2022/08/01 L & S Construction, Inc..ACORD"
pRoDUcER License # 0757776
HUB lnternational lnsurance Services lncPO Box 5345Riverside, CA 92517
INSURED
CERTIFICATE OF LIABILITY INSURANCE
(9s1) 788-8500 [XI. *a,1ssr; zae-esoz
L&SCONS-01 BM
3518r
202A1
INSURER(SLAFFORDING CO]/ERAGE
rNsuRER a , Executive Risk lndemnity
rNsuRER s , Federal lnsurance Company
INSIJRER D
lllirlSER E
712712022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISOERTIFICATE DoEs Nor AFFTRMATIvELy oR NEGATTvELy AMEND, ExTEND oR ALTER rne covemci IiFoRDED ByrHEpoLtctEsBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTTTUTE A CONTRACT eerweeN rHe rssutNe Nsunenlsl, auruontzeoREPRESENTATIVE OR PROOUCER, AND THE CERTIFICATE HOLDER.
certificate
f th ifirt atec deholr is a SUN ERD s m Iusthe ha DITAD o LNApi"y()sn be ndprovisBROGAUoTINIfIVEDsutoectthestetmnaditndiobjnstheoIcerlaolcunedolicypporsemnt.e statem nt onreqmaytsthcertificatedoesotnnItthehtdInsofchorseds
COVE CE UMBER:REVISION
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMEDABOVE FOR THE POLICY PERIODINDICATED, NOTWITHSTANDING ANY REQUIREI\,1ENT, TERI\,I OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTWITH RESPECT TO WHICH THISCERT]FICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERIVSEXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LII\,1ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIIVS
LIMITSAXCOMMERCIAI. GENERAL LIABILIry
I oc"rnCLA|MS-MADE X 8t1t2022 8t1t2023
EACH OCCURRENCE
OAT,TAGE TO RENTEI'PREIISES (Ea occurcrce)
1,000,000
100,000
a,ooo
1,000,b00
2,o00poo
2,000,000
x 54303181
54303180
GEN
x
,L AGGREGATE L MiT APPLIES PER:
"o.,"" fl 39".; Loc
oTHER P€r Prol Gon Ag9 per contr.ct
8t112022 8t1t2023
8t112022 8t1t2023
COMBlIIED S'NGLE L]I\IIi
f(Ea alciden0 . $
BoDILY INJURi (Per peBon) S
BOQI!!llrllrRY (per accdeir) $PROPFRTY NAMAGF(eerac!4!!r) ].
$
AUTOMOBILE LIABII.ITY
X nruyeuro
OWNEO
1,01r0,000
HiRED
SCHEDULED
NON OWNEDAUIOS ONLY
EXCESS LIAB
DED RETENTION $
CLAIMS.MADE
B WORKERS COMP€NSA'TIONAND EMPLOYERS' LlAAILlTY
ANY PROPRIETOR1PAq INER/EXECU NVEOFF CEFI]MEMBER EXCLIJDEO?
oTti-
ER54303182 '1,000,000
t,ooo,ooo
,1, EACH ACCIDENl s
E L D SEASE EA ET,4PLOYE $
DISEASE POLCY LIIU T
I 1,000,000
DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES TACORO 1Ol, Add'lionalRomarts Sch.dul€, mav bo atl.chod ifmoro soac6 's,6.un.drRE: Encroachment Permil for L & s construction. tnc. Job #934. watt cohnuniiiei ritl\ilo'ii-i;, i'Lb.'p;5j;;i-A;t;;;;: Tract 28206, Garbani Road and patomar
Road, MeniIee, CA. glai
city ol Menifee is included as Additional lnsured where required by an executed written contract as respects General Liability per attached endorsements.
CE DER
SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE W|LL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENIATIVE
TION
ACORD 25 (2016/03)o 1988-20'15 ACORD CORPORATTON
The ACORD name and logo are registered marks of ACORD
All rights reserved
IMPORTANT:ADOITIONAL INSURED
anlieu
L & S Construction, lnc.
674 North Batavia Street
Orange, CA 92868
s
s
$
$
$
PROOUCTS - COMP/OP AGG $
MEo qle f'.y one pelsg!)
PE&qq!A! & ADv IyJUBY
GENERAL AGGREGATE
sEACH OCCURRENQE
AGGREGAIE
I
City of Menifee
29714 Haun Road
Menifee. CA 92586
Nn,M,-,-
AGENCY CUSTOMER tD. L&SCONS-01
Loc #r 1
ADDITIONAL REMARKS SCHEDULE
ACORD"
Page 1 of 1
UB lnternational lnsurance Services lnc
EE PAGE 1
EE PAGE 1
ADDITIONAL REMARKS
License # 0757776
NAIC CODE
EEPl
@ 2006 ACORD CORPORATTON. A rights reserved
The ACORD name and logo are registered marks of ACORD
NAMED INSURED
L & S Construclion. lnc.674 North Batavla StreetOrange, CA 92868
THIS AODITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 FORM TTTLE: Cedficale of Liabitity tnsurance
Cancellation:
'.should the policy(ies) be cancelled before the expiration date, Hub lnternational lnsurance Services lnc. (Hub), independent of anyrights which may be afforded within the policies to the certificate holder named below, will proviae to iuiti ceriiticatE holder notice-of such cancellation within thirty (30) days of the cancellation date, except in the eveni the ;ancellation i; due to non.payment ofpremium' in which case Hub will provide to such certificate holder notice of such cancellation wirnin ien 1r oy aays or thJcancellationdate.
ACORD 101 (2008/01)
BMARIN
POLICY NUMBER: 54303181 COMMERCTAL GENERAL LtABtLtTy
cG 20 10 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
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, but only
with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury,,
caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf;
in the performance of your ongoing operations forthe additional insured(s) at the location(s)
designated above.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. lf coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insuredwill not be broader than that which you arerequired by the contract or agreement to
provide for such additional insured.
Name Of Additional lnsured Person(s)
OrO anization s rationsLocationsOf Covered O
Where required by written contract All locations where required by written contract
O lnsurance Services Offlce, lnc., 20'18 Page 1 of 2
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILIry COVERAGE PART
SCHEDULE
lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations.
B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. All work, including materials, parts or
equipment furnished in connection with suchwork, 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 operations for aprincipal as a part of the same project.
cG 20 10 12 ',tg
C. With respect to the insurance afforded 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 conlract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
'1. Required by the contract or agreement; or
2. Available under the applicable limits of
rnsurance;
whichever is less.
This endorsement shall not increase the
applicable limits of insurance.
Page 2 ol2 @ lnsurance Services Office, 1nc.,2018 cG 20 10 12 19
POLICY NUTVBER: s4303181
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAT IIABILIry COVERAGE PART
PRODUCTS/COI\4PLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
COMMERCIAL GENERAL LIABILITY
cG 20 37 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATTONS
All locations where required by written contract
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, but onlywith respect to liability for "bodily injury" or
"property damage" caused, in whole or in part, by"your work" at the location designated and
described in the Schedule of this endorsement
performed for that additional insured and included
in the "products-completed operations hazard".
However:
'1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. lf coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by lhe contract or agreement to
provide for such additional insured.
Name Of Additional lnsured Person(s)
Or Organization(s)Location And Description Of Completed Operations
Where required by written contract, but only where
the contract specifies coverage for
completed operations.
lnformation required to complete this Schedule , if not shown above, will be shown in the Declarations
cG 20 37 12 19 O lnsurance Services Offlce, Inc.,2018 Page 1 of 'l
B. With respect to the insurance afforded 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 agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. 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.