2022/03/30 V. Hunter, T. Lueras dba American Crane ServiceA6ORiJ
COVERAGES
CERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE NUMBER: 516333196 REVISION NUMAER
3t25t2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENO, EXTEND OR ALTER THE COVERAGE AFFORDEO 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 certificate holder is an ADDITIONAL INSUREO, the policy(ies) must have ADOITIONAL INSURED provisions or be endorsed.
lf SUBROGATION lS WAIVED, subject to the terms and conditions ol the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PROOUCER
Emery & Karrigan, lnc.
9880 SW Beaverton-Hillsdale Hwy
Suite 202
Beaverton OR 97005-3367
INSUREO
V. Hunter, T. Lueras
dba American Crane Service
370 N. Palm Street Ste C
Brea CA 92821
12537
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PHONE(rC, No,Ertl:
iilHtess, certs@"meryk€nrgan com
INSU RER(S) AFFOROING COVERAGE
rNsuREB4:qnited Specialty lns Co
[il,*o,503'sar-sora
INSURERB:
INSUREE! i
INSURERO:
INSURER E:
INSURER F:
THIS IS IO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO AELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWTHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUI'ENT WTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR I\,!AY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERI!,'IS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LlfIlTS SHOWN l\4AY HAVE BEEN REDUCED BY PAID CLAI[,lS
TYPEOFINSURANCE LIMITSAOOL SUBRINSR POLICY EFF POLICY EXP
X COMMERCIAL GENERAL LIAEILITY
. cLerus ltaoE X occun
X Hook L,ab y
X OverThe Roed ME
GEN L AGGR€GAIE LIM'T APPLIES PER
"o, c.7 X !|$ Loc
OTHER
EACH OCCURRENCE
OAI/IAGLIO RENTEO
PREMISES (Ee occud6n@)
MEo ExP (Any on€ poGon)
PERSONALA ADV INJURY
GEN€ RAL AGGR E GAIE
PRODI]CTS, COMP/OP AGG
s 1.000,000
$ 50,000
$ Exclud€d
$ 1 000,000
s2 000 000
$2.000,000
$
DLJ-GL-00000171,01 33At2A22 3i3012023
ANY AUTO
OV1NED
-
AUTOS ONLY
HIRED
j AUTOS ONIY
COIIB]NED S NGLE LIM T
aoo LY NJURY lP_.f pe.son)
BOO LY LNJURY (Per.cc,denll
$
$
$
s
AUTOMOBILELIABILITY DLJ-GL-00000171-01 313012022 3/30/2023
SCHEDULEOAUTOS
NON-OV\NEDAUTOS ONLY
UMERELLALIAB
EXCESS LIAB
OED RETENIION $
EACH OCCURRENCE
AGGREGATE
OCCUR
CLAIMS-MAOE
oEscRtpItoN oF oPERAl|ON S / LOCATTONS / VEHTC LES IACORO I O 1, Addltlon.l Rem.rk! Schedul., m.y be atrachod ll morc space is r.qul.sd)
City of l\renifee is named as additional insured when required by written contract per the attached endorsement.l
OTHWORKERSCOiIPENSATION
AND ETIPLOYERS' LIABIUTY
ANYPROPRIETOR/PARTNER/EXECUT VE
OFFICER/MEMBEREXCLUDED?
OESCRIPTION OF OPERAT1ONS b€low
STAI!]TE , ER
E L EACH ACCIDENT
E L D SEASE EA EMPLOYEE
E L OISEASE POLICY LIMIT
CERTIFICATE HOLDER CANCELLATION
City of Menifee
29844 Haun Road
Menifee CA 92586
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION OATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROV!SIONS,
AUTHORIZED REPRESENIAIlVE
iLzL
O 1988-2015 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)
I
s
$
I
Commercial General Liability
GLM 2033 03 ls
Pollcy Number: DLJ-GL-000001 71 -0'1
lnsured Name: V. Hunter, T. Lueras
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAT INSURED -ONGOING OPERATIONS OWNERS, LESSEES OR CONTRACTORS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SECTION ll -WHO lS AN lltsURED is amended to include
as an additional insured any person or organization that
the Named lnsured has agreed to name as an Additional
lnsured on its policy. However, such additionalinsured
status shall be granted only if such agreement was
evidenced "in writing" or by a written contract executed by
the Named ln5ured before the "occurrence" took place.
Furthermore, the conditions tri8gerinE such additional
insured status are governed as follows:
Such person or organization is an
Additional lnsured only with respect to
liability for "bodily injury" or "property
damaSe" that is directly caused by the
Named lnsured's performance of
"onBoinB operations" for at least one of
the Additional lnsureds.
However, where the Named lnsured has
agreed in a written contract to specific
editions of ISO additional insured
endorsements or to specific language as
delineated in those ISO additional insured
endorsements, Paragraph A above is
deleted and replaced with either
paragraph 8.1 or 8.2 below.
Caused in Whole or in Part -
Where the Named lnsured is required by
a written contract to make a person or
orBanization an Additional lnsured using
the language from ISO Additional tnsured
forms CG2033 or CG2010 with edition
dates of .,uly 2004 lO7/04), ot April2071
(04/13) such person or organiu ation is an
Additional lnsured only with respect to
liability for "bodily injury" or "property
damage" that is caused in whole or in
part by the Named lnsured's
performance of "onSoing operations" for
at least one of the Addrtronal lnsureds;
OR
2. Arising Out Of -
Where the Named lnsured is required by
a written contract to make a person or
organization an Additional lnsured usinB
the language from l5O Additional lnsured
forms CG2033 or CG2010 with edition
dates of 2001, 1993 or 1985, such person
or organization is an Additional lnsured
only with respect to liability for "bodily
injury" or "property damage" arising out
of the Named lnsured's performance of
"ongoing operations" for at least one of
the Additional lnsureds.
c Additionally:
1. The insurance afforded to any Additional
lnsured only apples to the extent
permitted by law; and
2. lf coverage provided to the Additional
lnsured is required by contract or
agreement an in writing, the insurance
afforded to such additional insured will
not be broader than that which the
Named lnsured is required by the
contract or agreement to Drovide for
such Additional lnsured.
B
GLM 2033 03 15 Page 1 ot 2
Policy Number: DLJ-GL-00000'171 -01
Exclusions
With respect to the insurance afforded to the Additional
lnsuredsi
A. This endorsement does not eliminate any
other exclusions in this policy or the
CG0001 (10/01) policy form.
B. This Additional insured Endorsement
does not apply to:
1. Any damages a rising from the
"products completed operataons
hazard";
2. "Bodily injury" or "Property damage"
arising out of the rendering of or
failure to render any professional
architectural, engineering or
surveying services, including:
a. The preparing, approving, or failing
to prepare or approve maps, shop
drawings, opinions, reports,
surveys, filed orders, change
orders or drawings and
specifications; or
b. Supervisory, inspection,
architectural, or engineering
activities;
c The Named lnsured completes
delivery, and/or assembly of
equipment at the project site
pursuant to the terms of the bare
lease agreement; or
d. The Named lnsured's equipment
has been assembled at the project
site, if the work to be performed
by the Named lnsured on behalf of
the Additional lnsured is limited to
the rental of equipment that must
be set up or assembled at the
project site. This exclusion does
not apply to liability caused by the
Named lnsured's acts or omissions
during the disassembly or the
equipment.
3. "Bodily injury" or "property damage"
occurring after:
Allthe work on the project to be
performed by Named lnsured on
beha lf of the Additional lnsured
has been completed; or
b. That portion of the work
performed by he Named lnsured,
out of which the injury or damage
arises, has been put to its intended
ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED
in this Endorsement, the following definitions
"Ongoing operations" shall mean that period of
time in which any insured is actively performing
work or operations on a project or in
preparation for work on a project. That period
of time commences when the insured actively
begins work to fulfill its contradualobligations,
and ends when their contractualobligations
have been fulfilled.
Definitions
As used
a pp ly:
a
-14
Authorized Representative
lncludes copyrighted material of lnsurance SeNices Office, lnc.,
with its permissron.GLM 2033 03 15 Page 2 of 2
vs, r!. ur LEv,,,rt
GLM 2033 03 15
use by any person or organization
other than another contractor or
subcontractor engaged in
performing operations for a
principal as a part of the same
projectj or