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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 />I PROOUCER
<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 OF INSURANCE 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 />ILiR TYPE OF INSURANCE RRi POLICY NUMBER POLICY EFF POLICY EXP
<br />GENERAL LWBILITY MM /DDIYYVY MMIDON:: ,
<br />X
<br />A COMMERCIAL GENERAL LIABILITY I A 11/15/2015111/1512016
<br />CLAIMS-MADE OCCUR
<br />EACH OCCURRENCE LIMITS
<br />S 1,000,000
<br />1
<br />DA AG 0 1 0
<br />PREMISES Ea occurrence
<br />S 50,000
<br />MED EXP(Any one person)
<br />S 5,000
<br />PERSONAL A ACV INJURY
<br />$ 11000,000
<br />j GEN'L AGGREGATE LIMITAPPLIERPER: i
<br />PRO-
<br />POLICY JEC LOC
<br />i
<br />GENERAL AGGREGATE
<br />S 2,000,000
<br />PRODUCTS - COMP /OP AGG
<br />2,000,000
<br />-$�
<br />AA;UT�OMOBILE LIABILITY
<br />B X ANY AUTO 124 -CC- 206754..9 11/15/2015 11175/2016
<br />ALL OWNED AUTOS I NCL PHYSICAL DAMAGE
<br />COMBINED SINGLE LIMIT
<br />(Ea ecddenq
<br />s 1,000,00
<br />B OOILYINJURY(Perperenn)
<br />$
<br />e CC IN JURY (P., eodenq
<br />g
<br />L�f
<br />! SCHEDULE) ALTOS
<br />X HIRED Nt1T05 I
<br />:10AMED
<br />PROPERTY DAMAGE
<br />(PER ACCIDENT)
<br />$
<br />X 011 AUTOS
<br />Hired Phys Dam I 1950,000 MAXIMUM LIMIT I IC011isiOr
<br />UMBRELLA LIAR 1i OCCUR
<br />X EXCESS LIAR _ CLAIMS -MAGE
<br />C F" 100002437205 11/15/2015 6 11/15/2016
<br />I DEDUCTIBLE
<br />RETENTION $
<br />Comprehensive
<br />$ $1,000 de
<br />n —��
<br />EACH OCCURRENCE
<br />$1,000 de
<br />$ 5,000,000
<br />AGGREGATE
<br />s 5,000,00
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY
<br />ANY PROPRIETORIPARTNEWEXECUTIVE YIN I IWVE5028828 01 101101/2016 01/01/2017
<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 11 /15 /2016ILLimit
<br />FROM OTHERS
<br />WC STATUS OE H-
<br />X (TORY _IM � I
<br />ELL. EACH ACCIDENT
<br />$
<br />___
<br />1,000000
<br />E.L. DISEASE - EA EMPLOYEEJ$
<br />1,000,00
<br />E. L. DISEASE POLICY LIMIT
<br />3 7,000,000
<br />500'000
<br />ESCRIPTION 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 (Get7oral and Auto
<br />'ability) Primary Non- Contributing
<br />and (General Liability) and Waiver of
<br />ubro aiicn (Genera m
<br />l and Auto Liability and Workers Corn can apply,
<br />ew Construction exclusion apply, Excess Policy follows 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 (2009109) The ACORD name and log20rBist3Onarks of ACORD
<br />
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