2022/03/01 RSG, Inc. (3)oiQo"OAIE (U I{'OO/YYYY)
12t06t2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOT{ ONLY AND COI{FERS t{O RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERNTICATE OOES I{OT AFFIRiIATIVELY OR }IEGATIVELY AMEI{O, EXTEND OR ALTER TXE COVERAGE AFFOROEO BY THE POLICIES
BELOW. THIS CERTIFICATE OF It{SURANCE DOES IIOT COXSTITUTE A CO'{TRACT BETTIYEE}.I THE ISSUING IISURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AIID THE CERTIFICATE HOLDER.
IMPORTANT: ll th. certiticrts holder l! an ADDITIOtIAL INSURED, ths pollcy(16!) mu3t h.ve ADDITIONAL INSUREO p.ovlslons or be ondo6.d
It SUBROGATION lS WAIVED, gubroct to tho torm! lnd condltion. of the pollcy, certrin policies may requhe rn ondoBoment, A statement on
thla cortlflcato doer not confer rlght! to the cortlflcato holder ln liou ol !uch ondor!omont{!).
PROI'UCER
The Empire Company
550 North Park Center Orive
Suite 205
Sant, Ane cA 92705
Enc€ Hornaday
ehornaday@empire-co com
INSU RER(S) AFFORDING COVERACE
rNslrRER a, Senlinei lnsurance Company, LTD 11000
RSG,lnc.
17872 Gillette Ave., Suite 350
cA 92614
tNsuRER 6. Trumbull lnsuaance Compafly 21124
tNsuRERc. Argonaui lnsu€nce Company 19801
CERTTFICATE I{UMBER: 202312024 MasterCOVERAGES REVISION UMBER:
rHIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOWHAVE EEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD
INDICATEO NOTWTHSTANOING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WTH RESPECT TO ffiICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN lHE INSURANCE AFFOROEO BY IHE POLICIES DESCRIAED HEREIN IS SUEJECT TO ALL THE TERMS,
EXCLUSIONSANO CONOITIONS OF SUCH POLICIES, LIMITS SHOW}.IMAY HAVE AEEN REOUCEO 8Y PAID CLAIMS
EACt] OCCURRENCE t 1 000,000
PRFMISFS IF' fuN.fuI r 1 000 000
MED €XP lAnv om @en)$ 10.000
PERSONAL &ADV NJLJRY $ 1,000,000
GENERALAGGREGAIE r 2,000,000
PROOUCTS - COMP/OP AGG $ 2,000,000
COI{ ERCIAL GENERAL LIA BILITY
G€N'LAGGREGATE L M TAPPLIESPER[--"] pao f-]L-I JECT L-I LOC
fi o""u^
OTHER
72SBAAQ7O19 01101t2023 o1t0't 12024
5
! 1,000,000
SOOTLY INJURY (Par p€66)5
aoorLY !NJURY (Pid ed40 t
s
AUTOSONLYI(REO
AUTOS ONLY
SCHEDULEO
AUTOSONLY
AUIOMOBILE LIABILITY
72SaAAO7019 011o1t2023 011o1t2024
$x EACI] @CURRENCE $ 2,000,000xEXCESSLIAE$ 2,000 000
DEO 10,000RETENTION
72SBAAO7019 41t01t2023 4114112024
sxOTH.
$ 1,000 000
EL DISEASE. EA EMPLOYEE $ 1,000 00001t011202301to1Da24
E L DISEASE. POL]CY LiMIT r 1,000.000
B
woRtGRs COi|PENSAiO
AND EIIPLOYERg' LIAEILITY
ANY PROPRIETOR,EAITNEB/EXECUTIVE
OFFICER/I,IEMBER EXCLUDEO?
DESCRIPTION OF OPERATIONS b€l*
72\t /ECYKAT 27
C
Enors & Omissions
Claims Made 121MP10167514-02 o3t01t2422 03to1t2023
AGGREGATE LIMIT
EACH CLAIM
DEDUCTIELE
4,000,000
2,000,000
10,000
OESCRIPTIOiI Of OPERATIONS / L@AIIONS / VEIIICLES (ACORO 101, Addhlotul R@.rt. S.h.dul., m.y b. .tL.h.d r moo .p.c. i. EqulDd )
W
NCELLA-
SHOULO AIIY OF THE AAOVE DESCRIEED POLICIES BE CANCELLEO BEFORE
IHE EXPIRATIOII OATE TI]EREOF. NOTICE WLL BE OELIVEREO IN
ACCOROANCE WTH TIIE POLICY PROVISIONS,
cA 92586
City ofMenitee
29844 Haun Road
DUra.WLMq
AI]THORIZED REPRESENTANVE
ACORO 25 (2016/03)
@ 1988-2015 ACORD CORPORATIOX. Alldghb rclorvod.
Tho ACORD nrme and logo ara r.glltorod merks oIACORO
CERTIFICATE OF LIABILITY INSURANCE
o.Go"
AGExcY cusroMER rD. ooolTsoo
LOC *:
ADDITIONAL REMARKS SCHEDULE Pego of
The Empue Company
ADDITIONAL REMARKS
THIS AOOITIONAL RETIIARKS FORII IS A SCHEDULE TO ACORD FOR]TI,
FORM NUtrlBERl 25 fon T|TLE. Certificate of Lrabilfy lnsurance Notes
Certificale Holder continued:The City ofM€nifee. its councilmembers ollicers, agonis, employees and authorized volunleers
@ 2008 ACORO CORPORATION. All right! rels.vod.
Tho ACORO nrme rnd logo.,c roglrtor.d mrrkt otACORD
ACORO 1O{ (2008'01)