2022/08/01 Cass Construction, Inc. (3)ACORif
COVERAGES
CERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE NUt{BER: 1 71563s582 REVISION NUMBER:
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON 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), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: ll the cortlflcato holder ls an ADDITIONAL INSURED, the pollcy(l.r) must h.vc ADDITIONAL INSURED provlslons or be endorred.
lf SUBROGATION lS WAIVEO, subi.ct lo tho t.rms and condltlons of tho pollcy, certain pollclos may raquiro an €ndorsomenl. A atatomont on
thi3 cartlltcat. doqs not confor rlght! to tho crrtificats hold.r in ligu ot 3uch ondoraamont(t).
PRODUCER
Alliant lnsurance Services, lnc,
701 B Street, 6th Floor
San Diego CA 92101
Lrcense#r0C36861
CONTACTNAgE:Robin Hamilton
iJ3''f" .,,, (s51) 225-2578
Robin.Hamilton liant.com
IN9URER(S} AFFOROING COVERAGE
r[suRER a: Federal lnsurance Company 20281
IN8URED
Cass Construction, lnc. dba Cass Arrieta
P.O. Box 309
El Cajon CA 92022
CASSCON,04 rrsuRER B : Executive Risk lndemnity lnc 35181
INSURER C
INSURER O
INSURER E
INSURER F
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED- NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOROED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIO CLAIMS-
TYPE OF INSURAI{CE POLICYNUMBER
POLICY EXP LIMITS
B x COMMERCIAL GENERAL LIABILITY
CLAIMS-MAOE OCCUR
GEN L AG6REGATE LIMJTAPPLIES PER:
POLICY
OTHER:
JECT LOCX
54303117 411/2022 at1no23
DAMAGE TO REN] ED
PREMISES (Ea occurene)5100,000
MED EXP (Any on. p6mn)$ 5,000
s 1.000.000PERSONAL & AOV INJL'RY
GEN ERAL AGGREGATE $ 2,000,000
PRODUCTS, COMP/OP AGG 5 2,000,000
s 5,000DEDUCTTBLE
X
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
SCHEDULEDAUTOSNON.OWNED
AUTOS ONLYxX
54303116 COMEINED SINGLE LIMIT s 1.000.000
BODILY INJURY (Per a6id€nt)5
-FRoFERrr oArirAGE I .rp.r *rldenrr
s
EICESS LlAB
X OCCUR
CLAIMS.MAOE
93652739 411/2022 8t1t2023 EACHOCCI]RRENCE $ 3,000,000
$ 3,000 000XAG6REGATE
oEo RETENTIONtr s
WORKERA COXP:NSANON
AND E PLOYERA' LIBILITY
ANYPROPRI ETOFYPARTNEF'EXECUTIVE
OFFICEP]MEMBEREXCLUOEO?
OESCRIPTION OF OPERATIONS below
54303118 81112022 811t2023 X STATUTE OTH,ER
E L EACHACCIDEN-T $ 1,000,000
E,L. OISEASE EA EMPLOYEE I 1,000,000
E.L OISEASE POLICY LIMIT s 1.000.000
DE8CR|PT|ON OF OPEnAT|ONS / LOCATTONS /VEH|CLEa (ACORO l Ol, Addldon.l R. .rt. S.h.dql., m.y b..tt ch.d I non .prc. 13 dqulDd)
Re: Encroachment Permit. Job 2490, Dry Utility Underground Street, St. Lt. & ln. for Audie Murphy Road Ph. 1 & Tract 36485-1
Certificate Holder is named as an additional insured (GL) per the attached G2012 endorsement.
CERTIFICATE HOLDER CANCELLATION
City of Menifee
29714 Haun Rd.
Menifee CA 92586-0000
SHOULD ANY OF THE ABOVE OESCRIBED POLICIEA BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE wlLL BE DELIVERED IN
ACCORDAICE wlTH THE POLICY PROVISIOIIS.
AUIHORIZED REPRESEiITAIIVEz(
@ 1988-2015 ACORD CORPoRATIot{. All rights r6sorvsd
Th6 ACORD name and logo are regl6tored marks qf ACORDACORO 2s (20r5103)
oarE (I[/Do/YYYY)
7D512022
EACHOCCTTRRENCE L S t.ooo,ooo
X
llltl
BODILY INJURY (P p6Bon) $
8t112022 ArnO23A AUTOIOBILE LIABILITY
,nII
El*,^l
POLICY NUMBER: 543031 17 COMMERCIAL GENERAL LIABILITY
cG 20 't2 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
ADDITIONAL INSURED - STATE OR GOVERNMENTAL
AGENCY OR SUBDIVISION OR POLITICAL
SUBDIVISION - PERMITS OR AUTHORIZATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
State Or Governmental Agency Or Subdivision Or Political Subdivision:
AS REQUIRED BY WRITTEN CONTRACT
Informalion required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section ll - Who ls An lnsured is amended to
include as an additional insured any state or
governmental agency or subdivision or political
subdivision shown in the Schedule, sub.iect to the
following provisions:
L This insurance applies only with respect to
operations performed by you or on your behalf
for which the state or governmental agency or
subdivision or political subdivision has issued a
permit or authorization.
However:
a, The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
b. lf coverage provided to the additional
insured is required by a contract or
agreement, lhe insurance afforded lo such
additional insured will not be broader than
that which you are required by the contract
or agreement to provide for such additional
insured.
2. This insurance does not apply to:
a. "Bodily injury", "property damage" or
"personal and advertising injury" arising out
of operations performed for the federal
government, state or municipality; or
b. "Bodily injury'' or "property damage'
included within the "products-completed
operations hazard'.
B. With respect to the insurance atforded to these
additional insureds, the following is added to
Section lll - Limits Of lnsurance:
lf coverage provided to the additional insured is
required by a contract or agreemenl, the most we
will pay on behalf of the additional insured is the
amount of insurance:
L Required by the contract or agreement; or
2. Available under the applicable limits of
insurance;
whichever is less.
This endorsement shall not increase the
applicable limits of insurance.
O lnsurance Services Office, |nc.,2018cG 20 12 12 19 Page 1 of 1