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20-0813_C.S. LEGACY CONSTRUCTION, INC._Insurance CertificateCSLEGAC OP ID: RWR ACORU" `�- CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 08/13/2020 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(les) must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of 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). PRODUCER Reed Surety & Insurance Services Inc Orrange CA 92859 KEVIN MEED cNOAMNTEA:CT KEVIN REED PHONE . 714-389.6797 A % No).. 714-276-2684 ADDRESS: KEVIN REEDSURETY.COM INSURER(8) AFFORDING COVERAGE NAIC s INSURER A: EVEREST DENALI INS. CO. 16044 0311912021 INSURED CS Legacy Construction Inc 5781 Schaefer Ave Chino, CA 91710 INSURER 8: ALLSTATE INSURANCE COMPANY 19232 INSURER C: BERKSHIRE HATHAWAY HOMESTATE 20044 INSURER D : LIBERTY INSURANCE UNDERWRITERS 19917 INSURER E: GENL AGGREGATE LIMIT APPLIES PER: POLICY X �O LOC INSURER F: is COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. L TYPE OF INSURANCE POLICY NUMBER (MhUODNYYYI 4MMtOD1YYYY1LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FKOCCUR X XCU INCLUDED X X X CF2GL00040-201 DEDUCTIBLE 5,000 PER OCC. 03119/2020 0311912021 EACH OCCURRENCE S 1+000,00 _ TO RENTED R' - (Ea anxumsrwel S 50,00 MED EXP (Any ane person) S 5,00 PERSONAL 8 ADV INJURY $ 11000,00 GENERAL AGGREGATE S 2.000,00 GENL AGGREGATE LIMIT APPLIES PER: POLICY X �O LOC PRODUCTS - COMPIOP AGG S 2,000,00 is B AUTOMOBILE LIABILITY JX ANY AUTO ALL �O ED SCHEDUX AUTOSLED HIREDAUTOS X AAUTOSWNED HIRED TRKS X PHYS DAM X X 648882260 0311912020 03119/2021 COMBINED ING LIMB 1,000,00 Ea accident BODILY INJURY (Per penwn) S BODILY INJURY (Per acddent) S PERTY DA-JW0K- PERACCIDE S S D X UMBRELLA LIAR EXCESS LIAe X OCCUR CLAIMS -MADE X X 1000337349-02 0311912020 0311912021 EACH OCCURRENCE S 4,000.00 AGGREGATE s 4,000,00 DED X RETENTION 10,000 FOLLOW s FOR C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y / N OFFICERWEMBER EXCLUDED? (Mandatory in NH) Or descdbaundar DESe;R19ION OF OPERATIONS below N I A X CSWC036876 1111512019 1111512020 X WC STATU• TH• gfllLL1Mt — _E6_ E.L. EACH ACCIDENT s 1,000,00 E.L. DISEASE - EA EMPLO S 11000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N mora space Is m4ulrod) PROJECT: NORTH WEST OPEN SPACE COMH=ITY PARR. The City, its officials, officers, employees, agents and authorized volunteers are added as Additional Insureds as respects the General Liability, Auto and Umbrella policies. Waiver of Subrogation applies to all listed policies. Thirty (30) days notice o£ cancellation. CERTIFICATE HOLDER CANCELLATION ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD CITYSCA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SAN JUAN CAPISTRANO F SANSE0 JUANCAPI THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 32400 ACCORDANCE WITH THE POLICY PROVISIONS. SAN JUAN CAPISTRANO, CA 92675 AUTHORIZED REPRESENTATIVE °o�'� 1gncO�'�"o� ora m.avwoorxn.o.amS,FtEt+r KEVIN REED uo Isow, rmactswc ,�wavnarrcert.us o.: womu,rm�s eanr ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0410B (Ed. 9-14) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA BLANKET BASIS 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.) The additional premium for this endorsement shall be 2%D of the total manual premium otherwise due on such remuneration. The minimum premium for this endorsement is $350. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE BLANKET WAIVER Person/Organization Blanket Waiver — Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Premium All CA Operations This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective 11/1512019 Policy No. CSWC036876 Endorsement No. Insured C.S. Legacy Construction, Inc. Premium $ Insurance Company Berkshire Hathaway Homestate Ins Co 0."41 U910 MslYII+rIUD yJ OM cn••Evp�ifED e•R[fDuxfTr AVD L M4A11MI SfihKES uA py-Mt5Ott11, -.u1.rM�nREfDSIRftt COnt c -l5 Countersigned by Dn.:o7oa1s 12nsgmar WC 99 04108 (Ed. 9-14) POLICY NUMBER: CF2GL00040-201 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization for whom or on whose behalf " you " are performing operations when "you" and such person or organization have agreed in writing in a contract to waiver any right of recovery "we" may have against such person or organization. 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 we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 O -Policy No.#: CF2GL00040-201 COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 0104 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: C172GL00040-201 COMMERCIAL GENERAL LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations ANY PERSON OR ORGANIZATION THAT ENTERED INTO ANY LOCATION FOR WHICH THE NAMED INSURED'S A WRITTEN CONTRACT WITH THE NAMED INSURED WORK WAS PERFORMED FOR SUCH PERSON(S) OR REQUIRING SUCH PERSON(S) OR ORGANIZATION(S) TO ORGANIZATION(S) FOR ANY COMPLETED OPERATIONS BE NAMED AS AN ADDITIONAL INSURED. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. 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 operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. 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 operations for a principal as a part of the same project. CG 2010 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 2010 0413 POLICY NUMBER: CG2GL00040-191 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 Name Of Additional Insured Person(s) Or Organ zations Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION THAT ENTERED INTO A WRITTEN CONTRACT WITH THE NAMED INSURED REQUIRING SUCH PERSON(S) OR ORGANIZATION(S) TO BE NAMED AS AN ADDITIONAL INSURED. ANY LOCATION FOR WHICH THE NAMED INSURED'S WORK WAS PERFORMED FOR SUCH PERSON(S) OR ORGANIZATION(S) FOR ANY COMPLETED OPERATIONS. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — 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 described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 INSURED: C.S. LEGACY CONSTRUCTION, INC. POLICY NO.: 64882260 COMMERCIAL AUTO AA CW 20 10 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO ENHANCEMENT ENDORSEMENT Coverage provided under this policy Is modified by the attachment of this endorsement If there is any conflict in coverage provisions between this form and any state specific endorsement also attached to this policy, the provision(s) of the stage specific form shall apply. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM In SECTION I - COVERED AUTOS, the following changes are made: The following is added: D. Physical Damage Coverage for Temporary Substitute and Leased Autos If Physical Damage Coverage is provided by this policy, the following kinds of "autos" are covered "autos" for the same coverages provided by the policy: 1. Any private passenger "auto", or other than private passenger vehicle with gross vehicle weight of 20,000 lbs. or less, you do not own while used with the permission of the owner as a temporary substitute for a covered "auto" you own that is out of service because of its: a. Breakdown; b. Repair; c. Servicing; d. 'Loss"; or e. Destruction. 2. Private passenger "autos" and other than private passenger vehicles with gross vehicle weight of 10,000 lbs. or less, leased, hired, rented, or borrowed for a period of 30 days or less. This does not include any vehicle you lease, hire, rent, or borrow from any of your "employees" or partners or members of their households. In SECTION II UABIUTY COVERAGE, the following changes are made.- Under ade:Under A. Coverage, Who Is An Insured, the following is added: d. Any organization, other than a partnership or joint venture, over which you maintain ownership or in which you hold a majority interest. This provision applies only if there is no similar insurance provided to that organization. e. Any organization you acquire or form after policy inception, other than a partnership or joint venture, over which you maintain ownership, or in which you hold a majority interest. Coverage under this provision does not apply; (1) If there is similar insurance provided to that organization; or (2) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. f. Any person or organization` that you are required to name as an additional insured'under the terms of a written job contract, or by written insurance requirements executed prior;to,any,covered "loss" or claim. This protection applies only if the person or organization is liable' for the conduct of an `Insured" and only to the extent of that liability. Under A. Coverage, Coverage Extensions, Supplementary Payments, subparagraphs (2) and (4) are replaced with the following: (2) Up to $5,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. Includes copyrighted material of Insurance Services Office, Inc., with its permission AA CW 20 10 11 Allstate Insurance Company Insured Full Copy Page 1 of 3 INSURED: C.S. LEGACY CONSTRUCTION, INC. POLICY NO.: 64882260 COMMERCIAL AUTO AA CW 20 10 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO ENHANCEMENT ENDORSEMENT Coverage provided under this policy Is modified by the attachment of this endorsement. If there is any conflict In coverage provisions between this form and any state specific endorsement also attached to this policy, the provision(s) of the state specific form shall apply. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM In SECTION I - COVERED AUTOS, the following changes are made: The following is added: D. Physical Damage Coverage for Temporary Substitute and Leased Autos If Physical Damage Coverage is provided by this policy, the following kinds of "autos" are covered "autos" for the same coverages provided by the policy: 1. Any private passenger "auto", or other than private passenger vehicle with gross vehicle weight of 20,000 lbs. or less, you do not own while used with the permission of the owner as a temporary substitute for a covered "auto" you own that is out of service because of its: a. Breakdown; b. Repair; c. Servicing; d. "Loss`; or e. Destruction. 2. Private passenger "autos" and other than private passenger vehicles with gross vehicle weight of 10,000 lbs. or less, leased, hired, rented, or borrowed for a period of 30 days or less. This does not include any vehicle you lease, hire, rent, or borrow from any of your "employees" or partners or members of their households. In SECTION II LIABILITY COVERAGE, the following changes are made:` Under A. Coverage, Who Is An Insured, the following Is added: d. Any organization, other than a partnership or joint venture, over which you maintain ownership or in which you hold a majority interest. This provision applies only if there is no similar insurance provided to that organization. e. Any organization you acquire or form after policy inception, other than a partnership or joint venture, over which you maintain ownership, or in which you hold a majority interest. Coverage under this provision does not apply; (1) If there is similar insurance provided to that organization; or (2) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. f. Any person or organization that you are required to name as an additional insured under the terms of a written jobcontract, or by written insurance requirements executed_ prior to any covered 'loss" or claim. This protection.applies only 1f the person or organization Is liable for the conduct of an "Insured" and only to the extent of that liability. Under A. Coverage, Coverage Extensions, Supplementary Payments, subparagraphs (2) and (4) are replaced with the following: (2) Up to $5,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. Includes copyrighted material of Insurance Services Office, Inc., with its permission AA CW 20 10 11 Allstate Insurance Company lnswod Full Copy Page 1 of 3 (4) All reasonable expenses incurred by the 'insured" at our request, including loss of earnings up to $500 a day because of time off from work. Under B. Exclusions, Fellow Employee, the following paragraph is added: But this exclusion does not apply to 'bodily injury" to a fellow "employee" caused by any person whose position within the insured organization is at or above the level of manager or supervisor. Coverage afforded by this provision is excess over any other collectible insurance. In SECTION III - PHYSICAL DAMAGE COVERAGE, the following changes are made: Under A Coverage, Glass Breakage - Hitting A Bird Or Animal - Failing Objects Or Missiles, the following is added: If damage to glass is repaired in lieu of being replaced, no deductible will apply for repair only. Under A. Coverage, Coverage Extensions, the following is added: Q Personal Effects Coverage In the event of a total theft of your covered "auto", for which you carry either Comprehensive or Specified Causes of Loss coverage, we will pay up to $500 for the personal effects which are: 1. owned by you; and 2. in your covered "auto" at the time of the total theft of such "auto". No deductible applies to Personal Effects Coverage. Under A. Coverage, the following is added: 5. Lease and Loan Gap Coverage In the event of a total 'loss" to a covered "auto" shown in the Schedule or Declarations for which a specific premium charge indicates that physical damage coverage applies, we will pay any unpaid amount due on the lease or loan for a covered "auto", less: a. The amount paid under the Physical Damage Coverage section of the policy; and b. Any: (1) Overdue leaselloan payments at the time of the loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Security deposits not returned by the lessor; (4) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and (5) Carry-over balances from previous loans or leases. Under D. Deductible, the following paragraph is added: When Collision Coverage is provided by this policy, the deductible amount will not be subtracted from the loss payment in collisions involving your covered "auto" and another auto covered by Allstate Insurance Company or any of it's affiliates. In SECTION IV - BUSINESS AUTO CONDITIONS, the following changes are made: Under A. Loss Conditions, Duties In The Event Of Accident, Claim, Suit Or Loss Condition, the following is added under subpart a: Knowledge of an "accident" or 'loss" by any of your agents, servants or "employees" shall not in itself constitute knowledge by you, unless you or one of your corporate officers or managers, or any assignee, shall have received such notice from the agent, servant or "employee". When you report an occurrence of any "accident" or loss" to a Worker's Compensation carrier or self insured plan providing the named insured's Worker's Compensation insurance which later develops into a claim submitted under this policy, failure to report such "accident" or loss" to us at the same time shall not be deemed a violation of this condition. After you become aware of such liability claim arising from the "accident" or loss", you must give us prompt notice. Under A. Loss Conditions, Transfer of Rights of Recovery Against Others To Us, the following is added: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of work you perform under a contract with such person or organization, in which you have agreed to waive your right of such recovery. Includes copyrighted material of Insurance Services Office, Inc., with its permission AA CW 20 10 11 Allstate Insurance Company Insured Full Copy Page 2of3 Under B. General Conditions, Concealment, Misrepresentation Or Fraud, the following is added: This condition does not apply to any omission or failure to provide material facts if the omission or failure was unintentional. Includes copyrighted material of Insurance Services Office, Inc„ with its permission AA CW 201011 Allstate Insurance Company Page 3 of 3 Insured F0 Copy