ATT 2 - Proposal from Roy Allan Slurry Seal, Inc. — Murrieta City Council, November 19, 2024

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE
INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #
NAME:

CONTACT
(A/C, No):

FAX
E-MAIL
ADDRESS:

PRODUCER
(A/C, No, Ext):

PHONE

INSURED
REVISION NUMBER:

CERTIFICATE NUMBER:

COVERAGES
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 rights to the certificate holder in lieu of such endorsement(s).

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.

OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD

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. $
$
$
$

PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY
AUTOS

AUTOS ONLY

NON-OWNED

SCHEDULED
OWNED

ANY AUTO

AUTOMOBILE LIABILITY
Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-

STATUTE
PER
LIMITS
(MM/DD/YYYY)

POLICY EXP
(MM/DD/YYYY)

POLICY EFF

POLICY NUMBER

TYPE OF INSURANCE
LTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

EXCESS LIAB

UMBRELLA LIAB
$

EACH OCCURRENCE
$

AGGREGATE
$
OCCUR

CLAIMS-MADE
DED

RETENTION
$
$

PRODUCTS - COMP/OP AGG
$

GENERAL AGGREGATE
$

PERSONAL & ADV INJURY
$
MED EXP (Any one person)
$

EACH OCCURRENCE

DAMAGE TO RENTED
$
PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE
OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY
PRO-
JECT
LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED

AUTOS ONLY
10/17/2024
Acrisure Southwest Partners Insurance Services, LLC
18952 MacArthur Blvd., Suite #300
Irvine, CA 92612
949-486-7904
www.patrisk.com 0K07568 Travelers Indemnity Company of Connecticut 25682 Travelers Property Casualty Co of America 25674
A 1,000,000DT22-CO-3S422962-TCT -24 7/1/2024 7/1/2025
300,000
✓
5,000
✓
1,000,000
2,000,000
✓GL ded $1,000
2,000,000✓
A 810-3S280586-24-26-G 7/1/2024 7/1/2025 1,000,000
✓
✓ ✓
B CUP-3S426186-24-26 7/1/2024 7/1/2025 5,000,000✓✓
5,000,000
✓ 10,000
B UB-5Y063159-24-26-G 7/1/2024 7/1/2025 ✓
1,000,000N
1,000,000
1,000,000
A Leased/Rented Equipment DT22-CO-3S422962-TCT -24 7/1/2024 7/1/2025 Limit $500,000 Dave Jacobson
Annette Romero
[email protected]
Roy Allan Slurry Seal, Inc.
12643 Emmens Way, Suite 'A'
Santa Fe Springs CA 90670
82415635
✓ ✓
✓✓
✓ ✓
✓
City of Murrieta, its officers, officials, employees and volunteers and Western Water are named as additional insureds as respects applies to GL, Auto and WC and in favor of the additional insureds per endorsements attached as required by written contract.

City of Murrieta
1 Towne Square
Murrieta CA 92562
Re: City Project #23-479 - CIP No. 13048 / 2023 Citywide Slurry Seal Project to General Liability, Auto Liability and Umbrella/Excess Liability coverage includes Primary and Non-contributory. Waiver of subrogation Umbrella/Excess Liability follows form over GL, Auto and Employers Liability.*30-day notice of cancellation / 10-days for non-payment of premium. 82415635 | 24-25 GL/AU/UMB/WC/IM | Annette Romero | 10/17/2024 11:33:35 AM (PDT) | Page 1 of 30 Roy Allan Slurry Seal, Inc.

UB-5Y063159-24-26-G07/01/2024
82415635 | 24-25 GL/AU/UMB/WC/IM | Annette Romero | 10/17/2024 11:33:35 AM (PDT) | Page 30 of 30

Murrieta City CouncilNovember 19, 2024

Murrieta City Council
November 19, 2024