2022/12/01 Santa Ana Creek Development CoACORD'
pRoDUcER License # 0757776
HUB Intemational lnsurance Services lnc.PO Box 5345Riverside, CA 92517
San-ta-Ana Creek Oevelopm€nt Co. dba: Malk Compahy2288 & 2290 North Batavia St
Orange, CA 92865
CERTIFICATE OF LIABILITY INSURANCE
jl3.-'i, ."), (9s1) 788-ssooE{AIIADORESS:
MARKCOM-03
rNsuRER(S) AFFORDft G COVERAGE
rNsuRER a , Executive Risk lndemnity
rNsuRER B rFederal lnsurance Company
[id, n", (gsr) zss-asoz
INSURED 35181
20281
INSURERSr
EL
11t29t2022THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND;BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSiITIJREPRESENTATIVE OR PROOUCER, AND THE CERTIFICATE HOLDiR.
LY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISEXTEND OR ALTER THE COVERAGE AFFORDED BYTHEPOLICIESTE A CONTRACT BETWEEN THE tSSUtHC lHSUnenlsl, aurtonrzeo
ANPORTT certithetf ficate h td is DAO otTrN theNRSUDE ol c tes m ts ha AD ITDlopv()NAL NSURED bprovr dSUROBTtfNtoISubcttohtrmsdnditionshtlenrtaismauvpoandotate treqthcertificatedrihtstothrtifihatetdiIsoluenhrsdo
ES FICATE to RlTHSISTocRTETTETHOLICESoF]NSU CE L S EB OW HDTE BEVE NE SUS DE THETO N DSURE N EMD BOVE Ro ETH L]PO C E roDNDICADTENOTWTHTSDNNGoEUNRENIEToTER[I co DN T CONoo CTNTRA o TNoE UDOC E[,1 NT ITH E PES TC To HC TH SCRTECATELtEBSSEUoDtERTNTHNUScEORDDEBHTEPOLcSEEDCSEBDHEENSSBJUCETToTHLTEEMSXCEUSLStoNl.l coD DN T ONS o UCHS POL ECS LI[4 ST HS MOWN VEHA EN8E ER CEDU D CD MS
LI EXNCEBER
lqcH ocEvRRENCE $
12/1/2023 _BAS0BEJ?E:EJJf,pe""") $
-\rED EXPlAny one pe6on) . $
JERSO!{L E ADV INJURY $
GENERAL 4\GGREGAT€ . $
PRODLJCIS. COMP/OP AGG $
1,000,000
54309582
A
B
X 54309583
x
121'12022
12t1t2022 121112023
X coMMERcIAL cENERAL LtaBtLrTy
clAr[4s,rvaoE X occuR
1,000,000
100,000
5,000
1,000,000
2,000,000
2,000,000
GEN'L AGGREGATE L MITAFPLI€S PFRX eorcv X !f6o; Loc
R Per Proj Gen A9g porcontfacr
COMBINED SINGLE LIMIT
BoDTLY INJURY (Per pe6on)
AqOILY TNJURY (Per accde.0
AUTOMOBILE LlAAILIT
X alvnuro
OWNEOAIJTOS ONLY
H RED
SCHEDULEO
AUTOS ONLY
D
54309584 '12t1t2022 121,1t2023
tTsEASE
IJMBRELLA LIAB OCCI]R
EXCESS LIAB CLAIMS.MAOE
OEO RETENTION S
E4qr occuRSENcE
AGGREGATE
1,000.000
r,000,000
1,000.000
B wonxenscotueersanor,rANO EMPLOYERS'LIABILITY
ANY PROPRIETOFiPARTNER/E^ECUTIVF
OFFICEFYMEMBER EXCLUDED 7
Y PER OIH^ STATUTE ER
E.L EACH ACCIOENT $
E,L, DISEASE - €A EMPLOYEE g
oEscRlPTloN oF oPERATIONS,l OCATTOI!s,vrHlcLEs lrqcoRo ro, Add,t,onlt R.h.rrs sch.dut6, m.y o..nached ithor. !o.col:r tl.9?"19,b."". ogdormeo by.rhe Named rnsi,,io J,iiiliiiii ii;,ii;i;;il;;;;;t;li: -- -.-" -" ;i;i**urty or Mendee is incruded as Additionar rnsured as respects Generar Liabirty per attached endorsiemenr.
ICATE ANCEL
City ot Menifee
297'14 Haun Road
Menifee, CA 92586
AUIHORIZED REPRESENTATIVE
ACORD 25 (2016/03)@ 19EE-2015 ACORO CORPORATTON
The ACORD hame and logo arc .egistered marks of ACORD
All rights reserved
WAIVEO,
s
$
5
s
5
$
SHOULO ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF. NOTICE WLL BE DELIVERED INACCORDANCE wlTH THE POLICY PROVISIONS.
&r-ru'*-
AGENCY CUSTOMER tD. MARKCOM-03
LOC #: 1
ADDITIONAL REMARKS SCHEDULE
SEDGEl
ACORD'
Page 1 ol 1
lllAfiEO INSUREDSanla_A-na Creek Oevelopment Co. dba: Mark Company2288 & 2290 Nonh Batavi, StO.ange, CA 92865
EE PAGE 1 SEE P .I
License f 0757776
UB lnternational lnsurance Services lnc.
PAGE 1
AODITIONAL REMARKS
THIS ADOITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: {coB!!l FORM TTTLE: certificata orL.abi
Cancellation:
should the policy(ies) be cancelled before the expiration date, Hub lnternational.lnsurance services lnc. (Hub), independent ol anyrights which may be afforded within the policies io the certificate holder named betow, will provide to such certificate holder noticeof such cancellation within thirty (30) days of the cancellation date, except in the event the cancellation i; due to non.payment ofpremium, in which case Hub will provide to such certificate holder notice of such canceilatir. *iittiri""ir of aays of ihdcancellation
ACORD 101 (2008/01)@ 2008 ACORO CORPORAT|ON. AI rights reserved
The ACORD name and logo are registered marks of ACORO
I
I
l
THIS ENDORSEMENT CHANGES THE POLIGY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES ORcoNTRAcroRS - coMpLETED 6penalottS
This endorsement modifies insurance provided under the following:
POLICY NUMBER: 54309583
COMMERCIAL GENERAL LIABILITY COVERAGE PARTPRODUCTS/COI\,4PLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
COMMERCIAL GENERAL LIABILITYcc 20 37 1219
A. Section ll - Who ls An lnsured is amended toinclude as an additional insured the person(s) ororganization(s) shown in the Schedule, but ontywith respect to liability for ',bodily injury,, or"property damage" caused, in whole or in part, by"your work" at the location designated anddescribed in the Schedule of this endorsementperformed for that additional insured andincluded in the "products-completed operations
hazard".
However:
1. The insurance afforded to such additionalinsured only applies to the extent permitted
by law; and
2. lf coverage provided to the additional insuredis required by a contract or agreement, theinsurance afforded to such additional insuredwill not be broader than that whjch you arerequired by the contract or agreement toprovide for such additional insured.
B. 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 isrequired 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
2. Available under the applicable Limits oflnsurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicableLimits of lnsurance shown in the Declarations
Name Of Additional lnsured person(s)
OrO anization s Location And Descri ion Of Com leted O erations
WHERE REQUIRED BY T{RITTEN CONTRACT, BUT
ONLY WI{EN THE CONTRACT SPECTFIES COVERAGE
FOR COMPLETED OPER"ATIONS
AIL IOCATIONS TiHERE REQUIRED BY flRIITEN
CONTRACT
bove, will be shown in the Declarationslnformation re uired to com ete this Schedule if not shown a
cG 20 37 12 19 @ lnsurance Services Office, lnc.,2Oi2 Page 1 of I
POLICY NUMBER: 54309583
This endorsement modifies insurance provided under the following
CO[4MERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
COMMERCIAL GENERAL LIABILITY
cG 20 10 1219
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES ORCONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
A. Section ll - Who ls An lnsured is amended toinclude as an additional insured the person(s) ororganization(s) shown in the Schedule, but onlywith respect to liability for,'bodily injury,,, ',propertydamage" or "personal anO aOvertiiing irilury,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 additionalinsured only applies to the extent permitted bylaw; and
2. lf coverage provided to the additional insured isrequired by a contract or agreement, theinsurance afforded to such additional insuredwill not be broader than that which you arerequired by the contract or agreement toprovide 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 "bodily injury,,or"property damage" occurring after:
1. All work, including materjals, parts orequipment furnished in connection with suchwork, on the project (other than service,
maintenance or repairs) to be performed by oron behalf of the additional insured(s) at thelocation of the covered operations has been
completed; or
2. That portion of "your work" out of which theinjury or damage arises has been put to itsintended use by any person or organization
other than another contractor or subcontractorengaged in performing operations for aprincipal as a part of the same project.
Name Of Addit
OrO
ona nS u Peredrson S
an az no s erationsLocationSOf Covered O
I{HERE REQUIRED BY flRTTTEN CONTRACT AII, OF YOT'R LOCATIONS WHERE REQUTRED BY
WRTTTEN CONTRACT.
ll be shown in the Declarations.lnformation re uired to com ete this Schedule , if not shown above
cG 20 1012 19 @ lnsurance Services Office, lnc., 2018 Page 1 of 2
C. With respect to the insurance afforded to theseadditional insureds, the following is added toSection lll - Llmits Of Insurance:
lf coverage provided to the additional insured isrequired 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
2. Available under the
insurance;
whichever is less.
This endorsement shall
applicable limits of insurance
applicable limits of
not increase the
Page 2 of 2 @ lnsurance Services Office, lnc.,2018 cG 20 10 12 19