2021/07/08 TR Design Group, Inc. (5)^CORD
TRDESIG-01
CERTIFICATE OF L!AB!LITY INSURANCE 718t2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITIJTE A CONTRACT BETWEEN THE ISSUING INSURER(S}, AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lf the certificate hold6r is an ADDITIONAL INSURED, ihe policy(ies) must have ADDITIONAL INSURED provisions or be endorsod.lf SUBROGATION lS WAIVEO, subject to lhs terms and conditions of ths policy, certain policies may requiro an endorsement. A slatement on
this conflcato does not confer rights to tho c6rtificatE holder in lieu of such endolsem€nt(s).
FilBHEss cal.cpu@hubinlernational.com
INSURER(S) AFFOROING COVERAGE
rNsuRER a : ohio security lnsurance company
tNsuRER B . Property and Casualty lnsurance Company oJ Hartford
rNsuRER C : Lexington lnsurance company
fiR Elcr Kllstil Igehrer
[il, r"r,(951) 231-2572
pRoDUcER License # 0757776
HUB lnternational lnsurance Servicos lnc
PO Box 5345
Rivorside, CA 92517
24082
34690
19437TR Oesign Group, lnc.
2900 Adams St., Ste. A400
Riverside, CA 92504 INSURER E
il3)fi, e,o, (ss1) 77e-8s58
COVERAGES CERTIFICATE NUMBER REV
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE FOR THE POLICY PERIOD
INDICATED NOTWTHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUN4ENT WTH RESPECT TO WTIICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOROEO BY THE POLICIES DESCRIAED HEREIN IS SUBJECT TO ALL THE TERMS
EXCLUSIONS ANO CONDITIONS OF SUCH POL]CIES L MITS SHOV1A MAY HAVE EEEN REDUCED BY PA D CLA MS
POLICY EFF POLICY EXP
!8S!,aAS9E8E!cE
DAMAOE TO RENTED
PAEULSES lEa aecweoEeL
!--EA!M4!r-s!c!9!!cnl--
!EESAI]A!_CaD-y]N&EY- _.
AEI{EB4IAqGAEAA.T!.-
PRODUCTS . COMP/OP AGG
2,000,000
2,000,000
15,000
2,000,000
4,000,000
4,000,000
BZS (23) s6 41 41 95 51812022
s
sx
s
s
s
s
s
CLAIMS MAOE 5t8t2023
il"o.,""fliF& fl,o"
OTHER
A X coMMERcTAL GEN ERA! LtAstLtrY
L4 ] occuR
COMBINED SINGIE LIMITtE€cc!!!lL- I
BODILY INJURY {P4 peTsn) 5
BootY lllJURY (Pq erdenr) I s
PROPERTY DAMAGE{P*..cld6n0 SI'
2,000,000
5ftt2022 5t8t2023X BzS (23) 56 /r1 41 95
[] Il-Fff" o^.' I tr
SCHEOULEOAUTOS
AUTOSONLY
A lu-rouoaLe ungury
OW\€DAUTOS ONLY
UMBRELLALIAE
ExcEss uaB f l
DED RETENTION$
OCCUF
CLAIMS MADE AGGREGATE
$
$B woRKERs coMPENsATroNANO EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTVE IOFFICER,,EMBER E^CLI]DED7lU!nd.lorv ln NH)
'1,000,000
1,000,000
1,000,000
OTH
72 WEC EV4335 11t22t2021 11t22J2022
x
xY NrA
DESC
STATUTE
E! EAcHAccrpENr ] !
E L DISEASE EA EMPLOYEE $
C Professional Liab.
C Professional Liab.
031711121
o317',l1',l21
718t2021
7 t812021
1'l 122J2O22 Oed S2SK/EAClaim Lmt
11122!2022 Aggrcgate
't,000,000
2,000,000
DESCRIPTION OF OPERATIONS / LOCAi|ONS / VEHICLES TACORD l Ol , Addnional Remlrl! Sc h.dul€, my b. .tteched ir mo€ .p.c. i. BqulEd)
RE: Agreement No. #2021-0214 and the corresponding Purchase Order (PO) #02975.
The City of Menifee and its officers, employees, agents, authorized volunteers and all persons or entities are Additional lnsured wilh regard to General and
Auto Liability when required by writt€n contract per the attached endorsement form BP79g6 0g/16. Primary & Non -Contributory wording applies with regard
to General Liability when required by writt€n contract per the attached €ndorsement form 8P1488 07113. Waiver ot Subrogation with regar.l to Workers
Compensation applies when required by written contract per the attached endo$ement form wc040306(l).
Should the policies be cancelled before the expiration date, Hub lnternational lnsurance Services lnc. (Hub), independent of any rights which may be allorded
SEE ATTACHED ACORD 101
The City ot Menifee
Attn: Paula Muratore
29844 Haun Road
Menifee, CA 92586
SHOULO AtIY OF THE ABO!'E OESCRIBED POLICIES BE CAI{CELLEO BEFORETHE EXPIRATION OATE THEREOF, I{OTICE WILL AE DELIVEREO IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATTVE
FCE TEH LDER CANCELLATION
ACORD 25 (20't6/03)
tr
l$
Nn'ru,^,-
O'1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks ofACORD
AGENCY CUSTOMER ID, TRDESIG-O,I
LOC #: 1
ADDITIONAL REMARKS SCHEDULE
SGONZALEZ
ACORD'Page 1 ol 1
License # 0757776
HUB lnternational lnsurance Services lnc.
NAMED INSIJREOTR Desion GrouD. lnc.
2900 Ad-ams St.,'Ste. A400Riverside, CA 92504
SEE PAGE 1
NAtC COOE
EE PAGE 1 P1 EFFEcnvE oArE: SEE pAGE 1
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 FORM TITLE:Certificate of Liability lnsuranco
Description of Operations/Locations/Vehicles:
within the policies to the certificate holder named below, will provide to such certificate holdsr notice of such cancellation within
thirty (30) days of the cancellation date, except in the event the cancellation is due to non-payment of premium, in which case Hub
will provide to such certificate holder notice of such cancellation within ten (10) days of the cancellation date,
O 2008 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registored marks of ACORD
ACORD 101 (2008/01)
lnsured: TR Design Group, lnc.
Policy No.: BZS (23) 56 41 41 95
Policy Period: 51812022 lo 51812023
BUSINESSOWNERS
BP 79 96 09 16
THIS ENDORSEMENT CHANGES THE POLICY. PLEASEREAD IT CAREFULLY.
This endorsement modifies insurance provided under the following
BUSINESSO\i\iNERS COVERAGE FORM
Below is a summarization of the coverages provided by this endorsement. No coverages are given by this
summary. Actual coverage descriptions are within this endorsement.
SECTION SUBJECT
A. Supplementary Payments
Bail Bonds
Loss Of Earnings
Broadened Coverage For Damage To Premises Rented To You
lncidental l\iledical Malpractice lnjury
Mobile Equipment
Blanket Additional lnsured (Owners, Contractors Or Lessors)
Newly Formed Or Acquired Organizations
Aggregate Limits
Duties ln The Event Of Occurrence, Offense, Claim Or Suit
Liability And Medical Expenses Definitions
Bodily lnjury
lnsured Contract
Personal And Advertising lnjury
Section ll - Liability is amended as follows:
A. Supplementary Payments
Section A.l, Business Liability is modified as follows:
1. The $250 limit shown in Paragraph A.f .f.(f Xb) Coverage Extension - Supplementary Payments for the
cost of bail bonds is replaced by a $3,000 limit.
2. The $250 limit shown in Paragraph A.1.f.(1Xd) Coverage Extension - Supplementary Payments for
reasonable expenses and loss of earnings is replaced by a $500 limit.
B. Broadened Coverage For Damage To Premises Rented To You
l. The last paragraph of Section 8.1. Exclusions - Applicable To Business Liability Coverage is replaced
by the following:
Wth respect to the premises which are rented to you or temporarily occupied by you with the permis'
sion of the owner, Exclusions c., d., e.,9., h., k., 1., m., n. and o. do not apply to "property damage".
BP 79 96 09 16 Page I of 4
BUSINESSOWNERS LIABILITY EXTENSION ENDORSEMENT
B.
c.
D.
E.
F.
G,
H.
t.
@ 2016 Liberty Mutual lnsurance
lncludes copyrighted material of lnsu.ance Services Offlce, lnc., with its permission.
2. Paragraph D.2. Liability And Medical Expenses Limits Of lnsurance is replaced by the following:
The most we will pay under this endorsemenl for the sum of all damages because of all "property
damage" to premises while rented to you or temporarily occupied by you with the permission of the
owner is the Limit of lnsurance shown in the Declarations.
3. Paragraph O.3. Liability And Medical Expenses Limits Of lnsurance does not apply.
C. lncidental Medical Malpractice lniury
l. Paragraph (4) under Paragraph B.l.i. Exclusions - Applicable To Business Liability coverage - Profes-
sional Services does not apply to "lncidental l\iledical Malpractice lnjury" coverage.
2. Wth respect to this endorsement, the following is added to Section F. Liability And Medical Expenses
Definitions:
a. "lncidental Medical Malpractice lnjury" means bodily injury arising out of the rendering of or
failure to render, during the policy period, the following services:
(l) Medical, surgical, dental, x-ray or nursing service or treatment or the furnishing of food or
beverages in connection therewith; or
(2) The furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances.
b. This coverage does not apply to:
(l) Expenses incurred by the insured for llrst-aid to others at the time of an accident and the
Duties in the Event of Occurrence, Ofiense, Claim or Suit Condition is amended accordingly.
(2) Any insured engaged in the business or occupation of providing any of the services described
under a. above.
(3) lnjury caused by any indemnitee if such indemnitee is engaged in the business or occupation
of providing any of the services described under a. above.
D. Mobile Equipment
Section C. Who ls An lnsured is amended to include any person driving "mobile equipment" with your
permission.
E. Blanket Additional lnsured (Owners, Contractors Or Lessors)
l. Section C. Who ls An lnsured is amended to include as an insured any person or organization whom
you are required to name as an additional insured on this policy under a written contract or written
agreement. The witten contract or agreement must be:
a. Currently in effect or becoming effective during the term of this policy; and
b. Executed prior to the "bodily injury", "property damage", or "personal and advertising injury".
2. The insurance afforded to the addilional insured is limited as follows:
a. The person or organization is only an additional insured with respect to liability arising out of:
(l) Real property, as described in a written contract or written agreement, you own, rent, lease,
maintain or occupy; and
(2) Caused in whole or in part by your ongoing operations performed for that insured.
b. The Limit of lnsurance applicable to the additional insured are those specified in the written
contract or written agreement or the limits available under this policy, as stated in the Declara-
tions, whichever are less. These limits are inclusive of and not in addition to the Limit of lnsurance
available under this policy.
c. The insurance afforded to the additional insured does not apply to:
(1) Liability arising out ofthe sole negligence ofthe additional insured:
(2) "Bodily injury", "property damage", "personal and advertising injury", or defense coverage
under the Supplementary Payments section of the policy arising out of an architect's, en-
gineer's or surveyor's rendering of or failure to render any professional services including:
o 2016 Liberty Mutual lnsurance
BP 79 96 09 16 lncludes copyrighted materiai of lnsurance Services Office, lnc., with its permission. Page 2 of 4
(a) The preparing or approving of maps, shop drawings, opinions, reports, surveys, lield
orders, change orders, or drawings and specifications; and
(b) Supervisory, inspection, architectural orengineering activities.
(3) Any "occurrence" that takes place after you cease to be a tenant in the premises described in
the Declarations; or
(4) Structural alterations, new construction or demolition operations performed by or for the
person or organization designated in the Declarations.
3. Any coverage provided hereunder shall be excess over any other valid and collectible insurance avail-
able to the additional insured whether primary, excess, contingent or on any other basis unless a
contract specifically requires that this insurance be primary or you request that it apply on a primary
basis.
F. Newly Formed Or Acquired Organizations
The following is added to Section C, Who ls An lnsured:
Any business entity acquired by you or incorporated or organized by you under the laws of any individual
state of the United States of America over which you maintain majority ownership interest exceeding lifty
percent. Such acquired or newly formed organization will qualify as a Named lnsured if there is no similar
insurance available to that entity. However:
1. Coverage under this provision is afforded only until the 180th day afier the entity was acquired or
incorporated or organized by you or the end of the policy period, whichever is earlier;
2. Section A.l. Business Liability does not apply to:
a. "Bodily injury" or "property damage" that occurred before the entity was acquired or incorporated
or organized by you; and
b. "Personal and advertising injury" arising out of an otfense committed before the entity was ac-
quired or incorporated or organized by you.
3. Records and descriptions of operations must be maintained by the first Named lnsured.
No person or organization is an insured with respect to the conduct of any current or past partnership, joint
venture or limited liability company that is not shown as a Named lnsured in the Declarations.
G. Aggregate Limits
The following is added to Paragraph D.4. Aggregate Limits Liability and l\iledical Expenses Limits Of
lnsurance:
l. The Aggregate Limits apply separately to each of the "locations" owned by or rented to you or
temporarily occupied by you with the permission of the owner.
2. The Aggregate Limits also apply separately to each of your projects away from premises owned by or
rented to you.
For the purpose of this endorsement only, "location" means premises involving the same or connect-
ing lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-
of-way of a railroad.
H. Duties ln The Event Of Occurrence, Offense, Claim Or Suit
1. Paragraph E.2.a. Duties ln The Event Of Occurrence, Offense, Claim Or Suit Liability And l\iledical
Expenses General Condition applies only when the "occurrence" is known to any insured listed in
Paragraph C.l. Who ls An lnsured or any "employee" authorized by you to give or receive notice of an
"occurrence" or claim.
Paragraph E.2.b. Duties ln The Event Of Occurrence, Offense, Claim Or Suit Liability And l\iledical
Expenses General Condition will not be considered breached unless the breach occurs after such claim
or "suit" is known to any insured listed under Paragraph C.l. Who ls An lnsured or any "employee"
authorized by you to give or receive notice of an "occurrence" or claim.
2
BP 79 96 09 16 Page 3 of 4
o 2016 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance Services Office, lnc., with its permission.
Section F. Liability And Medical Expenses Definitions is modified as follows:
1. Paragraph F.3. is replaced by the following:
3. "Bodily lnjury" means bodily injury, sickness, disease, or incidental medical malpractice injury
sustained by a person, and includes mental anguish resulting from any of these; and including
death resulting from any of these at any time.
2. Paragraph F.9. is replaced by the following:
9. "lnsured contract" means:
a. A contract for a lease of premises. However, that portion of the contract for a lease of prem-
ises that indemnifies any person or organization for damage by fire to premises while rented
to you or temporarily occupied by you with permission of the owner is not an "insured
contract":
b. A sidetrack agreement:
c. Any easement or license agreement, except in connection with construction or demolition
operations on or within 50 feet of a railroad;
d. An obligation, as required by ordinance, to indemnify a municipality, except in connection
with work for a municipality,
e. An elevator maintenance agreement,
f. That part of any other contract or agreement pertaining to your business (including an indem-
nification of a municipality in connection with work performed for a municipality) under which
you assume the tort liability of another party to pay for "bodily injury" or "property damage"
to a third person or organization, provided the "bodily injury" or "property damage" is
caused, in whole or in part, by you or by those acting on your behalf. However, such part of a
contract or agreement shall only be considered an "insured contract" to the extent your
assumption of the tort liability is permitted by law. Tort liability means a liability that would be
imposed by law in the absence of any contract or agreement.
Paragraph f. does not include that part of any contract or agreemenl:
(l) That indemnities a railroad for "bodily injury" or "property damage" arising out of con-
struction or demolition operations, within 50 feet of any railroad property and affecting
any railroad bridge or trestle, tracks, road-beds, tunnel, underpass or crossing;
(2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of:
(a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opin-
ions, reports, surveys, field orders, change orders or drawings and specifications; or
(b) Giving directions or instructions, or failing to give them, if that is the primary cause of
the injury or damage; or
(3) Under which the insured, if an architect, engineer or surveyor, assumes liability for an
injury or damage arising out of the insured's rendering or failure to render professional
services, including those listed in (2) above and supervisory, inspection, architectural or
engineering activities.
3. Paragraph F.l4.b. Psrsonal And Advertising lniury is replaced by the following:
b, Malicious prosecution or abuse of process,
BP 73 96 09 16 Page 4 of 4
@ 2016 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance Services Ofilce, lnc., wath its permission.
lnsured: TR Design Group, lnc.
Policy No.: BZS (23) 56 41 41 95
Policy Period: 5 l8 12022 lo 51812023
This endorsement modifies insurance provided under the following
BUSINESSOWNERS COVERAGE FORM
The following is added to Paragraph H. Other ln-
surance of Section lll - Common Policy Condi-
tions and supersedes any provision to the con-
trary:
Primary And Noncontributory lnsurance
This insurance is primary to and will not seek
contribution from any other insurance avail-
able to an additional insured under your poli-
cy provided that:
1. The additional insured is a Named ln-
sured under such other insurance; and
BUSINESSOWNERS
BP 14 88 07 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASEREAD IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY
OTHER INSURANCE CONDITION
2. You have agreed in writing in a contract
or agreement that this insurance would
be primary and would not seek contribu-
tion from any other insurance available
to the additional insured.
BP 14 88 07 t3 @ lnsurance Services Office, 1nc.,2012 Page 'l of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT . CALIFORNIA
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. (This agreement applies only to the extent that you
perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work
described in the Schedule.
The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due
on such remuneration.
SCHEDULE
Person or Organization Job Description
Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from
us
Countersigned by K-;Xz;" Krr/ur-
Authorized Representative
Form WC 04 03 06
Process Date: 10/07/21
(1) Printed in U.S.A
Policy Expiration Oalei 11122122
tr
Policy Number: 72 WEC EV4335 Endorsement Number:
Effective Datei 11122121 Effective houristhe sameas stated onthe lnformation Page ofthe policy.
Named lnsured and Address: TR DESIGN GROUP INC
29OO ADAMS ST UNIT A-4OO
RIVERSIDE CA 92504