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ry OP ID: DE8 <br />� o` DATE(MMIDDIYYYY) <br />e� CERTIFICATE OF LIABILITY INSURANCE 01/12/2015_ <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, <br />IMPURTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder In lieu of such endoreemen Nsl. <br />IPROOUCER <br />Crosbyy. Insurance, Inc <br />8181 E. Kaiser Blvd <br />Anaheim Hills, CA 92808 <br />John Sheffield <br />INSURED NPG, Inc„ aka: Nelson Paving <br />& Grading, Goldstar Asphalt <br />Products <br />P.O. Box 1515 <br />Perris, CA 92572 <br />-5255 <br />NPGCOJ <br />IrOnshore Specialty Ins Co <br />General Ins Co of America <br />Liberty Ins Underwriters <br />THIS 15 TO CERTIFY THAT THE POLICIES OFINSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS <br />'LTR TYPE OF INSURANCE RRi POLICY NUMBER POLICY EFF <br />GENERAL LWBILITY MM/DDIYYVY <br />X <br />A COMMERCIAL GENERAL LIABILITY I �AGS0058702 11/15/2015111/1512016 <br />CLAIMS-MADEOCCURMED <br />POLICY EXP <br />MMIDON:: , <br />EACH OCCURRENCE LIMITS S 1,000,000 <br />1 <br />DA AG 0 1 0 <br />PREMISES Ea occurrence S <br />50,000 <br />EXP(Any one person) S <br />5,000 <br />PERSONAL A ACV INJURY $ <br />11000,000 <br />j GEN'L AGGREGATE LIMITAPPLIERPER: i <br />PRO- <br />POLICY JEC LOC i <br />GENERAL AGGREGATE S <br />2,000,000 <br />PRODUCTS - COMP/OP AGG <br />2,000,000 <br />-$� <br />AA;UT�OMOBILE LIABILITY <br />B X ANY AUTO 124 -CC -206754..9 11/15/2015 <br />ALL OWNED AUTOS I NCL PHYSICAL DAMAGE <br />11175/2016 <br />COMBINED SINGLE LIMIT <br />(Ea ecddenq s <br />1,000,00 <br />B OOILYINJURY(Perperenn) $ <br />e LY INJURY (P., eodenq g <br />L�f <br />! SCHEDULE) ALTOSCCI <br />X HIRED Nt1T05 I <br />PROPERTY DAMAGE <br />(PER ACCIDENT) $ <br />X 011:10AMED AUTOS <br />Hired Hired Phys Dam I 1950,000 MAXIMUM LIMIT <br />UMBRELLA LIAR 1i OCCUR <br />X EXCESS LIAR _ CLAIMS -MAGE <br />C F" 100002437205 11/15/2015 <br />I DEDUCTIBLE <br />RETENTION $ <br />I IC011isiOr <br />611/15/2016 <br />Comprehensive $ <br />$1,000a <br />n —�_$ $1,000 de <br />EACH OCCURRENCE $ 5,000,000 <br />AGGREGATE s <br />5,000,00 <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'LIABILITY <br />ANY PROPRIETORIPARTNEWEXECUTIVE YIN I IWVE5028828 01 101101/2016 <br />OFFICERIMEMBER EXCLUDED? NIA <br />M andaloryinH <br />Uyyes, describe,undd er <br />DESCRIPTION OF OPERATION? below <br />EQUIPMENT RENTED I I 124 -CC -103552.1 71115/2015 <br />FROM OTHERS <br />01/01/2017 <br />11/15/2016ILLimit <br />$ <br />WC STATUS OE H- <br />X (TORY _IM � I <br />ELL. EACH ACCIDENT <br />___ <br />1,000000 <br />E.L. DISEASE - EA EMPLOYEEJ$ <br />1,000,00 <br />E. L. DISEASE POLICY LIMIT 3 <br />Dad <br />7,000,000 <br />500'0000 <br />00 <br />1ESCRIPTION <br />OF OPERATIONS /LOCATIONS / VEHICLES (Attach ACORO 101, Additional Remark, Schedule, If more space Ia mqulredl <br />f cancelled for non-payment of premium only 10 days notice will be given. <br />regired by written Contract, Additional insured (Ge oral and Auto <br />'ability) Primary Non <br />and -Contributing (General Liability) and Waiver of <br />ubro aiicn (Generam <br />l and Auto Liability and Workers Corn can apply, <br />ew Construction exclusion apply, Excess Policyfollows Corm. <br />FORINFO <br />For Information Purposes Only <br />-specific certificates can be <br />issued upon regUCEI <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2009 ACORD CORPORATION. All rights reserved. <br />CORD 25 (2009/09) The ACORD name and log20rBist3Onarks of ACORD <br />