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2023/03/01 Goforth and Marti Inc. dba GM BusinessINSR ADDL SUBR LTR INSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? EACH OCCURRENCE $ DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ PRO- OTHER: LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person)$ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS AUTOS ONLY HIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below POLICY NON-OWNED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 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 AFFORDED 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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) ACORDTM CERTIFICATE OF LIABILITY INSURANCE National Union Fire Ins Co of Pittsburg New Hampshire Insurance Company Hiscox Insurance Company Inc. 4/14/2023 EPIC Insurance Midwest 560 5th Street, Suite 202 Grand Rapids, MI 49504 Sue Nisoff - sue.nisoff@epicbrokers.com Goforth & Marti Inc. dba GM Business GM Business Interiors 1099 W. La Cadena Dr. Riverside, CA 92501 19445 23841 10200 A X X X X 5180177 03/01/2023 03/01/2024 1,000,000 300,000 25,000 1,000,000 2,000,000 2,000,000 A X X X X X 2961606 03/01/2023 03/01/2024 1,000,000 A N X 80756387 03/01/2023 03/01/2024 X 1,000,000 1,000,000 1,000,000 C Professional Liab ANE405372523 03/01/2023 03/01/2024 $1,000,000 Each Occ $2,000,000 Agg City of Menifee, its officers, agents and employees named as additionally insured (on a primary and non contributory basis) with respects to General Liability and Auto Liability as required by written contract; a Waiver of Subrogation is issued in favor of certificate holder with respects to General Liability, Auto Liability and Workers' Compensation as required by written contract; Excess is follow form; All policies contain a 30 day notice of cancellation (10 days for non-pay) subject to policy terms and conditions; GL additional insured endorsements include ongoing and completed operations. City of Menifee 29844 Haun Road Menifee, CA 92586 1 of 1 #S5482552/M5283427 GMBUSINClient#: 164812 SNI04 DocuSign Envelope ID: 95912C5E-37B2-43AD-9EEF-7D28FC1310E3 ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 143525 02/22 ©Includes copyrighted material of Insurance Services Office, Inc ., with permission. Page 1 of 1 This endorsement, ef fective 12:01 a.m., Forms a part of Policy No.: 5180177 Issued to: Goforth & Marti dba GM Business By: National Union Fire Insurance Company of Pittsburgh, PA ADDITIONAL INSURED – OWNERS, LESSEES, OR CONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Entity: Location(s): I.Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and d escribed in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard" This endorsement serves to modify only those terms, conditions and/or exclusions of the policy referenced therein. The remainder of the policy shall remain unchanged by this endorsement. __________________________ Authorized Representative 3/1/2023 &,7<2)0(1,)((,762)),&(56 $*(176$1'(03/2<((6 +DXQ5RDG 0HQLIHH&$ $///2&$7,216$1'352-(&76$6 5(48,5('%<:5,77(1&2175$&7: DocuSign Envelope ID: 95912C5E-37B2-43AD-9EEF-7D28FC1310E3 ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 143526 02/22 ©Includes copyrighted material of Insurance Services Office, Inc ., with permission. Page 1 of 1 This endorsement, effective 12:01 a.m., Forms a part of Policy No.: 5180177 Issued to: Goforth & Marti dba GM Business By: National Union Fire Insurance Company of Pittsburgh, PA ADDITIONAL INSURED – OWNERS, LESSEES, OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Entity: I.Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" 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 op erations for the additional insured(s) at the location(s) designated above. II.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage " occurring after: 1.All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2.That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operatio ns for a principal as a part of the same project. This endorsement serves to modify only those terms, conditions and/or exclusions of the policy referenced therein. The remainder of the policy shall remain unchanged by this endorsement. __________________________ Authorized Representative 3/1/2023 CITY OF MENIFEE, ITS OFFICERS, AGENTS, AND EMPLOYEES 29844 Haun Road Menifee, CA 92586 Location(s): ALL LOCATIONS AND ALL PROJECTS AS REQUIRED BY WRITTEN CONTRACT DocuSign Envelope ID: 95912C5E-37B2-43AD-9EEF-7D28FC1310E3 POLICY NUMBER: GL 518-01-77 COMMERCIAL GENERAL LIABILITY CG 24 0412 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): CITY OF MENIFEE, ITS OFFICERS, AGENTS AND EMPLOYEES 29844 Haun Road Menifee, CA 92586 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV-Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 0412 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 DocuSign Envelope ID: 95912C5E-37B2-43AD-9EEF-7D28FC1310E3 POLICY NUMBER: GL 518-01-77 DocuSign Envelope ID: 95912C5E-37B2-43AD-9EEF-7D28FC1310E3   DocuSign Envelope ID: 95912C5E-37B2-43AD-9EEF-7D28FC1310E3