2022/11/15 L.C. Paving & Sealing, Inc. (5)A(-()Rn'CERTIFICATE OF LIABILITY INSURANCE 12t2t2@
IHIS CERIIFICATE IS ISSUED AS A MAITER OF INFORMATION OIILY AND CONFERS NO RIOHTS UPON THE CERTIFICATE HOI.DCR. THIS
CERTIFICATE oOES NOT AFFIRMATIVELY OR NEOATIVELY AMEND, EXTEND OR ALTER THE COVERA9E AFFORDED SY THE POUCIES AELo!TV. fHlS
CERTIFICATE OF II{SUNAflCE DOES NOT CONSTITUTE A CONTRACT AETWEEI{ THE ISSUING ITISURER(S), AUTHORIZEO NEPRESENTATIVE OR
PROOUCER, AND THE CERTIFICATE HOI.DER,
IMIORTANT: ll th€ canifcrte hold.r is sn ADOITIONAL ltlSURED, the policy(i.s) rust hav. ADDTIONAL INSURED provlsions ( be eidorsed. Il
SUBROGATION lS WAIVED, srbj.ct to the tlrrE ,nd cdldlilons ol the pollcy. cerlain policies mry r.qulr. tn .n6rs.mart. A staterne.n on thls.dtlflrrt. doa .oi 6nlbr riohs to the cdtill.d. hol.lc. i. ll.u .l srh .ndftmnt{r}
FEDERATED MUTUAL INSURANCE coMPANY
HOME OFFICE: P.O. BOX 328
OWATONNA, MN 55060
CLIENI CONTACT CENTER
ralc. No. E r EE0'333-4949 ra,c. xorr 507-44646&
i-lll}rl<r, cL t rurcouucTcFNTFRrdFFDr Ns co[,
rirsuiER(s) aFf oRorNG cowRAot
r suRERA: FEOERATED MUTUAL lNsuRANCE cOMPANY 13935
L,C. PAVING & SEALING, INC
620 ALPINE WAY
ESCONOTDO. CA 92029-',t204
416 992 6
COVERAOES CERTIFICATE NUMBER:82 REvlslON ttuMBER:0
IHIS 16 TO CERTIFY IITAT IHE FOLIC ES OF INSURAIiCE LISIEO BELOW HAVE BEEN ]SSUED TO THE INSURED NAMEO ABOVE FOR THE POLICY PER OO
IIIOICATEO NOTW|THSTAAOING ANY REQIJIREM€NI. TERM OR COI{OIT ON OF ANY COTITRACT OR OTHER DOCI.]MEIiI WITH RESPECT TO wlIICH THIS
CERI]FICAIE MAY AE ISSUEO OR MAY PERIAIN TI]E IN6URANCE AFFOROED BY THE POL]CIES DESCEIBEO NEREIN IS 6IJ6JECT TO ^LL THE TERM6 EXCLUS ONS
AND CONDITION6 OF SIrcH POLICIES LIMITS SHOWN M^Y NAVE BEEN iEDITED BY PAIO CLAIMS
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$1,000,000
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CERIIFICAIE HOLDE R CAXCELTATION
4ltg2-6
CITY OF MENIFEE AND ITS OFFICERS EMPLOYEES AGENIS
AND AUTHORIZED \r'OLUNTEERS
23844 HAUN RO
MENtFEE, CA 92546-6539
820
SHOUL.D AIIY OF THE AEOVE DESCRIAED POUCIES BE CANCELLED BEFORE
THE EXPIRATION OATE THEREOC, NOTICE wlLL AE DEUVEREO IN
ACCORDANCE IryITH THE POUCY PROVISIOTIS
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ACORD 25 (2016103)
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Thc ACORD lum. end logo ar. r.gist.rd m ts of ACORD
LocArrors/ vEHrctEs {acoRD . E.yEftd.d irnd.9... ! rqiEd)
SEE ATTACHED PAGE
o.Qo"LOC #:
ADDITIONAL REMARKS SCHEDULE Page 61
FEOERATED MUTUAL NSL]RANCE COMPANY L,C. PAVING & SEALING. NC.
620 ALPINE WAY
ESCONDTDO, CA 929291204sEE CERT FICATE f 82.0
sEE CERr FTCATE f 82.0 ErEcIl\t oara: SEE CERTTFTCATE fl 82.0
IHIS ADOITIONAL REMARKS FORM IS A SCHEOUTT TO ACORD FONM
FORM I.iUMBERI 25 FORM TITTI:CFRTIF CATF OF I IABII ITY NSL]RAN'F
RE: CIP 20-12 ADAl,lS AVEIIUE STREET IIIPROVEIIENTS PHASE 2
THE CERTIFICATC TIOLOER IS AN ADDITIONAI INUREO SIIBJECT TO THE CONDITIq'E OF IIIE ADDITIOIIAL II{SI'iED - OUNERS,
LESSEES OR COI{TRACTORS - AUT(XATIC STATUS VIHEII RECUIRED IN A I{RITTEN C(I{STRIETION ACXEEIIENT I{ITH Yq' ENDORSEIIENT
FOR GENERAL LIABILITY,
II{SURIrcE PROVIDED BY TIIE GEITERAL L]ASII.IIY COVERAGE IS PRITIARY AIID I{OItrOIIRIBUIORY OVER OTIIER DISURANCE,
GENERAL LIABILITY CONTAIT{S A I{AIVER Of SUBTOGATId{ II{ FAVOR OF THE CERTIFICATE HOLDEi SUBJECT TO THE EONDITIONSOF fHE BLA'II(ET IAIVER OF IRAITSFEF OF iIGIITS OF RECOVEiY EiIDOTSEIIENT.
ADOITIONAL REMARKS
acoRD r01 (2@8/t)1)@ 2ql8 ACORD CORPORATION. Al rlghts rcs.rv.d.
Th. AC9RD n.m6 and logp ar6 Edn.r.d m{Is ot ACORD
AGETrcY CUSTOMER ID: 415-992€
I
COMMERCIAL GENERAL LIABILITY
cG 20 01 04 't3
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other lnsurance
Condition and supersedes any provision to the
contrary:
Primary And Noncontribulory lnsurance
This insurance is primary to and will not seek
contribution from any other insurance
available to an additional insured under your
policy provided that:
(1) The additional insured is a Named lnsured
under such other insurance; and
(2) You have agreed in writing in a contract
or agreement that this insurance would be
primary and would not seek contribution
from any other insurance available to the
additional insured.
@ lnsurance Services Office, lnc., 2012 Pago 1 of 1
Policy Number: 1845867 Transaction Effective Date: 1111512022cG 20 01 04 13
PRIMARY AND NONCONTRIBUTORY .
OTHER INSURANCE CONDITION
COMMERCIAL GENERAL LIABILITY
cG 20 33 04 't3
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:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section ll - Who ls An lnsured is amended to
include as an additional insured any person or
organization lor 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", "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 lhose acting on your
behalfi
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 agreemenl lo
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 additional insured
are compleled.
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, suryeys, field orders,
change orders or drawings and
specificalions; 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,
employment, training or monitoring of others by
that insured, if the "occurrence" which caused the
"bodily injury" or "property damage", or the
offense 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.,2012 Pago 1 of 2
Policy Number: 1845867 Transaction Effective Date: 11115/2022cG 20 33 04 13
2. "Bodily injury" or "property damage"
occurring after:
a. All work, including materials, parts or
equipment furnished in connection wilh
such work, on the project (olher than
service, maintenance or repairs) lo be
performed by or on behalf of the additional
insured(s) at the location of the covered
operations has been completed; or
b. That portion of "your work" out of which
the injury or damage arises has been putto its intended use by any person or
organization other lhan another contracloror subcontractor engaged in performing
operations for a principal as a parl of the
same project.
C. With respect to the insurance afforded lo 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 lhe 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.
O lnsurance Services Office, !nc.,2012
Policy Number: 1845867 Transaction Effective Date: 1111512022
PaEe 2 of 2
cG 20 33 04 't3
FEDERATED INSURANCE COMPANIES
THIS ENDORSEMETIT CHANGES THE POLlcY. PLEASE READ lT CAREFULLY.
BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST
OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to Paragraph 8. Transfer Of Rights Of R€covery Against Others To Us of Sec$on lV -
Conditions:
We waive any righl of recovery we may have against any person or organization because of payments we make for
injury or damage arising out of your ongoing operations or "your work" done under a conlract with that person or
organization and included in the "products-completed operations hazard", except when the payments result from the
sole negligence of that person or organization. We waive this right only when you are required to do so by written
contract or agreement with that person or organization, executed by you prior lo the occurrence of any loss.
lncludes copyrighted material of lnsurance Services Office, lnc. with its permission.
CG-F-81 (04-13) Policy Number: 1845867 Transaction Effective Date: 1111512022
416-992-6 82
#BWNDHBS Bo0o0 08 meo
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CIry OF MENIFEE AND ITS OFFICERS EMPLOYEES AGENTS
AND AUTHORIZED VOLUNTEERS
29844 Haun Rd
Menifee, CA 92586-6539