Loading...
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 l"*,"**. ".*" I:rs; x 1045667 11t15t2022 11115t2023 11,000,0@ s100,000 $aD aXP {eY. lrllol s5,000 $1,000.000 t2,000,000 x s2,000,000 x N N 1845867 111't5na22 11t1512023 $1,000,000 BoorLY J!RY lPlrp.uonl EoorLY NJr.rRY lP.. *ci(l..o x x N N 1845868 11/1512022 11t'l5t2023 14,000,0m t4,000,0@ orFrcairr*lMaai ExcLUDEo? Yt! tL OIIEASE - 6A:MPLOYCE a L orsEr"rE. polrcY LMrr 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 ,ni"-w ( )(w ACORD 25 (2016103) @ !s-2o15 acoRD coRPoRATroN_ ar dgrrrs r.scrvcd 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 #xwxw0021xxxxxxxs# CIry OF MENIFEE AND ITS OFFICERS EMPLOYEES AGENTS AND AUTHORIZED VOLUNTEERS 29844 Haun Rd Menifee, CA 92586-6539