBROGATION lS WAIVED, sublecl to the terms and condltions ot tho policy, cortain policies may require an endorsemsnt. A atat€ment on
thls c€rtltlcsle does not conler righls to iho c€rtlllcate holder in lieu or such ondorsement(s).
"Marsh llSA. lnc.
Two Alliance Cenler
3560 Lenox Road, Suite 2400
Atlanra. GA 30326
CN102986923 uplGAWU 22 23
CONTACT
PHONE
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INSIJREF(S) AFFOROINC COVENAGE
t suaEF a : Libeo Mutual Fire lnsurance Company 23035
INSUFEO
Cablecom, tLC
19910 No.lh Creek Pa way Norlh, Suite'100
Borhell, wA 9801]
tNsuREF B: LM nsurance Corporalion 33600
IIISUBEA C: Libertv Surolus nsurance CorD 10725
tNsuEEF D I Lrbeny nsurance Corporalion 42444
INSI.IREF E
COVERAGES CERTIFICATE NUMBER:ATL 004595347 21 REVISION NUMBEH: 0
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INOICATED, NOTWITHSTANDING ANY REQUIBEMENT. TERM OR CONDITION OF ANY CONTFACT OR OTHEF DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE I\,4AY BE ISSUED OB MAY PERTAIN, THE INSURANCE AFFOFIDED BY THE POLICIES DESCBIEEO HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LI[.,!ITS SHOWN I.JAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSF TYPE OF ITISUFANCE POLICY NUMBER LIMITS
x COMMEFCIAL GENEFAL LIABILITY
CLA MS MADE OCCUF
6ENL AGGNEGATE LIMIT APPLIES PEB
POLICY JECT
X
X
TB2 631 004260 012 01t31D422 a181t2A23 EACH OCCUBFENCE s 5.000.000
DAMAGE TO FENTEO
PFEMISES (Ea @curience)S I 000,000
MEO ExP (Any one p€lson)s
PERSONAL & AOV INJURY $5 000.000
GENEBALAGGREGATE $r0 000,000
PRODUCTS COMP/OP AGG $r0 000,000
$
AUTO OAILELIAAILIry
I
OWNEDAUTOS ONLYHIRED
AUTOSONLY
SCHEDULEO
AUTOS
NON OWNED
AUTOS ONLYX
AS2 63r 004260 022 0113112422 01t31t2423 $s,000,000
BOOIIY INJUFY (P€, pe6on)s
BOOILY INJUFY (P6.a€d€nt)s
S
L X UMBFELLALIAB
EXCESS LIAB
OCCUF
CLAIMS.MAOE
RFE 631 510733 r42 0113112022 01t3112023 EACHOCCUBFENCE $5 000 000
AGGREGATE $s 000,000
DEI)BETENTIONS $
u
fl
D
WOFKERS COIIIPENSATION
ANO EMPLOYEFS' LIABILITY
ANYPFOPRI€TOB/PAFINEFVEXECUTIVEOFFICER/M'MBEA EXCLUOED?
DEscFrPTroN oF oPEBATtoNS berow
N
wA5 63D 004260-032 (A0S)
wc 5-63 r .004260-042 (r\rN,wD
w47"630.5r068S-512 (MA)
01t3112422
01131t2422
01111t2422
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X STATUTE OTHEF
E,L EACH ACCIDENT r.000,000$
E,L, DISEASE. EA EMPLOYEE $r.000.000
E.L OISEASE, POLICY LIMIT g 1.000.000
oESCFPnOt OF OPEFAnONS / tocATlONS / vElllclEs (AcoBo 101, Addirionrl B.m..t. S!h.dul.. m.y !. duch.., li moro .p@ l. rqulhd)
to General Liability as required by wrinen conlracl
CEBTIFICATE HOLOER CANCELLATION
Cily ol Menfee
Anni PLrblic Works Depl. Engineering 0ept
29714 Haun Rd Bldg A
Sun City, CA 92586-65{0
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION OATE THENEOF, NOTICE wlLL BE DELIVERED IN
ACCOROANCE WITH THE POLICY PBOVISIONS.
AUTHORIZEO FEPRESENTATIVE
%azzA 2/Sr4 2a-.
@ 1988-2016 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks ol ACORDACOHD 25 (2016/03)
LOC
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P]
Ed O Marsh
1'1001 Lakeline Blvd., Building'1, Suite 200,
Austin. TX 787't 7
4803City of MenifeeAttn: Pu-blj-c Works Dept- - Engineerj-ng Depts
29714 Haun Rd Bldg A
Sun City, CA 92585-5540 t#
0004803 0001 0001 04902