PROOF OF INSURANCE (2015) CLOSED Trueline Corporation
Agreement No. 4626
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ACS CERTIFICATE LIABILITY I ;AT` I)HY ''
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: It the caritficats holder Is an ADDITIONAL INSURED,,the P011ty(les)must be endorsed. It SUBROGATI.0 1 N 18 WAIVED,subjoct to
the terms end conditions of the policy,certain policies may require An endorsement A statement on this certificate doss not confer rights to the
00111"cats holder in lieu of Such endoroamant s,
PRODUCER... 7.t,at,tly Xaciaffi-Ramirez
ffiillenaium Corporate Solutions . �626)275-3000 ..... +� ,(c2c)s7s-also
License # OC13480 bymencajus.com
550 N Brand Blvd #1100 wucs
Glendale CA 91203
Trueliae Construction �. ... .- .w_.. � ouraACe Co 37974
m..�. . .
iNa ERA t a1+r Ia p.Ias Cora Q636
d1s�RERR s.GoldawlD
�._.
Lion ri Surfacing, nc. I RLTtc.Btd+a111ati,t Co s¢ny 2314
g• ems' RS
.�...
dba: Trualine 5076
m..6te ... aeati�an las
1651 >lsarket Street, Ste. B
Corona CA 92880
COVERAGES CERTIFICATE NUMBER: 2014 - 2015 REVIS'IO'N NUMBER,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO TO THE INSURED NAMED ABOVE FOR THE POLICY PF_MOI7'
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 KXICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I.TR TYPE OFUNWRANCE Y P 'Y,:CY LarrtS ....... .^
GENERAL LLWLnY EACH s 11 000,000
.,COMMERCIAL d1, NERAL IMOLl°r'M' 1 .....,_..
Ma:ExP anu Imo. s 50.000
I 6.F
A � t, OL:CU!R I MItiL01®0931 /25/2014 /25/2015 5,000
PERSONAL A AM INJURY s 1,000,0_..
..... _ _ GENERAL AGGRFAATE ...._ 3 2,000,000
PRODUCTS Da
AUTOMOBILE A4O�1 Ada BEM; H -.... _.
F'h',SL94"� L�J �.
l,wIOPAOO i 2,000,000
._;J,0M.."
B EX.. ..i9OWNED SCHEDULED BAGO57081 /25/2014 1/25/2015 PMDr.ILVNIU
BODILY INJU
x � CH RY(
Para_s.udst)
P_ Y , EHIRED AUTOS NON-OWNED :
:.._...
COMP-51,000 X COLL-$100
Y UMMLLAUAB. .. .X OCCUR �i EACHOCCURRPNCE L..: 11000,000
C EXCESS LIAB CLAINIS-MADE KEOL236013 /25/2014 7/25/2015
10,00 'GATE
_ �. s _:L1000.000
N $
D CRS COr ENUTRMi E.L. WC$ATU 0TH- _
AND e•LIABILITY YIN Z .A....,,,....,,. ..„,.... ,.„,„,,.,..
ANY maw wrLrOwir rMRMrr a Mnsrl �..lAMOLO ,
OMrICERvUCIBER e°:1MCI,UDEDM NIA EL DISEASE EA EMPLOYEE 000 000 EACH
A
(Mond a' InNH) 9107693-2014 /25/2014 7/25/2015 ..
at dwr6ft ?LO s 1...000.a00Q
n�d16Pt OH _E�tn�wM� LIb4IP s ,a 11 000 000
DESCRPMN OF OPERATIONS I LOCATHM I VEHICLES (Athch ACORD 101.AddOmW Renawks Schedule,If mom spw Is reWirsd)
Rai Tennia Court Resurfacing, Project No. PW 13-30
City of 91 Segundo, its officers, officials, employee, agents, end volunteers are included as additional
insured for Gibneral Liability with primary wording, as respects to the insureds operations and only if
required by written contract per the attached endorsements. FTC waiver of subrogation applies. 30 days NOG
except non-payment/10 days given.
CERTIFICATE HOLDER -V CANCELLATION
—
I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City Of 81 Segundo ( ," ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street
81 Segundo, CA 90245 AUTHOMME)REPREMUATNE
Margaret Gilmore/NS -
ACORD 25(2010105) 01885-2010 ACORD CORPORATION. All rights reserved.
INS025(201006).01 The ACORD name and logo are regletmed marks of ACORD
Policy Number. MGLOIB 931 ML Hawley Insurance Compaury
THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY,
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
Ttds erdorssrnant modifies Insurance provided under ft blWMng:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name of Additional Insured Person(*) Location and Desc►Iptlon of
or Organ ion(s) !Comptsted Operations
All persons or organizations where required
by written contract
Information required to complete this Schedule, if not shown above,will be shown In the Declarations.
A. Section It — Who Is An Insured Is amended to B. YM respect to the Insurance afforded to two
41dude as an addMonal Insured the n(s) or additional Insureds, the following Is added 10 Section
organization(s) shown In the► Schedule, but only U 1ti— nft Of Insurance:
Pstpect to tltability for*bodlly Injury""or"property dam.
Caused, In whole or,In party„by''�our woW at the, If aovenage provided to the additional Insured Is re-
n designated described In the Schedule of Quind by a conbaot or @W ment, the most we will
this endorsement peftmed for that additional Insured par on behalf of the additional Insured Is the amount
and Included in the "products-completed operations of insuurance:
hazard'.
Howe 7. Required by the contract or agreement or
ver.
2. Available under the applicable Urrlts of insunnoe
1. The insurance afbrded to such additional insured shown In the Declarstlons,
only aWles to the extent permitted by law,and
Is less.
2. If oovsnge provided to the additional Insured is whld�evsr
required by a contract or agrssnent, the Ineur- This endorsement shop not inmass the appocabie
once afforded to such aCkIftr it insured will not Limits of Insurance shown In the Declarations,.
not be broader than that which you are required
by it*contract or agreement to provide br such
additional Insured.
CG 20 37 0413 G Insurance Services Offfce,Inc.,2012 Page 1 of 1
Insured
Policy Number MGL0180931 Mt Hawley Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ R CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -
SCHEDULED PERSON OR ORGANIZATION
This andornmerd mods les insurance provided under the bllawlng:
COMMERCIAL GENERAL LABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Porseon(sr)
Or nlzstJtrn(s : Location e Of Covered Operafl�ons:
All persons or orWizatlons where nequked
by written contraat
..................
l n required to complete this Scheadule„ lf not shown above,wvllj be shown In the tea.
A. Section 11 —Who Is An Insured Is arnended lo In- not be broader than that which you are required
clude as an oddWonal Insured the pe Ns)or orponl- by the oonbvO or agreement to provide for such
a ,$)shown in the Schedule, but only with respect addrdonal Insured.
to llability for "bodly Injury'", "property da a"' or
"psawal andadvertlaing Injury" caused, in wiuAs or B. With respect to the Insurance afforded to theas
in Psi iy, additional Insureds,the following addltlorwl awkWons
1. Your acts or omissions;or apply:
This Insurance does not apply to "bodily Injury' or
2. The acts or omissions of thoes acting on your "property darrrage"o=xTing after.
behalf;
1. AU world Inducting materlala, parts or equlpment
In the onai Insured(s)o the q)�� furnished In connection with such work, on the
Project (other then service, maintenance or r�
above. pairs)to be performed by or on behalf of the addf-
Corral Insured(s) at the location of the covered
However operations has been completed;or
1. The Insurance afforded to such addltlonal Insured 2. That portion of"your work""out of which the Injury
only applies to the uUM permitted by law;and or damage Woes has been Put to Its Intended we
by any person or orp another
2. If coverage provided to the addltlonal Insured Is contractor or subboorhtrecior engaged In npsrbnrring
required by a contract or agreement, the In- operations br a principal as a part of the am
surance afforded to such additional Insured will Project
CG 2010 04 13 O Insurance Services Office, Inc.,2012 Pape 1 of 1
Insured
Policy Number: MGLO180931 ML Hawley Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY —
OTHER INSURANCE CONDITION "
TN$OndorMme d modNles Insurance
Provided under the folbwing:
COMMERC AL GENERAL,L LIABILITY COVERAGE PART
PRODUCTSICOMPLET"EI OPERATIONS LIABILITY COVERAGE PART
The f0f0wing Is added to the OtIm Insurance Condition (2) You have agreed In wwralting In a conhad or agree.
and San es any Provfalon to the contrary: MOM that this Insurance would be p ary and
Pri And Nonoorrtrl
would not t i from any in-
y bubory Insurance surance available to ft additional In
This Insurance is primary to and will not seolk con-
tlon from any otor Insurance available to an
addifional Insured under your Politer Provided that:
(1) The addttlarral Insured Is a Named Insured under
Such other Insurance;and
CG 20 010413 O Insurance Services Office,Inc.,2012 Page 1 of 1
Insured
EINIDORS04WT AGRBRAW
9107893-2014
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2-24-96-63
24-
96
� PAGE 163
ALL OIRCTIVE DATES IFnCTIV6 JULY 25, 2014 AT 12.01 A.M.
AT 1401 AM PACIFIC AND 2"IRIM JULY 25, 2015 AT 12.01 A.M. ..�
TIME ACA
PACIFIC StAryaApI6 TIINAN(
k
TRUEIINE CONSTRUCTION &SURFACING INC.
1651 NPIMT ST 8TZ H 0`6
CORONA, CA 92880
WE HAVE THE RIGHT To RECOWR MR PAyXEN= FR
LIABLE FOR AN JVJURV COVERED By TMS POLICY. WE WILL
I+IO',T ORCE OUR RI ,INST FF OR
O I2ATI WPJ= Itl THE SCHEMXE.
THIS AGREDCMT APPLIES ONLY To THE =rWr THAT yoU
PERFORK WORK LWDER A WRI'rM C T RLIQUI "OU
TO OBTAIN THIS AGRE �" ' us.
IIIE ADDITIONAL PMrM FOR THIS ENDORsEwW SHALL BE
OFMX TO"I"AL POLICY P I
scuu=
bi J019 w
ANY PERSON OR OAMNIzATION B
FOR M S IR LAMT WAIVER OF
MS AGREED By �� SUBROGATION
I"I
CWM, CT TO FISH THIS
WAIVE
G 114 TM$ &AXM3v~ COWAINSO S To NARY, ALTO, WAIVII
POUCY ,, OR t�I AIT"AIIONN TFN S
0TK A "A N'NOTNII " IN yM pOLMY *"U BE
NEW TO VARY, ALTER, WAIVE OIL LIMIT THNE ?VMS, CONDITIONS, AGREEMENTS OFD
L04NTATIOM OF TA11 s ZIMMSOWIEW,
catNgr&"WMEO AID ISSU® AT SAN FRANCISCO. AUGUST 1, 2014. 2572
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