2022/11/15 L.C. Paving & Sealing, Inc.,4<:o.Ri7 CERTIFICATE OF LIABILITY INSURANCE Pn1twz
IHIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMAIION ONLY AND CONFERS NO RIOHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATII./€LY OR NEOATIVELY AMEND, EXTEND OR ALTER THE COVERAOE AFFORDEO BY THE POUCIES EILOW, THI5
CERTIFICATE OF INSURATICE DOES NOT CONSTITUTE A CONIRACT BETWEEN THE ISSUINC INSURER(S), AUTHORIZEO REPRESENTAIIVE OR
PROOUCER, ANO THE CERTIFICATE HOLDER,
IMpORTANI: ll lhe ccrtificate hold€r ir an ADOITIONAL INSURED, the policy(ies) must have AODITIONAL INSURED provisiofls d be endoried ll
SU8ROGATION lS liVAlVED, subj€cl to th6 lonyrs and conditions ol the policy, cerlain policies may require an endorement A statemql on this
.atiaicete do6 not conler.lohts to tfie catlfic.te holds ln lieu ot sich endorsefi€d(s).
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFF CE: P.O. BOX 328
o1/1/ATONNA, MN 55060
CIIFNT CONTACT CFNTFR
{A7c. N.. Erh: 888-33-4949 ,^,i ro': 507-446-4664
iiBllss, crr ErrcoNTAcTCENTERa.nFEor NS coM
13935
LC. PAVING & SETALING. INC
520 ALPINE WAY
ESCONDTDO, CA 92029-120,t
416 992 6
COVERAgES CERTIFICATE NUMAER 27 REVISION NUMBER:0
THIS IS TO CERTIFY TIIAT THE POLIC ES OF INSURA'ICE LISIEO BELOW HA!€ BEEN ISSUEO TO THE INSURED NAMEO ABOV€ FOR THE POLICY PER OD
INOICATEO NOIWITHSTANOINC ANY REQI]IREM€I{I. TEiM OR CONOIT ON OF ANY CONTRACT OR OTNER DOCUMENT WITH RESPECT TO WHICII TIIIS
CERTIF CATE MAYBE ISSUEO OR MAY PERIAIN TNE INSURANCE AFFORDED BY THE POL]CIES DESCRIBEO HERE N S SIJBJECT TO ALL IHE TEAMS €XCLI.,S OI'JS
AND CONOITIONS OF SUCII POLICIES LIMITS SHOWN MAY IIAVF 6EFN FFDUCED BY PAID CLAIMS
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N 1845867 1111512022 11t15t2023
$1,000,0m
€DExF lay on. Frr-l
s100,0m
s5,000
s1.000,000
$2,000,000
$2,000,000
x
N N '11/15t2422 11t1512023
11,000,000
BOOILY ]NJURY IPE I'EON}
soorLY NJURY lP.r rcci&,0
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N N 11/15t2022
t4,000 000
$4,000,000
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SEE ATTACTIED PAGE
CERTIFICATE HOLDER CANCELLATION
41&S2$
CITY OF MENIFEE
29714 HAUN RD
MENTFEE, CA 925866540
270
SHOUTD ANY Of THE ABOVE OESCRIBED POUCIES BE CANCELLEO BEFORE
IHE EXPIRAIION DATE THEREOF, NOTICE WILL BE DEUVERED IN
ACCORDANCE WITH THE POUCY PROVISIONS,
,IU*L*J ( )(r*
acoRD ?5 (2016m3)
O l$-2ois ACORO CORpORAIION All .lgits.6Rcd
rh. acoRo n h. .nd logo ar6 r6gist6r6d marts of acoRD
'{supER a: FEDERAIED MI]TUAL INSURANCE COMPANY
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1845467
1845868 11t15t2023
aiQo'
AGENCY CUSTOMER ID: 416-992{
LOC #:
ADDITIONAL REMARKS SCHEDULE
FEDERATED MUTUAL INSURANCE COMPANY L,C. PAVING & SEALING, INC
620 ALP NE WAY
ESCONDTDO. CA 92m91204SEE CERTIFICATE # 27,0
sEE CERTTFTCATE # 27.0 sEE CERTTFTCATE # 27.0
THIS ADOITIONAL REMARKS FORM IS A SCHEOUT! TO ACORD FORM,
FORM IUMSER] 25 FORM TITTI:.FRIIEI'ATF .)F
RE: St l CIIY B[VD. ADA IIIPROVEI{ErIS - CIP 18-04CIIY OF IIENIFEE AND ITS ELECIED OFFICIALS, OFFICERS, EIIPLOYEES, AGENTS, REPRESENIATIVES, CONSULIANTS, CONTRACI
EI{PLOYEES ANO VOLUI{TEERS ARE HEARAY ADDEO AS
ADOITIOI{AL INSURED
THE CERTIFICAIE TIOLDER IS AI{ AI'DIIIONAL Ii,ISURED sI'BJECT TO THE CONOITIq|S OF THE ADDIIIONAL INSURED . OWNERS,
LESSEES OR CONIRACTORS ' AUTOIATIC STATUS IIIEN REQIJIRED IN A TRITTEN CC|.'SIRIETIOITI AGiEEIIENT IiIIH YOU ENDORSETIENT
FOR GENERAL LIABIIITY.
ADDITIONAL REMARKS
ACORO 101 (2@/!1)o am AcoRD coRPoRATtoN. aI rlglrt3 rcacrvcd.
Thc ACORD nem. and logD ar. r.gln.r.d ma*s of ACORO
I
COMMERCIAL GENERAL LIABILIry
cG 20 33 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED. OWNERS, LESSEES OR
CONTRACTORS . AUTOMATIC STATUS WHEN
REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU
This endorsement modifies insurance provided under the following:
COMT/ERCIAL GENERAL LIABILITY COVERAGE PART
A. Seclion ll - Who ls An lnsured is amended to
include as an additional insured any person or
organizalion for whom you are performing
operations when you and such person or
organization have agreed in writing in a contracl
or agreement that such person or organization be
added as an additional insured on your policy.
Such person or organization is an additional
insured only with respect to liability for "bodily
injury", "properly 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 lhose acting on your
behalf;
in lhe performance of your ongoing operations for
the additional insured.
However. the insurance afforded to such
additional insured:
'1. Only applies to the extent permitted by law:
and
2. Will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
A person's or organization's status as an
additional insured under this endorsement ends
when your operations for that addilional insured
are completed.
B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to:
1. "Bodily injury", "property damage" or
"personal and advertising injury" arising out
of the rendering of, or the failure to render,
any professional architectural, engineering or
surveying services, including:
a. The preparing, approving, or failing to
prepare or approve, maps, shop drawings,
opinions, reports, surveys, field orders,change orders or drawings and
specifications; or
b. Supervisory, ihspection, architectural or
engineering activities.
This exclusion applies even if the claims againstany insured allege negligence or other
wrongdoing in the supervision, hiring,
employment, training or monitoring oI olhers by
that insured. if the "occurrence" which caused the"bodily injury" or "property damage", or lheoffense which caused the "personal and
advertising injury", involved the rendering of orthe failure to render any professional
architectural. engineering or surveying services.
O lnsurance Services Office, lnc.,20'12 Pagg'l ot2
Policy Number: '1845867 Transaction Effective Dale: 1111512022cG 20 33 04 13
2. "Bodily injury" or "property damage"
occurring after:
a. All work, including materials, parts or
equipment furnished in conneclion 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
b. That podion of "your work" out of which
the injury or damage arises has been putto its intended use by any person or
organization other than another contractoror subcontractor engaged in performing
operations for a principal as a part of the
same project.
C. Wath respect to the insurance aflorded to these
additional insureds, the following is added to
Section lll - Limits Of lnsurancei
The most we will pay on behalf of the additional
insured is the amount of insurance:
1. Required by the contract or agreement you
have entered into with the additional insured:
or
2. Available under the applicable Limits of
lnsurance shown in the Declarations:
whichever is less.
This endorsement shall not increase the
applicable Limits of lnsurance shown in the
Declarations.
@ lnsurance Services Office, lnc., 2012
Policy Number: 1845867 Transaction Effective Date: 1111512022
Page 2 ol 2
cG 20 33 04 t3