2022/08/28 Dudek (6).q<:c>nif
08t1712022
THIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATIOT{ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR t{EGATIVELY AMENO, EXTEND OR ALTER THE COVERAGE AFFORDEO BY THE POLICIES BELOW.
THIS CERTIFICATE OF INSURANCE OOES t{OT CONSTITUTE A CONTRACT BETWE€I{ THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE
OR PRODUCER. AND THE CERTIFICATE HOLDER,
IMPORTANT: It th6 certificate holder iB an AODITIONAL INSURED, the policy(ler) must h.ve ADDITIONAL INSURED provlslon8 or be endo.sed. lf
SUaROGATION lS WAIVED, subrect to th6 t6rm3 and condltions of the policy, cenain policies may rsquire an endoBsment. A statement on this
conifbato do63 not confer rights to the certificate holder in lieu ol such endoBomont(s).
PRODUCER LocktonCompanies
444 W. 47th Street, Suite 900
Kansas City MO 6,4112'1906
(816) 960-9000
kctsu@lockton corn INS UR ERIS
'
AFFOROING COVERAGE
tNsuRER A: American Guarantee and Liab lns co 26247
INSURED DUDEK
1477058 6os rHIRO STREET
ENCINITAS CA 92024
rNsuRER B: Zurich American lnsurance Company 16535
rNsuRER c : continental casualtv comDanv 20443
CERTIFICATE OF LIABILITY INSURANCE
CE ICATE NUMBER
CANCELLATION ee
REVISION NUMBER:
me
o'1988-2015
8/28t2023
COVERAGES
CERTIFICATE HOLDER
THIS IS TO CERTIFY THAT T).]E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMEO ABOVE FOR THE POLICY
PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREI!4ENT TERM OR CONDITION OF ANY CONIRACT OR OTHER OOCUMENT WTH RESPECT TO
WHICH THIS CERTIFICATE II4AY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 8Y THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO
ALLThETERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIM ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
tNso
$ 1.000,000
s 100,000
MED ExP iAny ore oe6on)$ '10.000
PERSONAL A ADV INJURY $ 1.000.000
GENERAL AGGREGATE $ 2.000.000
$ 2.000.000PROOUCTS. COMP/OP AGG
s
GLOo146311 08t28t202 08t28t2023BCOMMERC AL GENERAL LIAB L TY
FNI AGGRFGAIF IIMIT APPLIES PER
X
X
X
OTHER
Y Y
COMBINEO SINGLE LIM T $ 1.000,000
BODILY INJURY (PerpeGon)I XXXXXXX
BOoILY INJURY (Per acc'de.l)$ XXXXXXX
E $ xxxxxxx
$ xxxxxxx
Y
8AP0146329 a8t28t2422 48t28t2023
$ 5,000,000XEACH OCCURRENCE
t 5,000,000EXCESS LIAB
X 04t28t2022 oat2at2023
DED RETENIION I
N
AUC0146407
X
$ '1,000,000
E L O SEASE. EAEMPLOYEE $ 1,000,000
48128t2422 aat28t2023
E L DISEASE. POL]CY LlMT r 1.000.000
Y
wc0146330
WORXERS COiTPENSATION
AND EMPLOYERS' LIABILI'Y
OFF CEMEMBER EXCLUDEOT N
B
EEH591932835 NCL POLL 08t28t2022 08t2812023 PER CLArM $1.000.000AGGREGATE $2 OOO OOO
C PROFESSTONAL
LIABILITY
INCLUDES POLLUTION N
oEscRtPnoN oF oPERATTONS / LOCATTONS / VEH|CLES (ACORD 101. Addltlon.l R.m.rk6 Sch.dul., n.y b. rt ch.d ll moc .prc. l. rEquiEd)
RETANNUAL ON CALL PROFESSIONAL SERVICES THE CITY OF MENIFEE, ITS COUNCILMEIt4BERS, OFFICERS, AGENTS, ANO EMPIOYEES ARE ADDITIONAL
INSUREO ON GENERAL AND AUTO LIABILITY COVERAGE ON A PRIMARY. NON.CONTRIEUTORY 8ASIS, IF REOUIRED BY WRITTEN CONTRACT WATVER OF
SUBROGATION IN FAVOR OF THE ADOITIONAL INSURED APPLIES ON GENERAL. AUTO. AND UMBRELLA LIABILITY COVERAGE IF REOUIRED BY WRITTEN
CONTRACT ANO WHERE ALLOWED BY LAW COVERAGE IS SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY
SHOULO ANY OF THE ABOVE OESCRIBED POLICIES AE CANCELLEO BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WLL BE DELIVEREO IN
ACCORDANCE WITB THE POLICY PROVISIONS.
,b*/4
16753224
CITY OF T./lENIFEE
29714 HAUN ROAD
tvlENtFEE CA 92586
acoRo 25 (2016/03)
The ACORD name and logo are registered marks ot ACORD
ORO CORPORATION. All rights reserved
5f"oi [X.o"
B AUTOIOBTLE LtAArLrrY
tr r ^^"^,,"lscHFDrr FD
L----.1 aLrros oNLY L--l Auros] HjRED I NoN owNEDL l auros oNLY L---..1 AUTos oNLY
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Y
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Attachment Code . D564542 Master lD: 1477058, Certificate lD.. 16753224
DUDEK.;1477058
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16753224
CIW OF M ENIFEE
29714 HAUN ROAD,
MENIFEE , CA 92586
Dear Valued Client:
ln our continuing effort to provide timely certiflcate delivery, Lockton Companies is utilizing paperless
delivery of Certificates of lnsurance. To ensure electronic delivery for future renewals of this certificate, we
need your email address. Please contact us via the email below and reference Certificate lD:16753224.
You must reference this Cetifieate lD number in order for us to co
Certificate lt 16753224
Email: kctsu@lockton.com
Subject Line: TSU E-Delivery
u)ofloir
,r-.-bbE(*-b rrnalt,.it ua. * r- -.r o-...4 .n.
Thank you for your cooperation.
Lockton Companies
Technical Services Unit
5na lrafing LJpoere - L jabrh] .-,e1'f cates
L
Signing up for this will NQf siqn you up for any solicitation emails - your email Wll only be used to
forward updated or renewal certificates direct from Lockton. The email you receive will look like this:
lf you received this letter with a certiflcate via email, no further action on your part is necessary. lf you no
longer need this certificate, please contact us at the email address above, reference the Holder lD number
and use this subject line: "Certiflcate Removal"
L
,AC:C)RI).CERTIFICATE OF LIAB]LITY INSURANCE 08t17 t2022
THIS CERTIFICATE IS ISSUED AS A i/IATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER. 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, ANO THE CERTIFICATE HOLOER.
IMPORTANT: lf the certiticate holder is an ADDITIONAL INSURED, the policy(iB) must hav6 AOOITIONAL INSURED provbions or be endoB6d. lf
SUBROGATION lS WAlvED, lubjoct to the terms and condition. of th€ policy, certain policie3 may roqulrc an endorsement. A ltatement on this
csrtiticate does flot confer right! to the c6rtilicate holdor in lieu ol3uch endoBement(3).
PROOUCER LocktonCompanies
4,14 W. 47th Strcet. Suite 900
Kansas City MO 64112-1906
(816)960-9000
kctsu@lockton.com INSURERISI AFFOROING COVERAGE
rNsrrRERA: American Guarantee and Liab. lns. co 26247
INSURED DUDEK
1477058 605 THrRD STREET
ENCINITAS CA 92024
rNsuRER B: Zurich American lnsLlrance ComOany 16535
rNsuRER c : Continental Casualtv Comoanv 20443
INSURER D
8t28t2023
COVERAGES CERTIFICATE NUMBER: 1 7 53211 REVISION NUMBER:XXX
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO AELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
PERIOD INDICATED NOTWTHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO
WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO
ALL THE TERMS EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
TYPE OF INSURANCE lr,lSD SUBR
EACH OCCURRENCE $ 1,000,000
$ 100.000
MEO ExP lAnv on€ @rso.)$ 10.000
$ 1.000.000
GENERAL AGGREGATE s 2 000.000
PRODUCTS. COMP/OP AGG s 2.000 000
B COMMERCIAL GENERAL LIABILITY
NL AGGREGATE LMITAPPL ES PER
x
X X
X
CLAIMS.MADE
LOC
OTHER
JECT
Y Y
GLOo146311 0812812422 08t24t2023
COMBINED SINGLE L MIT $ '1,000,000
BOD LY INJLJRY (Per pe.son)S XXXXXXX
BOD LY INJURY (Peraccdent)$ XXXXXXX
$ XXXXXXX
oa128t2023
$ xxxxxxx
B AUTOMOBIL' LIABILITY
owrED
HIRED
SCHEOIJLED
AUTOSNON-O\ANEO
AIJTOS ONLY
X
Y Y
8AP0146329 08t28t2022
X $ 5,000,000EACH OCCURRENCEIJMBRELLA LIAB
EXCESS LIAB
X
LAIMS,MADE $ 5,000,000
DED RETENTION S
N Y
AUC0146407 1at2at2a22 0at2at2023
S
X lolH
r '1.000,000
E L DISEASE. EA EMPLOYEE $ 1,000,000
wc0146330 0at28t2022 0812812023
E L DISEASE POLCY LMIT $ '1.000.000
B
WORXERS COUPENSATION
ANO ETPLOYERS' LIABILITY
N
C PROFESSIONAL
LIABILITY
INCLUDES POLLUTION N N
EEH591932835 INCL POLL 48t2812022 oa2aDo23 PER CLATM $1.000.000
AGGREGATE $2,OOO.OOO
DESCiTPTTON OF OPERATTONS / LOCAnONS / VEHTCLES {ACORO 10r,Addrflo..r R.m.rtt S.h.dult, m.y b..rl.!h.d rl rnor..p.c. r. Equir.d}
PROJECI NEWPOR'T ROAD WDENING (ANIELOPE ANO MENIFEE) CIP *01.13 CITY OF MENIFEE AND ITS OFFICERS, OFFICIALS, EMPLOYEES, ANO AUTIIORIZEO VOLUNTEERS ARE
AODITIONAL INSURED ON GENERALANOAIJTO LIABILITY CO\€FAGE, ON A PRIi/IARY, NON.CONIRIBUIORY BASIS,IF REOUIREO AY U/RITTEN CONTRACT WAIVER OF SUSROGATION
IN FAVOR OF THE ADOITIONAL INSUREO APPLIES ON GENERAL, AUTO AND UMBRELLA LIABILITY COVERAG€ IF R€OUIREO BY IIRITTEN CONTRACT ANO I^+IERE ALLOV\ED AY LA!!
COVERAGE IS SUBJECTTOTHE TERMSANO CONDI'TIONS OF IHE POLICY
CERTIFICATE HOLDER CANCELLATION ee me
o 1988-2015 CORO CORPORATION. All rights reserved
SHOULOANYOF THE ABOVE DESCRIBEO POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE OELNERED IN
ACCOROANCE WTH THE POLICY PROVISIONS,
167 53211
CITY OF MENIFEE
2971! HAUN ROAD
MENIFEE CA 92586
AIJTHORIZED REPRESENTATIVE
/v"/4
ACORO 25 (2016/03)
The ACORD name and logo arc registered marks of ACORD
I
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Attachment Code : D564542 Master lD: 1477058, Certificate lD: 16753211
DUDEK.; 1477058
16753211
CITY OF MENIFEE
29714 HAUN ROAD,
MENIFEE, CA 92586
Dear Valued Client:
ln our continuing effort to provide timely certificate delivery, Lochon Companies is utilizing paperless
delivery of Certiflcates of lnsurance. To ensure electronic delivery for future renewals of this certificate, we
need your email address. Please contact us via the email below and reference Certificate lD: 16753211.
You must reference this Certificate lD number in order for us to comolete this orocess.
Certificate lD: 16753211
Email: kctsu@lockton.com
Subject Line: TSU E-Delivery
Signing up for this will Nqf sign you up for any solicitation emails - your email will only be used to
forward updated or renewal certificates direct from Lockton. The email you receive will look like this
rra-(-.,---
,a--ts.so-r !l<ED, r^ rrl, xa..- --. -a. r arr
lf you received this letter with a certificate via email, no further action on your part is necessary. lf youno
longer need this certificate, please contact us at the email address above, reference the Holder lD number
and use this subject line: "Certiflcate Removal"
Thank you for your cooperation.
Loclton Companies
Technical Services Unit
L
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ErEil / Marling Updale - Lrabilny Certifcates