2022/11/15 L.C. Paving & Sealing, Inc. (4)ACORi)"CERTIFICATE OF LIABILITY INSURANCE 12n1tM
THIS CERTIFICATE IS ISSUED A! A MAITCR OF INFORMATION ONLY AND CONFERS NO RIOHTS UPON THE CERTIFICAIE HOLD€R, THIS
CERTIFICAIE DOES NOT AFFIRUATI\./ELY OR NEOATIVELY AMEND, ETTEND OR ALTER THE COVERAOE AFFORDEO BY THE POUCIES BCLOW, THIS
CERTIFICATE OF INSURANCE DOES IIOT CONSTITUTE A CONTRACT BETWEEN TIIE ISSUING INSURER(S), AUTHORIZEO REPRESENTATIVE OR
PROOUCER, AND THC CERTIFICATE HOLDER,
IMPORTANT: ll th€ c€rtificate holder is an ADOITIONAL INSURED, the policy(ies) must hrve ADDITIONAL INSURED Provisions ( be edorsed. ll
SUBROGATTON lS WAIVED, subject ro the lcflns and condiliom ol the policf, ceriain policies mey require an endorsement A slatemeit on thas
.dtiri.ate do6 not conl€r riotils to thc ccrlilicat€ holder in lieu ol lrich endorcenEnt(s)
FEDERAIED MUTUAL INSURANCE COMPANY
HoME oFF CE: P.o. Box 328
OA/ATONNA. MN 55060
CLIENI CONIACT CENTER
(arc, Nd:507-446-4664rarc. No. € r 888'333-4949
i,ll1l.., crrelrcolucTCENTERr.dFEDlNS.coM
rNsuiER A: FEDERATED MIJTIJAL INSURANcE coMPANY 13935
LC. PAVINO & SEALING. INC,
620 ALPINE WAY
ESCONOTDO, CA 9029-1204
416 992 6
CERIIFICATE NUMBER 28 REvlsrotl NUMaER:0
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO BELOW HA!'E BEEN ISSIJED TO THE INSURED NAMED ABOVE FOR THE POLICY PEROD
INOICATEO NOTIA/IIHSIANOING ANY REQI]IREMENT. TERM OR CONOIT ON OF ANY CONIRACI OR OTNER DOCUMENT WITH RESPECT TO WNICH THIS
CERTIFICATE MAY BE S6UED OR i'AY PERIAIN TIE INSURANCE AFFORDED BY THE POLICIES DESCRIBED I,]EREIN S SUgJECT TO ALL THE TERMS EXCLUS ONS
AND CCNOITIOIJS OF SUCII ?OLICIES LIMITS SHOWN t.iIAY IAVE AEEN NEDUCED B PAiO CLAIMS
i::::"
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N 1845867 11t15Q422 11tl5i2023
$1,000,000
MEoE)(P lA.Y.i. r.lal
s100 0m
s5,000
$r,000,0@
$2,000,0mE
x $2,000,000
N '11115t2422 11t15t2023
lr,000.000
BoDTLY 'uuav ltur e.Bonl
soorlY Nr!RY lPr rdhr,
x
* t-t N N I84586a 1111512022
$4,000 000
$4,000 000
ATO
'M'LOYE
RS' LIAAILITY
omcER/,!ra eERa)(cLUoao'
LGArons r vtN cr.s lAcoRo ,6iyb.86.d .'. erE ' r4rE4
RE: cIP 2l_09: IIuRRIETA RoAL AI{o Sl,N CITY BLVD. TtAfFIc SIGt{At IlrPRovEllEMT PRoJECT
CIIY OF I.IENIFEE, ITS OFFICERS, AGENTS AND EI{PLOYEES SHAL! BE I{AI.!ED ADDITIONAL INSURED.
IHE CERTIFICATE IIOLDER IS AI{ ADOITIONAL I|lsl,RED SUAJECI TO IIIE CONDITIOI{S OF THE ADDITIONAL INSUIEO - OIiNERS, LESSEES
OR CII}ITNACTORS - AUTOI'IATIC STATUS }iHEN REAOIRED IN A I{RITTEN CONSTRIrcIIoiI AGREEI1ENT IIITH Y(l' ENDoRSEIIENT EOR GENERAL
LIABILITY.
CERTIFICAIE HOL.DER CANCELLATION
41SS2-6
C!TY OF MENIFEE
29714 HAUN RD
MENTFEE. CA 92s85-5540
280
SHOUTD AI{Y Of THE ASOVE DESCRIAED POUCIES BE CANCELLED BEFORE
IHE EXPIRATION OATE TIIEREOf, NOTICE WILL A€ DEUVERED IN
ACCORDANCE wlTH THE POUCY PROVISIOIIS.
'tuilr*J ( )(q*-
ACORD 25 (2O18/O3)
o rs-2or5 acoRD coRPoRATloN. Alr rights rc.€fvcd
InG ACORD n lrl. rnd logo arG r.gin&.d h.rrs ol AcoRD
COVERAOES
I
-t
184586/
11t15t2023
COMMERCIAL GENERAL LIABILITY
cG 20 33 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED. OWNERS, LESSEES OR
CONTRACTORS . AUTOMATIC STATUS WHEN
REQUIRED !N CONSTRUCTION AGREEMENT WITH YOU
This endorsement modifies insurance provided under the following;
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section ll - Who ls An lnsured is amended to
include as an additional insured any person or
organization for whom you are performing
operations when you and such person or
organization have agreed in writing in a contract
or agreemenl that such person or organization be
added as an additional insured on your policy.
Such person or organizalion is an additional
insured 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
beh alf:
in the 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 organizalion's status as an
additional insured under this endorsement ends
when your operalions for that additional 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 lo
prepare or approve, maps, shop drawings,
opinions, reports, surveys, field orders,change orders or drawings and
specifications; or
b. Supervisory, inspection, architectural or
engineering activities.
This exclusion applies even if the claims againstany insured allege negligence or other
wrongdoing in the supervision, hiring,
employmenl, training or monitoring of others by
that insured, if the "occurrence" which caused the
"bodily injury" or "property damage", or theoffense which caused the "personal and
advertising injury", involved the rendering of orlhe failure to render any professional
architectural. engineering or surveying services.
@ lnsurance Services Office, lnc., 2012 Page 1 ol2
Policy Number: '1845867 Transaction Effective Date: 1111512022cG 20 33 04 13
2. "Bodily injury" or "property damage"
occurring after:
a. All work, including materials, parts or
equipment furnished in connection with
such work, on the pro.iect (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 compleled; or
b. 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 contractoror subcontractor engaged in performing
operations for a principal as a pad of the
same project
C. With respect to the insurance afforded to these
additional insureds, the following is added to
Section lll - Limits Of lnsurance:
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 endorsemenl shall not increase the
applicable Limits of lnsurance shown in the
Declarations.
O lnsurance Services Office, lnc.,20'12
Policy Number: 1845867 Transaction Effective Date: 11t1St2OZz
Page 2 ol 2
cG2033(M13
416-992-6 27
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CITY OF MENIFEE
297'14 Haun Rd
lilenifee. CA 92586-6540
BMOOo o9 0051