2021/04/01 SEMA Construction, Inc.Client#:1481884ACORD* CERTIFICATE OF LIABILITY INSURANCE
COVERAGES CERTIFICATE NUMBER REVISION NUMBER:
DATE (M[,/OO/YYYY)
3103n022
FICATEcTH IS ERTI CAFITE tsss DUE S TTER OF N TIFORMA No coNFERS oN GRI UHTS NPO ETH ERTI HO ELOR.TH SERTIFtcATEE00NOsTAFFTIVEIRMALORNGATLEYDEXTENORTLREETHECOVERAGFFOREDDTHBYPOLEtcESEBLOWTHSEcFRTICAOFTENUNCRADENoEscoOTNSTITUTENTRACcoBTTETWEENtssHEUINSUINERUTHORIZEDR(sRPEERENsTTORERPODUCTNDHEERTIER,FI TECA DEHOLR.
M ORTPANT thetf holcertificate tsde,DDITtoNAL REDNSU h m haveust DAD ONrTtpoicy(i AL suN ERD istons beor dorsedIIBSUGAROTtotsNDEsuectthetotermndadbjofitionsthncertaitcpotcypendomenreqaystatementisthIicerticatedoenotsconferthelonhcertificatederghtsuofhlseendoment().PRODUCER
USI lnsurance Services, LLC
P.O. Box 7050
Englewood, CO 80155
800 873{500
INSURED
SEMA Construction, lnc.
7353 S. Eagle St.
Centennial, CO 80'l l2
rNsuiERA I Greenwich lnsurenca company
tNsuRER a: Alliecl World Assurance Company, Ltd
tNsdRERc. XL Specialty lnsurancs Company
N
E
rNsuRER(S) AFFOROTNG COVERAGE
den.contractors@usi.com
800 873-8500
|NSORER D. XL lnsuaance America, lnc,
22322
24s54
NONAIC
37885
$4,000 000
SOOIIY INJURY (P€r p€Bon)
AOOILY INJURY (Pe. a€den0
A
1202'1 04t01t20
1t2021 04t01t202
,000,000
TOS TCER TSTH THTE OF Ns NC LE S DTE ELOWB VE UE TOD ETH NS RED ED OR ETH CYPOLi PE ODNDITEOoNANDTHSTNGEToRDcoNTtoNcoNTRACTTHEooocl',4E TN RES TOPECT HITSBEoUEDRt\,4A RTE NSN.CE RDo DE B POLTHE C ES DESCRI B DE HERE N TSUBJEC TO ALLLUEXCNSsloDOFUCHSCPOLLILtTSHOWSNVEEENBcADN4S
s300 000
s10 000
s4,000 000
EACIj OCCURRENCE
NIEO
$2,000,000
COMBINEO SINGLE LIMIT
PERSONAL A ADV INJURY
GENERAL AGGREGATE
PRODUCTS. COMP/OP AGG
1t2021 04t01t20
OTH,
$
2,000 000
s'1 0,000,000
sl0,000,000
E19H gqclltRElll
AGGREGATE
x
E,L, EACH ACCIOENT
EI DISEASE. EA EMPLOYE $l 000 000
$'1,000,000
x
,YFE OF INSIJRAIICE
x coxraERcta! GENEttat LIAB|LITY
CLAIMS.MADE
cAS740982402
X UMERELLA LIAB 03122848
cwDT 409A2202
us00099103Lt21A
OL
x x
x
c x
D
x
x
AUTOMOAIIE TIABILIIY
EXCESS LnA
GEN'L AGGREGATE LIM TAPPLIES PFR
RETENTION$
INSR WVD POLICY NUMAEFx x cco740982302
CLAIMS MADE
AIJTOS ONLY
HIREOAUTOSONLY
] SCHEOITLED
- I NoN-owNEDl!-] ALrros oNLY
Excess
Liability
[I 5g"oi ]f,,o"
WORKERS COMPENSA'ION
ANO ETIPLOYERS' LIABILITY
aNy pRoPRrETowpARrNEruExrc-rrvr t' n
OFFICERJMEMBER EXCLUDED" ] N( .nd.lory ln NH)
DESCRIPTION OF OPERATIONS below
DED
4101t2021 04t01t202
1t202't o4to,U20
E orsE 000,|000
$15,000,000 Ea Occ
$15,000,000 Aggregate
The General Liability and Automobile Liability policies include an automatic Additional lnsured endorsement
that provides Additional lnsured status to city of Menifee, its mayor, councir, officers, agents, employeesand volunteers, only when there is a wriften contract that requires such status, and only with regard towork performed by or on behalf of the named insured. The General Liability and Automobile Liability
(See Attached Descriptions)
OESCRIPTION OF OPERATIONS /LOCATIONS/ VEH
RE: City qf Menifee, Holland Road I
ICLES (ACORL IOI, A.t tfiton.t R.m.rt. Sch.d!h, roy b. rn ch.d DoE .p.o r. nqut.d)-25 overpass
CERTIFICATE R CANCE ON
@ 1988-2015 ACORD CORPORAT|ON. A[ righb r.$erved
The ACORO name and logo are registercd merks of ACORD
KQSZP
SHOULO ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BETORETHE EXPIRANOT OATE THEREOF, NOTICE wlLL AE OELIVERED INACCOROANCE IIITIH THE POLICY PROVISIONS,
City of Menifee
29844 Haun Rd
Menifee, CA 92586
ACORo 25 (2016/03) 1ot2f s35l 95864/M3.t 5471 23
SEMACON
ONLY AND
AMEND,
-1--
REOUIREMENT.
POLICIES BEEN ABOVE
OF OR WHICHCERIIFICATETHEISTHETERI\,4SCONDITIONSREDUCED
$
S
S
l9qen,
s
B x x
LIM T
AUTHORIZED REPRESENTATNE
Ss
DESC RIPTIONS (Gontinued from page 1)
policies contain a speciar endorsement with primary and Noncontributory wording, when required bycontract. The workers comp€nsation policies includo a Waiver of Subrogation endorsement in favorAdditional lnsureds as referenced above. A[ poricies incrude an endorsement providing that 30 daysof cancellation will be given to the Certificate Holder by the lnsurance Carrier.
written
of
notice
SAGITTA 25.3 (2016/031 2 ol2
#S3519586/UM31547123
POLICY NUMBER CGD740982302 COMMERCTAL GENERAL LtABtLtTycc 20 10 04 t3
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional lnsured Person(s)
Or Or nization s rationsLocationsOf Covered O
ANY PERSON OR ORGANIZATION THAT YOU AREREQUIRED IN A WRITTEN CONTRACT OR WRITTEN
AGREEMENT TO INCLUDE AS AN AODITIONAL
INSURED PROVIDED THE 'BODILY INJURY'OR,PROPERTY DAMAGE' OCCURS SUBSEOUENT TOTHE EXECUTION OF THE WRITTEN CONTRACT ORWRITTEN AGREEMENT.
VARIOUS AS REQUIRED PER WRITTEN
CONTRACT.
ete this Schedule, if not shown above, will be shown in the Declarations-lnformation uired to com
A. Section ll - Who ls An lnsured is amended toinclude as an additlonal insured the person(s) or
organization(s) shown in the Schedule, but onlywith respect to liability for'bodily injury',, "properttdamage" 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
behalf;
in the performance of your ongoing operations forthe additional insured(s) at the tocation(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 additjonal insured is
required by a contract or agreement, the
insurance afforded to such additional insuredwill not be broader than that which you arorequired by the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to theseadditional insureds, the following additional
exclusions apply:
This insurance does not apply to .bodity injury. or
"property damage' occurring after:
1. All work, including materials, parls orequipment fumished in connection with suchwork, on the project (other than service,
mainlenance or repairs) to be performed by oron 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 theinjury or damago arises has been put to its
intended use by any person or organization
other than another conlractor or subcontractor
engaged in performing operations for a
principal as a part of the same project.
cG 20 10 04 13 @ lnsurance Services Office, lnc.,2012 Page 1 of 2
C, With respect to the insurance afforded to theseadditional insureds, the following is added toSection lll - Limits Of lnsurance:
lf coverage provided to the additional insured is
required by a contract or agreement, the most wewill pay on behalf of the additional insured is lheamount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits oflnsurance shown in the Declarations;
whichever is less-
This endorsement shall not increase theapplicable Limits of lnsurance shown in the
Declarations.
Page 2 ol 2 O lnsurance Services Oflice, lnc-,20.12 cG 20 10 04 13
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
pOLtCy NUMBER. CGD740982302
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 onlywith respect to liability for ''bodity injury,' or''property damage" caused, in whole or in part, by
''your work" at the location designated and
described in the Schedule of this endorsementperformed for that additional insured andincluded in the "products-completed operations
hazard"
However:
1. The insurance afforded to such addltional
insured only applies to the extent permifted
by law; and
2. lf coverage provided to the additional insuredis required by a conlract or agreement, the
insurance afforded to such additional insured
will not be broader lhan that which you arerequired by the contract or agreement toprovide for such additional insured.
COMMERCIAL GENERAL LIABILITY
cG 20 37 04 13
B. With respect to the insurance afforded to theseadditional 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 wewill pay on behalf of the additional insured is the
amount of insurance:
'1. Required by the contract or agreement; or
?, Available under the applicable Limits of
lnsurance shown in the Declarations;
whichever is less.
This endorsemenl shall nol increase the applicable
Limits of lnsurance shown in the Declarations.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY COVERAGE PARTPRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional lnsured Person(s)
OrO anization s Location And Descri n Of Com edO erations
ANY PERSON OR ORGANIZATION THAT YOU ARE
REQUIRED IN A WRITTEN CONTRACT OR
WRITTEN AGREEMENT TO INCLUDE AS AN
ADDITIONAL INSURED PROVIDED THE 'BODILY
INJURY' OR 'PROPERTY DAMAGE'' OCCURS
SUBSEOUENT TO THE EXECUTION OF THE
WRITTEN CONTRACT OR WRITTEN AGREEMENT.
will be shown in the Declarationslnformationuired to com lete this Schedule if not shown above
cG 20 37 04 13 @ lnsurance Services Office, lnc,2012 Page I of 1
VARIOUS AS REOUIRED PER WRITTEN
CONTRACT.