2022/03/01 System Pavers, LLCClient#: 1928397 SYSTEPAVACORD* CERTIFICATE OF LIABILITY INSURANCE
COVERAGES CERTIFICATE NUMBEB REVISION NUMBER
DATE (MM/OD/YYYY)
3t24t2022
IMPORTANT: lf th
If SUBROGATION
this certificate do
e ce(ilicate holder is an ADDITIONAL tNSURED,lhe poticy(ies) musl have AODITIONAL INSUBED proviaions or be endorsedlS WAIVED, subiect to the terms and conditions ol the policy,certain policies may require an endorsement. A slatement ones not confer any rights to the cerlilicate holder in lieu ol such endorsement(s).
EGAT
TH s Ec RTI rc TE IS DEUs S M TT BE o N BFOM ONTI LON AND Nco RE NOs IGR PUHTSON HT cEERTI CATE HO ERLD HT sETRFICDTENOESOTRMATLEoNBELNEDDEXTENRoTERALHTcEEovREGFARFOEDBDTHPEtctOLESLOWBETHISEcTIRcFITEFoNUNCERANDOEScoOTTUTENSTIcoNTRAcBTENETWEETHSSUNGNUsEBRUTHOtzER0),(s
ER RESP NTE TI oVE PBOR cDU BE DAN ETH R FITIc TE HO DELR
PRODUCER
USI lnsurance Seryices LLC-CL
3'190 Fairyiew Park Drive Suite 400
Falls Church, VA 22042-4546
703 698.0788
_&,re. e!e!q2-9927
42579
INSUREO
adri,eathorne@usi.com
703 698-0788
INSUBER E
Adri Eathorne
INSUFEF B
INSUREA C
10677
16045System Pavers, LLC
1570 Brookhollow Drive
Santa Ana, CA 92705 tNsuBEF o. Nationwide Mutual lnsurance Company
The Cincinnali lnsurance Company
Everest Premier lnsurance Company
tNsu8EF a. Allied Properly & Casually tnsurance Co
TH S To E THAT TH PO IC S OF INSU NCE L STED E H VE BEEN SSUED To THE NSU D N ED BoVE FO THE PO C E oNOTHSNGREOUEl,l l- fiT TE o C:_,1!D TON o NY co CT o OTHE DOCUr/ENT i{TH ESPECT TO t-l cH TH SCRTICATEBESUEL)o E N I HE NSU cE FOADED B THE OL]C ES D SC BED HEB N S S tsJECT TO L THE T SEXCLUSoNSNL)cON D T ONS o SUCH PO tc SHO N HA E EEN El)UCED B D c MS,
tNSFtTR TYPE OF INSUBANCE PoLrcY EIF PoLrcY Ex(MM/ODTYYYY) (MMrD0/YYY LIMIIS
x coMMERCTAL GENEFAL LtABtLTTY PGLO3100336800 131t2022 03t01t2 EACH OCCURFENCE $ 1,000,000
CLAIMS MADE f1] o"","TO FENTED
S IE! alludence)s100 0
PEBSONAL & ADV INJUFY $'1,000,000
GEN'L AGGFEGATE LIMITAPPLIES PEB GENEBAL AGGAEGATE s2,000,000II,P& tX LOC PBODUCTS COMP/OP AGG s2,000,000
D AUTOMOsILE LIABILITY x x AcP8A3100336800 3t3112022 03101 t202^-coMBrNED sNGLEL
BOOILY INJUBY (Per
] eoorrv ruunv qee,
'w sl,ooo,oqlx
OWNEO
AUTOS ONLY
H FEDAUTOS ONLYx ;
SCHEOULED
AUTOSNON.OWNED
AUTOS ONLY
B OCCUF
CLAIMS MADE
xs1180839 313112022 0301t20 s5,000,000
$5,000,oQq
$
EXCESS LIAB AGGREGATE
DED REIENTION$
c WORKEFS COiIPENSATION
AND EMPTOYEFS'IIAAILIry
ANY PBOPBIETOB/PABTNEF/EXECIJTIVFOFFICEF/MEMA€R EXCLUOEO?
OESCBIPTION OF OPERAIIONS below
x sw3wc00073221 1t2022 03t01120 x OTH
N N E L EACH ACC DENT s1,000,000
E,L. DISEAS€. EA EMPLOYEE !1 ,000,090
i€L DrsEAsE ".."!ru;];i ,000,000
oF oPEFATIONS I LocAlloNS / vEtilcLEs (ACoFo 101, Addhional Renarks schedule, may be attached ti more spac. ts requked)sured lncludes: Systems Pavers Holdings, lnc.; Sp Marketing, LLC; System pavers ol Oregon, LLC;
System Pavers ol Colorado, LLC; System pavers ol Texas, LLC; System pavers ol Washinglon, LLC
City ol Menilee is included as Additional lnsured under the General Liability Per form GECG970 attached
OESCFIPTION
Named ln
FTIFICATE HOLDEF CAN E TION
ol 1
50
SHOULD ANYOFTHE ABOVE DESCBIBEO POLICIES BE CANCELLED BEFORETHE EXPIBATION OATE THEREOF, NOTICE WILL BE DELIVEBED INACCOBOANCE WITH THE POLICY PROVISIONS,
City of Menilee
Engineering Department
297'14 Haun Boad
AUTHORIZEO REPBESENTATIVE
ACOBD 2s (2016i03) Ifs354022 12lM353891
It.l_SUBEi(S) AFFOFOTNG COVEFACE
IS
IND CATED
LIMITS
I,rvrco exe lrny one peao.r ] s5,000
l
OTHEB
$
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O 1988"2015 ACORD CORPORAT|ON. A[ rights reserved.
The ACORD name and logo are registered marks of ACORO
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