2022/07/13 W.D. Gott Construction CoWDGOT-1
CERTIFICATE OF LIABILITY INSURANCE 7
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 AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE OOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PROOUCER, AND THE CERTIFICATE HOLOER.
TMPORTANT: tf the certificate hold€r is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSUREO provisions or be endo.sed.
It SUBROGATION lS WAIVED, subject to the torms and condltlons ol the policy, cortain policios may require an endo6em€nt. A statement on
hits to the certificate holder ln llou of 6uch endorsement(s).this ce.tiflcate doe8 not confer rlg
626"577-6656626-795-992'lPHONE
N
INSURERISI AFFORDING COV€RA6E ,r4393tNsuRER A:west American lnsurance co.
PROOUCER
Supple-Merrill & Orlscoll lnc.
lnsurance Ag€nt9 and BaokeB
P O. Box 2,108
Pasadena, CA 91102
James A. Dilks
626-795-9921
rNsuRER s . Great American Assurance co.
rNsuRER c. Allstate lnsurance Company
INSURER D :
INSURER E
INSURER F
INSUREO
W.O. Gott Construction Co
'1656 W. gth Stre6t, Suito A
Upland, CA 91786
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWTHSTANDING ANY REQUIREMENI TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUEO OR MAY PERTAIN, THE INSURANCE AFFORDEO BY THE POLICIES OESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS.
DITIONS OT SUCH POLICIES. LIMITS SHOWN I\,iAY HAVE BEEN REDUCED BY PAID CLAIMSEXCLUSIONS ANO CON
B POLICY NUiTBERTYPE OF INSURANCE
1,000,000X
50,000RENTEOT
MEO Excluded
1,000,000
TE 2,000,000
2,000,000T
07 t13t202307r1312022xLP4051510
B COIIMERCIAL GEN6RAL LIABILITY
x
L MIT
]ECT
CLAIMS MADE OCCUR
EN'L AGGREGA
POLICY
PER
LOC
1,000,000INEO SINGLE LIMIT
x
IN
OAMAGExx
07t13t2023904'i33 o7t'13t2022
c
OWNEO
AUTOS ONLY
HIRED
SCHEDUL€OAUTOS
lSlaBtNtP
AUTOMOBITE LIAEILITY
9,000,000EACHx
9,000,0
UMBRELLA UAB
EXCESS UAA
OCCUR
CIAIMS.iIADE 0711312022 07113t2023UM8,1051511
DEO x RFTENnoN r 10000
B
TH
EL
EA EMPLOYEE
WORKERS COMPENSATIOI{
ANO EMPLOYERS' LIABII.ITY
ANY DROPRIETORFARTNES/EXECUTIVE
or FrcER,niEMhER t^CLU!:Eo?
N
75,000
2,500
07113t2023 ILREN
Ded
5685,t529 t1312022
oEscRtpltoN oF opER noN s / LocaTtoNS / vEHtcLEs {AcoRo ! ot, addltlon.l R.m.r*. sch.dul., m.y b. t.ch.d llmo...p.c. h roqulr.d)
Certificate Holder i8 Additional lnsured with respect to lnsured's
operations,
CITYMEN
City of Menifee
29844 Haun Rd
Menifee, CA 92586
SHOULD ANY OF THE ABOVE DESCRIBEO POLICIES BE CANCELLED SEFORE
THE EXPIRATION DATE THEREOF, NOTICE wlLL BE OELIVEREO IN
ACCOROANCE wlTH THE POLICY PROVISIONS,
AUTHORIZEO REPRESENIATIVE
James A. Dilks
o 1988-2015 ACORD coRPORATloN. All rights reservedACORD 25 (20't6/03)
The ACORD name and logo are registered marks of ACORO
A,CORD
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EQUIPMENT
^CORD"
woGoT-1
cenrriclrE oF LrABrLrw TNSURANcE 07108t2022
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 AMEND, EXTEND OR ALTER THE COVERAGE AFFORDEO BY THE POLICIES
BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEO
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
TMPORTANT: It tho certificate holds. ls an AODITIONAL INSUREO, the policy(les) must havo ADDITIONAL INSURED provision6 or be endorsed.
lf SUBROGATION lS WAIVEO, subioct to the terms and condltions of the policy, certain pollcies may require an endorsemont. A statement on
thig certificate does not confer rlghts to the certlricate holdsr ln lleu of such endorsement(s).
626-577-6656626-795-9921
INSURERIS) AFFOROING COVERAGE
44393rr.rsunen a ,West American lnsurance Co
PROOUCER
Supple-Merrill & Oriscoll lnc.
lnsurance Agents and Brok€rs
P O. Box 2,108
Pasadena, CA 91102James A- Dilkg
626-795-9921
rNsuRER B. Great American Assurance Co.
rNsuRER c Allstate lnsurance Company
INS!RER O:
iNSURER F
INSt'RED
W.D. Gott Construction Co
1656 W. gth St.e€t, Sulte A
Upland, CA 91786
THIS IS TO CERTIFY IHAT TIIE POLICIES OF INSURANCE LISTEO BELOW HAVE EEEN ISSUEO TO TTIE INSURED NAT/EO ABOVE TOR THE POLICY PERIOD
INDICATED NOIWTHSTANDING ANY REQUIREMENT, TERM OR CONOITION OF ANY CONTRACT OR OTHER OOCUMENT WTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOROED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS
EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAID CLAIMS
POLICY EFF LIMITSSUBPOLICY NUMBERINSRIYPE OF INSUI{ANCE
't,000,000EACHx
OAMAGE IO RENTED 50,000
Excluded
1,000,000PERSO
2,000,000
2,000,000
07 t,1312022 0711312023xxLP4051510
COIIIMERCIAL GENERAL LIABILITY
x
]ECT
CLAIMS MAOE OCCUR
POL CY
'L AG LIMITAPPLIES PER
LOC
IN€O SINGLE LIMIT 1,00
X
IN
xX
07 t131202313307 t13t2022xx
OWNEOAUTOS ONLY
AUTOS ONLY
SCHEOULEO
AUTOS
IBtattNt?
AUTOMOBILE UABIUTY
9,000,000xx9,000,000UIIBRELLA UAA
EXC€Ss UAa
OCCUR
CIAIMS"iIADE 07 t13t2022 07 t13t2023uM8405 t 511
RETENI6N $ 10000
B
DED x
OTH
IDENT
WORXERS COMPENSATIONAND EMPLOYERS' LIABILITY
OED'
RENT
Ded
75,0
2,500
13t2022 07 t131202351529
oEscRtpTtotit oF opERAIloNs / LocAno s / vEHtcLES (acoRo I ol, addftion.l R.m.rt. sch.dul., m.y b. .tlrch.d ll mor .p... l. ..qulr.d)
strict enter;
as respects to
Liability. OCIPlicable on and PPrteons onlv with resDect to Goperati6ns. Auto' Liability
of Subrogation applies to
perati
n site off project
Auto Liab
The ofnUfeennooSchDistrioltcRocEducationMeC ity
s iteoffddaaunsredifeeMennaISedmasition
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CITOFMA
City of Menifee
29844 Haun Road
Menifee, CA 92586 AUTHORlzEO REPRESENIAIIVE
James A. Oilks
O 1988.2015 ACORD CORPORATION. All rights reservedACORD 25 (2016/03)
The ACORO name and logo are registered marks of ACORD
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SHOULO ANY OF THE AAOVE OESCRIBED POLICIES BE CANCELLEO BEFORE
THE EXPIRATION OATE THEREOF, NOTICE WILL BE OELIVERED IN
ACCOROANCE wlTH THE POLICY PROVISIONS.
NOTEPAD:HoLoER cooE CIIOFMA
rNsuREo s NAIIE W.D. GOtt Construction Co
WDGOT-1
OP lO: LH
PAGE 2
oata 07t08t2022
Liability Cc20110i!13,CG20370413, CG2,10,10509, GAc36{9CG, cAc3?3'1,:cc25030509, AAcw2o1ol1. 30 dav notice of canc€Ilation 6xc€pt 10-days for aon-palrd€ntof proeiuE (lrenifee Middle school tl)