2022/03/16 Integrated Project Services, Inc. dba Pettit (3)A,COfr'D
COVERAGES
INTEGRA.Ol
CERTIFICATE NUMBER REVISION NUMBER
3118t2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORI'TATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AME'{D, EXTENO OR ALTER THE COVERAGE AFFOROED BYTHEPOLICIESBELOW. THIS CERTIFICATE OF INSURAI{CE OOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S), AUTHORIZED
REPRESENTATIVE OR PROOUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lI the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endors6d.lf SUBROGATION lS WAIVEO, subject to the terms and conditions oI the policy, certain policics may requirc an endoGement. A statement onthis certilicate does not confer rights to the c€rtiticate holder in lieu of such endorsement(s).
R!ilIAcr Jena Harrison
INSURERISI AFFOROING COVERAGE
rNsuRER a: state comDensation lns. Fund 35076
pRooucER License # 0C77485
Spectrum Risk Management & lnsurance Services. LLC
74 Discovervlrvine, CA 91618 ena ctrumrisk.com
lntsgrated Projsct Sorvlces, lnc. dba Pettit
1787 Pomona Road, S!lte D
Corona, CA 92878
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE FOR THE POLICY PERIOO
INDICATED NOTWTHSTANOING ANY REOUIREIV1ENT TERM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENTWTH RESPECTTO WtiICH THIS
CERTIFICATE MAY BE ISSUED OR IVAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDIIIONS OF SUCH POLICIES LIMITS SHO\A/N MAY HAVE BEEN REDUCEO BY PAID CLAIMS
LIMITS
EACH OCCURRENCE s
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OVINEDAUTOS ONLY
AI]TOS ONLY
SCHEDULEDAUTOS
AUTOMOBILE LIABILITY
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WORKERS COMPENSATIONAND E MPLOYERS' LIABILITY
ANY PROPR EIOR/PARTNER/EXECUT VE T 11
OFF CER/MEMEER E^CLUDED' I(ir.nd.loft ln NHI
OESCRIPTIONOFOPERATIONS/LOCATIONS/VEHICLES(ACORo101,Addition.lR.m.Schedul.,m.yb..ttch.ditmoE!p.c.lrroqul@dl
Re: FY2021-22 On-Call Engineering Services (Land Development Review) (Recoverable)
The City of Menife€, its directors, officials, oftice6, employees, agents and volunteers are certificate holder. waiver of subrogation applies to certificate
holder. 30 day notice of cancellalion applies.
City of Menifee
29844 Haun Rd.
Menifee. CA 92586
SHOULO ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION OATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCOROANCE WITH THE POLICY PROVISIONS-
AUTHORIZED REPRESENTATIVE
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ACORO 25 (2016/03)O'1988-2015 ACORO CORPORATION. All rights reserved
The ACORO name and logo are registered marks of ACORD
CERTIFICATE OF LIABILITY INSURANCE
JH408r
GENL AGGREGATE .,MIT APPLIES PER ]f l"ou"' f l!gp. [].o. I
HOME OFFICE
SAN FRANCISCO
ENDORSEMENT AGREEMENT
WAIVER OF SUBROGAT I ON
BLANKET BASIS
EFFECTIVE I.{ARCH 16, 2022 AT 12.01 A.M.
AND EXPIRING MARCH 15, 2023 AT }2.01 A,
BROKER COPY
93L3908-22
RENEWAL
SP
5-50-55-04PAGE 1 08
M
I
ALL EFFECTIVE DATES ARE
AT 12101 AM PACIFIC
STANOAFO TIME OB THE
TIME INDICATED AT
PACIFIC STANDARD TIME
PETT I T
1787 POMONA RD STE. D
coRoNA, cA 9287I
PERSON OR ORGAXIZATlON
WE HAVE THE RIGHT TO RECOVER OUR PAYT{ENTS FROI'I ANYONE
LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE HILL
NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR
ORGANIZATION NA}{ED IN THE SCHEDULE.
THIS AGREEHENT APPLIES ONLY TO THE EXIENI THAT YOU
PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU
TO OBTAIN THIS AGREEI{ENT FROT,I US.
THE ADDITIONAL PREI{IU FOR THIS ENDORSEUENT SHALL BE
2.OOZ OF THE TOTAL POLICY PRE}IIUH.
JOB DESCRIPTION
dNY PERSON OR ORGAI'{IZATION
FOR WHOII THE NA}{ED INSURED
HAS AGREED BY WRITTEN
CONTRACT TO FURNISH THIS
WAIVER
BLANKET WAIVER OF
SUBROGATION
NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE
OR EXTEND ANY OF THE TERMS, CONDITIONS, AGBEEMENTS, OR LIMITATIONS OF THIS
POLICY OTHER THAN A.S STATEO, NOTHING ELSEWHEBE IN THIS POLICY SHALL 8E
HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONOITIONS, AGREEMENTS OR
LIMITATIONS OF THIS ENDORSEMENT.
COUNTEBSIGNED AND ISSUED Ar SAN FRANCISCO: IiARCH L7, 2022
257 2 AUTHORIZED REPRESENTsctF FoFM 10217 iREV 7-20trt)VE
//-,.- a-:.-.^_
PRESIDENT AND CEO oLo oP 21)
STATE
COMF! NSA?IONINSURANC'FUND
SCHEDU LE