2022/08/28 Dudek (7)A(:()RI)"
08t17 t2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY At{D CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEIID OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
THIS CERTIFICATE OF It{SURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE
OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lr the coniflcate holder is an ADDITIONAL INSURED, rhe policy(ies) must have ADDITIONAL IIISURED provisions or be endorsed. lf
SUBROGATION lS WAIVED, subject to the terms .nd condilion3 of the policy, certain policaes may rGquire En endoraement. A 3tatement on this
certificeto do6r not conl6r rights to the certificat€ holdsr in lisu of such sndorsement(s).
PROOUCER Lockton Companies
444 W. 47th Street, Suite 900
Kansas City MO 64112-1906
(816)960-9000
kctsu@lockton.com INSURERISI AFFORDING COVERAGE
tNsuRERA: zUrich American lnsurance company 16535
lNsuREo DUDEK
1474537 605 THIRO STREET
ENCINITAS CA 92024
rNsuR€R B: Continental Casualty Companv 20443
CERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE NUMBER: 1 28273
CANCELLATI
REVISION NUMBER:
men
o 1988-2015
812812023
COVERAGES
CERTIFICATE HOLDER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO EELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
PERIOD INDICATEO NOIWITHSTANDING ANY REOUIREMENT. 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 OESCRIBED HEREIN IS SUBJECT TO
ALL THE TERMS EXCLUSIONS AND CONDTTIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REOUCED AY PAIO CLAIMS
tNso SUBR
EACH OCCURRENCE s 1.000.000
s 100.000
MED EXP rAnv.ne De6on)s 10,000
PERSONAI & ADV NJURY 5 1,000,000
GENERAL AGGREGATE r 2,000,000
PRODICTS - COMP]OP AGG s 2.000.000
COMMERCIALGENERAL LAAILlTY
L AGGREGATE LIMIT APPLIES PER
X
X X
X
JECT
Y Y
GLOo146311 48t28t2022 08t28t2024
s
COM6INEO SINGLE LIMII s 1,000.000
AODILY NJURY (PeI Deuon)S XXXXXXX
SOOILY INJURY (Per a@idenl)6 XXXXXXX
$ XXXXXXX
AUTOMOBILE LIABILITY
SCHEOULEO
NONOW!ED
X
OW\ED Y Y
8AP0146329 08t28/2022 08t2u2423
S XXXXXXX
S XXXXXXX
EXCESS LIAB AGGRE6ATE S XXXXXXX
RETENT ON 5
NOT APPLICABLE
s
X PER I IOTH.
$ 1,000,000
E L DISEASE EA EMPIOYEE s 1.000,000
WORKERS COIIIPEN6ATION
ANO EIUPLOYERS' LIABILIIY
DESCRTPTToN oF OPERATiONS b.e
N
08t2at2a22 08t28t2023
E L DISEASE, POLCY LIM T s 1.000.000
B PROFESSIONAL
LIABILITY
EEH591932835 INCL POLL 0812812422 08t28t2023 PER CLAI\.' $1,000 000AGGREGATE $1.OOO,OOO
DESCRIPTIOII Of OPEFATIOIIS / LOCAITONS / VEHICLES (ACORD i 0 l, Addruon.l i.mrrt. Sch.dul., m.y b. .tt ch.d l, mon .p.c. l. oquhd)
2020-2021 ON-CALL CONSTRUCTION INSPECTION SERVICESt CITY AND ITS OFFICERS. OFFICIALS. EMPLOYEES. AND AUTHORIZED VOLUNTEERS ARE
INCLUDED AS AN ADOITIONAL INSURED ON THE GENERAL AND AUTO LIABTLITY POLICIES WAIVER OF SUBROGATION IN FAVOR OF THE ADDITIONAL
INSURED ON THE GENERAL AUTO, AND WORKER'S COMPENSAIION POLICIES 30 DAY NOTICE OF CANCELLATION APPLIES 10 DAYS NOTICE FOR
NON,PAYMENT OF PREMIUM
SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DA]E THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE wlTH THE POLICY PROVISIONS.
16828273
CITY OF MENIFEE
23844 HAUN ROAD
MENIFEE CA 92586
AUTHORIZEO REPRESENTATIVE
,$,"2^*/ *1
ACORo 2s (20r6i03)
The ACORD name and logo are registered marks of ACORD
ORO CORPORATION. All rights reserved
loeoL
" l*".'ou"o
I
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5ee
/
Attachment code : D564542 Certificate lD : 16828273
DUDEK.; 1474537
L
uxxroil
1828273
CITY OF MENIFEE
29844 HAUN ROAD,
IVI EN IFEE, CA 92586
Dear Valued Client:
Certifi cate lD: 15828273
Email: kctsu@lockton.com
Subject Line: TSU E-Delivery
Signing up for this will Ng[ sign you up for any solicitation emails - your email will only be used to
forward updated or renewal certiflcates direct from Lochon. The email you receive will look like this
u)0fl10tt
It-t6-.-*-tlt..rliErut*.-E L,&a.lr.
lf you received this letter with a certificate 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: "Certificate Removal"
L
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: 16828273.
You must reference this Certificate lD number in order ror us to complete this process,
Thank you for your cooperation.
Lockton Companies
Technical Services Unit
ErrEil/ iraihng Update - Liabihy Certifrcaios
Attachment Code : D574649 Certificate lD : 16828273
Additional Insured - Owners, Lessees Or
Contractors - Scheduled Person Or Organization
a
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Policy No. G1O0146311 Effecti\e Date: OB I 281 2022
This endorsement modifies insurance provided under the
Commercial General Liability Coverage Part
Name Of Additional lnsured Person(s)
Or Organization(s):Location(s) Of Covered Operations
ANY PERSON OR ORGANIZATION ARE REOUIRED
TO PROVIDE ADDITIONAL INSURED STATUS IN
A WRITTEN CONTRACT, AGREEMENT OR PERMIT.
ALL
LOCATIONS
CHEDULE
lncludes copyrighted rmlerial of lnsurance Services Office, lnc , w dh its pernission
u-GL-2169-A CW (02/19)lge1of2
ZURICH
Attachment Code : D574649 Certificate lD . 16828273
A. Section ll - Who ls An lnsured is amended to include as an additional insured the person(s) or organization(s)
shown in the Schedule of this endorsement, but only with respect to liability for "bodily injury", "property
damage" or "personal and advertising inrury" caus€d, in whole or in part, by:
l. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insured(s) at the location(s) designated in
such Schedule.
B. With respect to the insurance afforded to these additional insrrreds, the following additional
exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring
after:
'1. All work, including materials, pa rts or equipment furnished in connection with such work, on the project
(other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s)
at the location of the covered operations has been completed; or
2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by
any person or organization other than another contractor or subcontractor engaged in performing
operationsfora principal asa partofthe same project.
All other terms, conditions, provisions and exclusions of this policy remain the same.
u-GL-2169-A CW
(02/19)
Page 2 of 2
lncludes copyrighted materialof lnsurance Services Office,lnc., with its permission.
Attachment Code : D574649 Certiflcate lD . 16828273
Attachment Code . 0574648 Certificate lD : 16828273
Waiver Of Subrogation (Blanket) Endorsement
Policy No ElT. Dale of Pol ExD. Date of Pot Eff. Date of End.Add l l'rem
G 1o0146 3l.1 o8 /28/2022 o8/28 /2023 08/28n023 37385000 $ INCI,$
The follou,ing is added to the Transfer Of Rights Of Recorery Against Others To [-b Condtion:
Ifyou are required by a written contract or agreernent, u4rich is e)€cuted before a loss, to waive your rights ofrecovery Aom
others. we agree to waive our rights ofrecovery. This uaiver ofrights shall not be construed to be a waiver with respect to any
other operations in utrich the insured has no contractual interest.
u-GL-925-B CW
(r 2/01)
Page I of I
T}IIS E.{DORSTME{T CTIANGES THE POUCY. PLMSE READ IT CARIFT]LLY
This endorsernent mcdifies insurance provided under the:
Comrnercial C,eneral Uatilig Cowrage Part
Attachment Code : D574648 Certificate lD : 16828273
Attachment Code : D574651 Certificate lD : 16828273
cA20€1013
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED FOR
COVERED AUTOS LIABIL!-TY COVERAGE
With respect to co\erage pro\ided by this endorsement, the provsions of the Co\erage Form apply unless modified
by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" for Co\ered Autos Liability Co\erage
under the Who ls An lnsured pro\,,ision of the Co\€rage Form. This endorsement does not alter co\erage provded in
the Co\€rage Form.
This endorsement changes the policy efiecti\€ on the inception date of the policy unless another date is indicated
below.
Named lnsred: DUDEK
Endorsement Effective Date : 081281 2022
SCHEDULE
Name Of Person(s) Or Orga nization(s):
ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE REOUIRED TO
PROVIDE ADDITIONAL INSURED STATUS OR ADDITIONAL INSURED STATUS ON A
PRIMARY, NON.CONIRIBUTORY BASIS, IN A WRITTEN CONTRACT OR WRITTEN
AGREEMENT E)GCUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR
AGREEMENT IS PROHIBITED BY LAW.
red to com ete will be shown i
POLICY NUMBER: BAP0146329
COMMERCIAL AUTO
This endorsement modifies insurance pro\,ided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
Attachment Code : D574651 Certificate lD : 16828273
cA 20 48 10 13 @ lnsurance Senices Ofice, lnc., 2011 Page 1 of 2
Attachment Code : D574651 Certiflcate lD : 16828273
Each person or organization shown in the Schedule is an
'insured" for Co\ered Autos Liability Co\erage, but only to
the extent that person or organization qualifies as an
"insured" under the Who ls An lnsured pror,ision
contained in Paragraph A.1. of Section ll - Co\ered
Autos Liability Co\erage in the Business Auto and N,lotor
Canier Cowrage Forms and Paragraph D.2. of Section I
- Co\€red Autos Co\erages of the Auto Dealers Corerage
Form.
cA 20 48 10 13 @ lnsurance Senices Offce, lnc., 2011 Page 2 of 2
AttachpgB6pqtui\ffiAoEhF0l!fi"j,g tD : 1682827 3
Name(s) Of Person(sl Or Oroa nization(s):
ANY'iERSoN oR6RGANI-ZAION YdLJ ARE REOUIRED TO WAIVE YOUR RIGHTS
OF RECOVERY IN A WRITTEN CONTRACT. AGREEMENT OR PERMIT WITH THE
NAMED INSURED,
COMMERCIAL AUTO
cA 04 44 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WA]VER OF TRANSFER OF RIGHTS OF RECOVERY
AGATNST OTHERS TO US (WATVER OF SUBROGATTON)
This endorsement modifes insurance pro\,ided under the following
AUTO DEALERS COVERqGE FORM
BUSINESS AUTO COVERAGE FORN/
MOTOR CARRIER COVERAGE FORM
Named lnsured: DUDEK
Endorsement Effective Date : 081281 2022
SCHEDULE
nformation uired to com ete this Schedule if not s abore will be shown in the Declarations
The Tran$er Of Rights Of Recovery Againsl Others
To Us condition does not apply to the person(s) or
organization(s) shown in the Schedule, but only to the
extent that subrogation is wai\ed prior to the "accident"
or the "loss" under a contract with that person or
organization.
cA 04 44 10 t3 O lnsurance Sen,ices Ofice, lnc., 201'l Page 'l of 1
With respect to co\€rage provided by this endorsement, the pro\,isions of the Co\,erage Form apply unless modified
by the endorsement.
This endorsement changes the policy effecti\e on the inception date of the policy unless another date is indicated
below.
Attachment Code : D574651 Certificate lD . 16828273
Atta?00RRldkre6BF405flf, efi$iAflo Brrd$?ffiL3 r-reg Lrry r NS uRANcE poucy
wc0146330 Dudek 08t28t202208t28t2023
wc 00 03 13
(Ed. 4-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We ha\e the right to reco\€r our payments tom anyone liable for an injury corered by this policy. We will not enforce our
right against the person or organization named in the Schedule. (This agreement applies only to the extent that you
perform work under a written contract that requires you lo obtain this agre€ment from us. )
This agreement shall not operate directly or indirectly to beneft anyone not named in the Schedule.
Schedule
ANY PERSON OR ORGANIZATION YOU ARE REQU]RED TO WAIVE YOUR RTGHTS OF
RECOVERY IN A WRTTTEN CONTRACT, AGREEMENT OR PERMIT WITH THE NAMED
INSURED.
wc 00 03 13
(Ed. 4-84)
€ 1983 National Council on Compensation lnsurance.