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2022/10/01 HHS Construction, LLC:-,-ACORiS 10101t2022 THIS CERTIFICATE IS ISSUED AS A MATTEB OF INFORMATION ONLY ANO CONFERS NO BIGHTS UPON THE CERTIFICATE HOLOER. THIS CEBTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTENO OR ALTEB THE COVEBAGE AFFOROED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUBER(S}, AUTHORIZEO BEPRESENTATIVE OB PRODUCER, ANO THE CERTIFICATE HOLDER. IMPORTANT: lf the certificate holder is an AODITIONAL INSURED, the policy(ies) must have AOOITIONAL INSUREO provisions or be endorsed. lf SUBROGATION lS WAIVED, subjoct to the lerms and conditions of the policy, certain policies may require an endoBemenl. A statement on this certilicate does not conter rights to the certificate holder in liou of such endorsement(s). PFOOUCEF Lockton Companies, LLC 3657 Eriarpark Dr., Suite 700 Houston. TX 77042 CONTAEI PHONE(A/c-11o, Exl): E.MAITAODFESS: 888.828.8365 INSI]FER A INSUFEB B INSUFER C INSUBER O INSUFEF E INSUFEB F INSPERITYCERTS@LOCKIONAFF NITY COM tNsuhER(s) aFFoBDtNG COVEFAGE Ace Amencan lnsurance Co INSUREDHHS CONSTRUCTION. LLC 2042 S GROVE AVE oNTARIO. CA 91761-5617 CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE NUMBER:COVEBAGES BEVISION NUMBER THIS IS TO CEF]TIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUF]ED NAMED AAOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TEFI\,I OR CONOITION OF ANY CONTBACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE I!,4AY BE ISSUED OB MAY PEFIAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCFIBED HEREIN IS SUBJECT TO ALL THE TEBMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCEO BY PAID CLAIMS. TYPE OF INSURANCE LIMITSPOLICY EFF POLICY EXPIMM/DD/YYYY) IMM/DD/ryYYY) $ $ s s S SOTHEB COMMEFCIAL GENEFAL LIABILITY CLAIMS.MADE OCCUF PEFSONAL A ADV INJUBY GENEBAT AGGFEGATE PAODUCTS, COMP/OPAGG EACH OCCUFiFIENCE DAMAGE TO RENTED PREMISES (Ea occ!dencel MED EXP (Any ono person) s S s s s AUTOTNOAILE LIABITITY HIFED AUTOS SCHEDULET) AUTOSNON OWNED AUTOS COMBIN€D SINGLE LIMIT 1E4q lideil) BODILY INJUFY (P6, person) BODILY INJUFY (Por accdsnl) PBOPEBTY DAMAGE ALL OWNED AUTOS UMEAELLA L|AE occuB EXCESS LIAB CLATMS.MADE DED RETENTIONS s s EACH OCCUFFENCE AGGBEGAIE olH- EB PLOYEE YLMIT c5161396A 10t01t2022 10to1t?o23 x STATUTE E L EACI] ACC]DENT E L DISEASE . EA EM EL DISEASE POL C WOFKERS COMPENSATION AND EMPLOYEFS' LIABILITY ANY PFOP'I ETOR/PARTNER,iEXECUTIVE OFFICEFTMEMBEF EXCLUDED?s 1 9@iA s 10g!ry I 1,000 000DESCBIPTION OF OPERATION OESCaIPnON OF OPEFAnONS / LOCAIONS ,I VEHICLES (ACOEO 101 , A<ldirlon.l R.rn.rb Schldule, mry be rtl.ch.rt ll hor. .p.c. i. Gquircd) Warver ol Subrogalon 6lavorolCerl Eate Hordorwhon reqwod by wrinen.ontracl BE ALL OPEBATIONS PEFFOAMED BY THE NAMEO INSURED OURING THE CURRENT POLICY PEFIOD, CERTIFICATE HOLDER CANCELLATION SHOULO ANY OF THE ABOVE OESCNIBEO POLICIES AE CANCELLEO BEFONE THE EXPIFANON DATE THEFEOF. NOTICE WILL AE DELIVEFEOIN ACCOFDANCE WITH lHE POLICY PAOVISIONS, THE CITY OF MENIFEE 29714 HAUN HOAD MENIFEE, CA 92586 AUIHORIZEO FEPRESENTATIVE acoBD 2s (2016i 03) o 1988-2016 ACORD COBPOFATTON The ACORO name and logo are registered marks of ACORD All riqhts reserved 22667 GEN LAGGREGATE LIM]T APPLIES PEF POLTCY jsL'r LOC C>\->e-z-<->- Workers' Compensation and Employers' Liability Policy Named lnsured HHS CONSTRUCTION. LLC 2042 S GROVE AVE oNTARIO, CA 91761-5617 Endorsement Number Policy Number Symbol RWC Number C51613964 PoIcy Period 1 0101 t2022 r o 1 0to1 t2023 Effective Date of Endorsement 1010112022 lssued By (Name of lnsurance Company) ACE AMERICAN INSURANCE COI\,{PANY lnsert the policy number. The remainder ofthe informalion is to be completed only when this endorsement rs issued subsequent lo the preparation of the policy This endorsement changes the policy to which it is attachocl and is effective on ihe date issued unless otherwise stated CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in ltem 3.A. of the lnformation Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule X Specific Waiver Name of person or organization THE CITY OF MENIFEE 29714 HAUN ROAD MENIFEE, CA 92586 ()Blanket Waiver Any person or organization for whom the Named lnsured has agreed by written contract to furnish this waiver. 2. Operations 3. Premium: The premium charge for this endorsement shall be l_,10 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: S0 @zgj;..< wc 90 03 75 (05/18) Authorized Agent o.Go' THIS CEBTIFICATE IS ISSUEO AS A MATTER OF INFORMATION ONLY AND CONFEBS NO RIGHTS UPON THE CEBTIFICATE HOLOER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENO, EXTEND OB ALTER THE COVEBAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUBEB(S), AUTHORIZED REPRESENTATIVE OB PBODUCEB. AND THE CERTIFICATE HOLDER. IMPORTANT: lf the certiticate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endoGed. lf SUBROGATION lS WAIVED, sub.iect to the terms and conditions of th6 policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the cortilicate holder in lieu of such endorsement(s). INSURED HI.IS CONSTBUCTION, LLC 2042 S GROVE AVE oNTARtO, CA 91761'5617 CONTACT PHONE ADDflESSI 888-828-836s N SPERITY C E BTS@LOC KTONAF F INITY COM INSURER(S) AFFOFOING COVEFAGE INSUBEF B INSt-IRER C INSURER O INSUFER E INSUNER F Ace American lnsurance Co 22667 CERTIFICATE NI,,'MBEBCOVERAGES BEVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSUBANCE LISTED BELOW HAVE EEEN ISSUED TO THE INSUBED NAMED ABOVE FOR THE POLICY PEBIOD INOICATEO NOTWITHSTANOING ANY BEOUINEMENT TERM OB CONDITION OF ANY CONTRACT OR OTHER DOCUII'ENT WITH BESPECT TO WHICH THIS CERTIFICATE IUAY BE ISSUED OR i,lAY PERTAIN. THE INSURANCE AFFORDED 8Y THE POLICIES DESCRIEEO HEREIN IS SUBJECT TO ALL THE TER[,{S, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN [,lAY HAVE EEEN REOUCED 8Y PAIO CLAIMS IYPE OF INSURANCElNSF POLICY €FF POLICY EXPIUM/DOTYYYYI (MM/ODTYYYY) EACH OCCURFENCE DAMAGE TO FENTED PREMISES lEa@cu encei MED ExP (Any one pecon) PERSONAL & ADV ]NJUFIY GENEFAL AGGFIEGATE s $ S s $ S s COMMEBCIAL GENERAL L'ABILI'Y CLAIMS.MADE OCCUB GEN L AGGFEGATE LIMIT APPLIES PEBI l Do^PoLrcY jib"r Loc OTHEB: PFODUCTS COMP/OP AGG $ 5 s s AUTOMOBILE LIAAILITY B NED AUTOS SCHEDULEO AUTOS NON.OWNED AUTOS ALL OWNEDAUlOS BOoILY TNJURY (Perac.denr) $ COMBINEO SINGLE LIMIT(Ea acod€.t) BOOILY INJUBY (Pe.pe6on) UMEBELIA L|AB occuF EXCESS LIAB CLATMS,MAOE DED BETENTION $ s 5 5 EACH OCCUBBENCE AGGBEGATE WOFKEFS COMPENSATION AND EMPLOYENS' LIABIfITY ANY PROPRIETOF]PAFTNEF/EX.ECI]T VFA oFFtcEFTMEMBEBExcLUDEo,(Mandelorv in NH)llws doscrlbo undero€scBrPTroN oF oPEBAT|oNs beto* ., PEN OIH^ srarUTE EB e.L ercn rccroent $ E,L, OISEASE. EA EMPLOYEE $ r 000.000 r 000.000 r 000.000 c51613964 1A1A112022 10101t2a23 E L OISEASE - POLICY LIMIT $ DESCBIPTION OF OPERAIIONS / LOCAI]ONS / VEHICLES (ACOFO l0l , Addilio.al R.m.rk! Sch.dol.. m.y b. rtr.ched ii moc ip.c. i. rcquir.d) Wa&er ol Sutogalron rn lalorol Cerl iicale Holder when.equrcd by w ll6n conka.l FIE ALL OPERAI ONS PEFFOFMEO BY THE NAMEO INSUFED DUBING THE CUFFENT POLICY PERIOD CEBTIFICATE HOLDER CANCELLATION CITY OF MENIFEE 28944 HAUN RD MENtFEE. CA 92586-6s39 AUTHOFIZEO REPFESENTATIVE ACORD 2s (2016/03) @ 1988-2016 ACOBD CORPORATToN The ACORD name and logo are registered marks ot ACORD All rights reserved CERTIFICATE OF LIAB!LITY INSURANCE OATE (MM/DO/YYYY) 10t01t2022 PFODUCEF Locklon Companies, LLC 3657 Briarpark Dr., Suite 700 Houslon.lX 77042 lrra x SHOULO ANY OF THE ABOVE OESCBIBEO POLICIES AE CANCELIEO BEFORETHE EXPIFATION OATE THEFEOF, NOTICE wlLL BE OELIVEAEDIN ACCOFOANCE wlTH THE POLICY PROVISIONS, O:--=-ez-<n Workers' Compensation and Employers' Liability Policy Named lnsured HHS CONSTRUCTION, LLC 2M2 S GROVE AVE oNTAR|O CA 91761-5617 Endorsement Number Policy Number Symbol RWC Number C5161396,4 Policy Period 1 0t0 1 12022 r o 1 0 t01 12023 Etfective Date of Endorsemenl 1010112022 lssued By (Name of lnsurance Compeny) ACE AMERICAN INSURANCE COMPANY lnsert the policy nuryrber The rema nder of the information is lo be completed only when thrs endorsement is issued subsequent to the preparatron of the poircy This endorsement chenges the policy to which it is attached and rs effective on the date issued unless otherwise stated CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in ltem 3.A. of the lnformation Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1 (X () Specific Waiver Name of person or organization CITY OF MENIFEE 28944 Haun Rd MENtFEE, CA 92586-6539 2. Operations 3. Premium: The premium charge for this endorsement shall be 1.0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: $0 ?zapi,,..< wc 90 03 75 (05/18) Authorized Agent Blanket Waiver Any person or organization for whom the Named lnsured has agreed by written contract to furnish this waiver. o.Go' 10/o112422 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENO, EXTEND OR ALTER THE COVERAGE AFFOROEO BY THE POLICIES BELOW. THIS CEBTIFICATE OF INSURANCE OOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED BEPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: lf the certificate holder is an ADDITIONA L INSU RED, the policy(ies) must have ADDITIONAL INSURED provisions orbeendorsed. lI SUBROGATION lS WAIVED, subject to the terms and conditions oI the policy, certain policies may require an endorsemenl. A statement on lhis certificate does not confer rights to the certificate holder in lieu of such ondorsemont(s). PFOOUCEF Lockton Companies, LLC 3657 Briarpark Dr., Suile 700 Houston, TX 77042 INSUFEO HHS CONSTRUCTION, LLC 2042 S GROVE AVE oNTARtO. CA 91761-s617 CONTACT AODFESS: 888-828-8365 141c, !!di INSURER B INSURER C INSIJBEF O INSUBER E 1!SPEIi!IYQERTS@LOCKIONAFF NIILCOI4 rNsuFEF(S) AFFOBOTNG COVEAAGE Ace American lnsurance Co 22667 CERTIFICATE OF LIABILITY INSURANCE CEBTIFICATE NUMBEBiCOVEBAGES REVISION NUMBER THIS IS TO CEBTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAI\.I|EO ABOVE FOR THE POLICY PERIOOINDICATED NOTWITHSTANDING ANY BEOUIREMENT TERM OB CONOITION OF ANY CONTRACT OR OTHEB OOCUMENT WITI-I BESPECT TO WI]ICH THIS CERTIFICATE MAY BE ISSUED OB I\,4AY PERTAIN, THE INSURANCE AFFORDEO 8Y THE POLICIES DESCRIBED HEREIN IS SUAJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIIVITS SHOWN MAY HAVE EEEN REOUCED gY PAIO CLAIMS. 'lff t""* **". i"'g' ty,tr poLrcy NU,,TBEF ,,i9H-B[ii,]. ,,iSHBIri,{,"r, Lrurrs $ $ COiIIIEBCIAL GENEFAL LIABILITY CLAIMS MAOE OCCUB PEFSONAL & ADV INJURY GENEFIAL AGGFEGATE PRODUCTS - COMP/OP AGG GEN L AG6BEGATE LIMIT APPLIES PEB PoLrcY 5E& Loc OTHEB EACH OCCUFBENCE OAMAGE TO HENTED_ PBEMISES tEa occu(en.el MED EXP {Any one person) S s s S s AIIIOMOBITF TIABILITY HIFEO AUTOS SCHEOULEO AUTOS NON-OWNED AUTOS aooiLY TNJUBY (Per accdenr) PFOPEBTY OAMAGE ALL OWNEO AUTOS COMEINED SINGLE LIMIT(Ea accid6nl) BOOILY INJURY (Per pe.son) UMBRELLA LIAB OCCUR EXCESS LIAB CLATMS MAOE OEO FETENTON$ s s s EACH OCCUFFENCE AGGFEGATE c5161396AX o t TI NS XWOF(EFS COMPENSATION AND EMPLOYEBS' LIABILITY ANY PROPR ETOR/PAFTNEF/EXECUT VEOFFICFR/i,|EI FFA FX'I IJDFO? STATUTE E L EACH ACCIDENT S E L DISEASE , EA EMPLOYEE S E L DISEASE . POLICY L MIT 5 000 000 000,000 000.000 OESCFTPTTON Ot OPERAnONS / LOCATIONS / VEHICLES (ACOhD 10i , Addirion.l Remark! Sch.dql., m.y b. .t.chod il mor6 lprd i3 Equlrod) waNer ol subrolalo^ rn,avor ol cenincab Holder when requrcd by M tlen contracl AE ALL OPEBATIONS PEBFOBMEO BY THE NAMED INSUFED DUFING THE CUBBENT POLICY P€FIOO CERTIFICATE HOLDER CANCELLATION SHOULO ANY OF IHE AEOVE OESCBIBED POLICIES 8E CANCELLED AEFONETHE EXPIBATION OATE THEFEOF, NOTICE WILL AE OELIVEFEOIN ACCOFOANCEWITH IHE POLICY PFOVISIONS, CITY OF MENIFEE DEPARTMENT OF FINANCE 29844 HAUN BD I\,tEN|FEE, CA 92s86-6s39 ACOBD 25 (2016/03) @ 1988-2016 ACOnD CORPORATTON The ACOHD name and logo are registered marks ol ACOBD All rights reserved Acct 2795388 q $ $ $ $ 10to1t2022 10to112a23 AUTHORIZED FEPBESENTAiIVE O:-->e:z-- Workers' Compensation and Employers' Liability Policy HHS CONSTRUCTION, LLC 2042 S GROVE AVE oNTARtO. CA 91761-5617 Endorsernent Number Polrcy NLrmber Symbol: RWC Number C5161396A Policy Period 10t41 12022 T O 10101 t2023 Effective Date of Endorsement 10to1t2022 lssued By (Name of lnsurance Company) ACE AMERICAN INSURANCE COI\ilPANY Insert the pohcy number The remainder oflhe information is to be compleled only when this endorsement is igsued subsequent to the preparation ofthe policy This endorsement chanqes the poLicy to which rt rs atached and is effechve on the date issued unless otherwise stated CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in ltem 3.A. of the lnformation Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. X Schedule Specific Waiver Name of person or organization: CITY OF MENIFEE; DEPARTTVENT OF FINANCE 29844 Haun Rd MENIFEE, CA 92586.6539 Blanket Waiver Any person or organization for whom the Named lnsured has agreed by written contracl to furnish this watver 2. Operations: 3. Premium: The premium charge for this endoGement shall be l-]0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. tvlinimum Premium: $0 () Qzaei;*< wc 90 03 75 (05/18) Authorized Agenl