2022/07/01 Riverside Construction Company, Inc. (7)ACORif CERTIFICATE OF LIABILITY INSURANCE 7 t1t2022
THIS CERTIFICATE IS ISSUED AS A IIIATTER OF INFORT{ATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVELY AIIIENO, EXTENO OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: lf the co.tlffcato holder b an ADOITIONAL INSUREO, tho policy{ios} murt have AOOITIONAL INSUREO provisions or bo endorsod.
It SUBROGATION lS WAIVEO, subioct to the tanna end condltlons ot the policy, c.rtain pollcio3 may roquire an endors6mont. A statemont on
thi! cortilicato doos not conlor right! to tha cortrflcato holdrr in llou ot such enaloBoment{3).
Edqewood Partners lnsurance Center (EPIC)
1gdOO MacArthur BIvd PH Floor
lrvine, CA 926'12
Shirley Sandoval
PHONE 949 417,9153
IL shirley sand rcbrokers.com
INSI]RER(S}AFFORDING COVERAGE
www.edgeuoodins.com [r$]RER a: Executi\€ Rtsk lndemn lnc q!L8'!
20281INSIJREF B FEdETAI I urance coRiverside Construction Company, lnc.
PO. Box 'l '146
Riverside CA 92502
COVERAGES CERTIFICATE NUMBER: 691 08794 REVISION NUMBER
CERTIFICATE HOLOER CANCELLATION
O 1988-2015 ACORD CORPORATION. All rights rBsrved
ACORD 25 (2016/03) The ACORO narp and logo ae regi8b,Ed rnarks ofACORD
/, rir'ar/0MB/r.x/wc/PFo
'r "fi
,,pip o l-",. .7 '.r \" i ."'i
CrtY of lvlenrfee
29844 Haun Road
Menifee CA 92586
qq 0l
Anthony D'Asaro
TI]IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO lHE INSURED NAMED ABOVE FOR THE POIICY PERIOO
INDICATED NOTWTHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OIHER OOCUMENT WTH RESPECT TO WI]ICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOROEO BY THE POTICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES LIMITS SHOVI./N MAY HAVE BEEN REDUCED 8Y PAID CLAIMS
EACHOCCURRENCE
5
a2 000 000
s2 000 000
o E )
000000S
19,0,SS0
s4.000 000
PROO.]CTS COMP/OP AGG
GENERALAGGRE6ATE
PERSONAL A ADVINJL]RY
s5000
54309745 711t2022 7 t112023COi'MERCIAL GENERAL LIABILITY
Bl/PD Deductible: $25,000
GEN'LAGGREGATE L MIT APPLES PER
OCCUR
LOCPO!tCY
O-IHER
PRO f lJECI L I
't t112022 7 t1t2023
BODILY TNJURY (Per a@donl)
bieCo
000
s
s2 500
$1 000
SODILY NJURY (P€TPCI$N)
B
AUTOS ONLY
HIREO
AUTOSONLY
SCHEOULED
AUTOS
NON-OWNEOAUTOS OI.ILY
A UTOiiOBII E IiABILITY 54309463
s
$
EACHOCCURRENCE
AGGREGATE
DED
OCCURU BREILALIAB
EXCESSLIAS
711/2023
s1 000 000
s 1.000.000
s1 000
E L EACHACCIOENT
ATI-]'IE
E L OISEAS€ POIICY LIM1T
E L OISEASE. EA EMPLOYE
54309464 7 t1t2022IWORXERS COXPENSATIOI{
AIiIO €I'PTOYERS LIABIITTY
ANYPROPRIETOR/PARTNER/EXECU'TIVE
OFFICEFYMEMSER EXCLUDEO?
DEsiRrPTroN oF oPERAToNS b€r@
DESCitPtiON OF OPERATiOiIS / IOCATTONS r VEHTCLES {ACORO r 0i, Addnlon.r Rm.rrc S.trdur., mry b. .lt.6lFd il moE rprc. i. 6qui6d)
RE Holland Road/l-215 Overpass CIP 13-03 tor Prequalificalion Purposes
Tho C y of tvlenrbe, its mayoi. counol. officers. agenis, snployees and \olunteers are addtlional insured as respecls
cenerai Lrab ity and Automobile Liability per the ittached endbrsemenl(s). Primary and Noncontributory wordjng applies to general kability
per lhe atlached endorsement(s). Wai\er of Subrogation applies lo Vlbrkers Compensation.
NAICg
Ill
I
I I
$
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SITOULO ANY OF THE ABOVE DESCRIBED POLTCIES BE CANCELLED BEEORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
ACCORDANCE WIIH THE POLICY PROVISIONS,
AUTIIORIZED REPRES€N TA IIVE
l{r!crsrdr( urstructr(,r ( ompan!. Inc
POLICY NU|\ilBER: 5.lroeTls COi,lMERCIAL GENE RAL LIABILITY
cG 20 37 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED _ OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEOULE
Name Of Additional lnsur6d Person(s)
Or Organization(s)Location And Description Of Completed O!9I4!!9!9
!{HERE REQUIRXD BY
'IRITTEN
CONTRACT, BUT
lnformation required to complete this Schedule,if not shown above. will be shown in the Declarations
A. Ssction ll - Who ls An lnsu.ad is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect io liability for "bodily injury" oI
"property damage" caused, in whole or in part, by
"your work" at the location designated and
described in the Schedule of this endorsement
performed for that additional insured and
included in the "products-completed operations
hazard".
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
2. lf coverage provided to the additional insured
is required by a conlract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
cG 20 37 12 19 O lnsurance Services Office, lnc., 20'12
B. With respect lo the insurance afforded to these
additional insureds, the following is added to
Section lll - Limits Of lnsurance:
lf coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
l. Required by the contract or agreement, or
2. Available under the applicable Limits of
lnsurance shown in the Oeclarations;
whichever is less.
This endorsement shall not increase the applicable
Limits of lnsurance shown in the Declarations
69r03?9{ I :?/2ir GLlALlo{E/Eilra/pRorporl, I shlrt€y s..dov.t | 1/,2022 ltrtt16 px (pDl.) I p.q.Thi3 ccrlifrcatn caD.els and supersedes ALL' p!evjously rssued certi!icdtes,
Page 1 of I
Riverside Construction Company, lnc.
POLICY NUMBER: s430s745 COMMERCIAL GENERAL LIABILITY
cG 20 101219
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRAGTORS - SCHEDULED PERSON OR
ORGANIZATION
Name Of Additional lnsured Person(s)
Or Organization(s)Location(s) Of Covered Operations
WHERE REQUIRED BY }IRITTEN CONTRACT
lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations
A. Section ll - Who ls An lnsured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but 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 ot those acting on your
behalf,
in the performance of your ongoing operations forthe additional insured(s) at the loc€tion(s)
designated above.
However:
'1. The insurance afforded to such additional
insured only applies to the extent permitted by
law, and
2. lf coverage provided to the addilional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that whach you are
required by the Contract or agreement to
provide for such additional insured.
cG 20 101219
B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring afier:
1. All work, including materials, parts or
equipment furnished in connection with such
work, on the pro.,ect (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
2. 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 contractor or subconlractor
engaged in performing operations for a
principal as a part ofthe same project.
O lnsurance Services Office, lnc., 201E
Gr,,Ar/wB/Ex/f/pRoFpolr_ sh,rl.v i.nnov.l t 1/t/zo-t t:)t:46 pta tptfith's rer'rlr(d,e ran.els a,'d 3upersedes ArL prev,ousty rssuBd cFr-itL.drFs.
Page 1 of 2
This endorsement modifies insurance provided under the follo\,ving:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
C. With respect to lhe insurance afforded to these
additional insureds, the following is added to
Section lll - Limits Of lnsuranco:
lf coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of
insurance i
whichever is less.
This endorsement shall not increase the
applicable limits of insurance.
Page 2 ot 2 @ lnsurance Services Otfice, lnc., 20'18
1r t]:46 PM rtl Trhrs.arr a, dL- 'rl.a.i dnd fJperqcoe" At.t'pre! . Ls y ..suFd ier-rt|ar46.
cG 20 10 12 19
Worker3 Compensation and Employers' Liability Policy
Named lnsured
Riwrside Construction Company, lnc.
Endorsement Number
Policy Number
54309464
Polcy Period
07 t01t2022ro 07t01t2023
Elfedive Oate of Endo.sement
07t01t2022
lssued 8y (Name of lnsurance Company)
Federal lnsurance Comoanv
lnsen lhe policy n u mber The remamdea of the hfo.mation rs lo be complet€d only when this efldorsemenl rs rssued subsequenl to the preparalon ot lhe pol€y
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the
work described in the Schedule.
Schedule
(x) Blanket Waiver
Any person or organization for whom the Named lnsured has agreed by written contract to furnish this
waiver.
2. Operations
3. Premium
The premium charge for this endorsement shall be 1.0 percent of the California premium developed
on payroll in connection with work performed for the above person(s) or organization(s) arising out of the
operations described.
4. Minimum Premium: $0
w lc
Authorized Representative
wc 90 03 75 (05/18)
.':i :L/A),/LAB/L^-HC/qR) rrrlr45 pH {pM I pdqe ) of or.dre .'dnfels dnd supersedes aLL prevl0usly rssued cer-rticar.s.
I
CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because California is shown in ltem 3.A. of
the lnformation Page.
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule, but this wajver applies only with respect
to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract
to obtain this waiver from us.
1. ( ) Specific Waiver
Name of person or organization:
Rrvcrsrdc (irnstructron Company. lnc
POLICY NUMBER. .1roe71s
1 t)072
COMMERCIAL GENERAL UABILITY
1042-2451 (Ed. 7-15)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY INSURANCE FOR
SCHEDULED ADDITIONAL INSURED
This endorsement modlfics lnsuranc€ provided under the followint:
COMMERCIAT GENERAL LIABIUTY COVERAGE PART
SCHEDUI.E
Addlllon.l lnsured:
rHlRl RE9(,IRED BY I{RITTE}I CONTRACI
Location Ol Cov€red Operadons:
AI,I, IOCATIONS
(lf no entry eppears above, informatlon required to complete thls endoEement will be shown in the
Declarations as applicabl€ to thls endorsement.)
with respect only to the Additional lnsured and at
the locition of Covered Operations shown in the
Schedule, the followlng h added to SECnON U -
COMMERCI.AL GENERAI IIABILITY CONOlnoNS.
Paregraph il.Othct lnsuranceand supeEedes any
provislon to thecontrary:
Prlmary And Noncontributory Insurance
This lnsurance is primary to and wlll not
seekcontrlbulion from any other insulance
avaihble to the Additional lnsured whh respect
to the Location Of Covered Operations shown in
the Schedule under thispolicyprovlded that:
(1) The Additional lnsured is a named
insuredunder such other insurance; and
(2) You have agreed in wrltlng in a contract
onrgreement that this insurance would
beprimary and would not seek
contributionfrom any other insurance
available to theAdditional lnsured.
1042-24A1(Ed. 7-15) lndudes copFghted mat€rlal of lnsuranco Sorvlc€s Oflica, lnc.,
whh its psrmlsslon.
/PROTPOLL Shrrr.v S.nd.r.L I l1//O22 r:lrrtb px rpDr,I supersedes AIL p!eviously ,ssueo .err rfrcatcs.
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