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Insurance Certificates 2018/19 Pacific West Industries, IncPACIWES-01 DIANI A�ORO" CERTIFICATE OF LIABILITY INSURANCE DATE 11/16/201 YY) 11116/2018 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(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). PRODUCER Goodman Insurance Services, Inc. 101 Pacifica, Suite 150 Irvine, CA 92618 INSURED Pacific West Industries, Inc. 4051 E. La Palma Ave. #A Anaheim, CA 92807 NAME: - PHONE FAX (AIC, No, Ext): (949) 769-3100 (A/C, No):(949) 769-3930 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Colony Insurance Company 39993 INSURER B:Watford Insurance Company 25585 INSURERC:Falls Lake Fire and Casualty Company 15884 INSURER D : INSURER E : INSURER F 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. INSR TYPE OF INSURANCE AODL SUER POLICY NUMBER POLICY EFF POLICY EXP LTR 1NSD WVD M D LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,060 CLAIMS -MADE X OCCUR X X 103GLOO2071601 11/01/2018' 11/01/2019 DAMAGETO(Ea NTEDence) 5 100,000 PREMIS GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PEST LOC B AUTOMOBILE LIABILITY X ANY AUTO AUTEO�S ONLY SCHEDULED X AUTOS ONLY X A V0 p& A UMBRELLA LIAB X OCCUR X EXCESS LIAB CLAIMS -MADE DED RETENTION S MED EXP (Any one person) $ 5 PERSONAL & ADV INJURY S 1,000 GENERAL AGGREGATE S 2,000 PRODUCTS - COMP/OP AGG S 2,000 (Ea acddent) 5 X X WIC1000573-00 03/01/2018 03101/2019 BODILY INJURY (Per person) 5 BODILY INJURY (Per accident) 5 PROPE,JY. DAMAGE (Peraant) 5 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE W.1.10ERIf1SEMBER EXCLUDED? Y N I A `Mandatory in NH) Ilxes, describe under n crcivrrner nr naroerrnnrc �...i..., EACH OCCURRENCE S XS172720 11/01/2018 11/01/2019 AGGREGATE $ X FLA002263-02 X PER OTH- STATUTE ER 11/17/2018 11/17/2019 E. L EACH ACCIDENT S 1,000 E.L DISEASE -EA EMPLOYEE S 1,000 E.L. DISEASE • POLICY LIMIT 5 1,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Addilional Remarks Schedule, may be attached it more space is requrmd) The certificate holder(s)T are named additional insured per the attached with respects to General Liability, Insurance is primary, and Waiver of Subrogation in respects to the General Liability applies, Additional Insured 8r Waiver of Subrogation with respects to the Auto Liability, & Workers' Compensation Blanket Waiver of Subrogation applies per the attached where required by written contract, with regard to the following project: 30 Day Notice of Cancellation - 10 Day for Non Payment of Premium operations as required by written contract. City of La Quinta 78945 Calle Tampico La Quinta, CA 92253 CANCELLA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Number: WIC1000573-00 THIS ENDORSEMENT CHANGES THE POLICY — PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT PRIMARY This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to SECTION II — LIABILITY COVERAGE only, Who is An Insured is amended to include as an Additional Insured any person(s) or organization(s) whom you are required to add to this policy as an Additional Insured under a written agreement in effect or becoming effective during the policy period. This insurance applies only to "bodily injury" and "property damage" that occurs subsequent to execution of the written agreement and subsequent to the issuance of a certificate of insurance indicating such person(s) or organization(s) as Additional Insured(s). The insurance provided hereby to the Additional Insured(s) is limited as follows: 1. The coverage afforded hereby to such Additional Insured is limited to imputed liability specifically resulting from the conduct of the Named Insured for which the Additional Insured was held liable. 2. The limits of insurance applicable to the insurance afforded hereby are those specified in the written agreement or in the Declarations or Schedules of this policy, whichever is less. The limits of insurance applicable to the insurance afforded hereby are not inclusive and not in addition to the limits of insurance shown in the Declarations or Schedules of this policy. 3. Any coverage provided under this endorsement for any Additional Insured will never be broader than coverage provided to any Named Insured. Any other policy terms, conditions, limitations, exclusions, and definitions apply to this endorsement. WIC AUTO CW 0013 (10/17) 'Includes copyrighted material of Insurance Services Office, Inc with its permission" Page 1 of 1 Policy number: WIC1000573-00 THIS ENDORSEMENT CHANGES THE POLICY — PLEASE READ IT CAREFULLY. BLANKET WAIVED OF SUBROGATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM We agree to waive any and all subrogation claims or rights of recovery against any person(s) or organization(s) if there is an executed written agreement with that person(s) or organization(s) which requires a Waiver of Subrogation Clause from the Named Insured, except for "losses" which are due in whole or part to the negligence or errors and omissions of such person(s) or organization(s). All other terms and conditions of the policy remain unchanged. WIC AUTO CW 0014 (10/17) "Includes copyrighted material of Insurance Services Office, Inc. with its permission" Page 1 of 1 POLICY NUMBER: 103GL00201601 COMMERCIAL GENERAL LIABILITY CG20100413 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): Location(s) Of Covered Operations All persons or organizations as required by written As designated in written contract with the Named contract with the Named Insured Insured 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" damage" or "personal and advertising injury" or "property damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with 2. The acts or omissions of those acting on your such work, on the project (other than behalf; service, maintenance or repairs) to be in the performance of your ongoing operations for performed by or on behalf of the additional insured(s) at the location of the covered the additional insured(s) at the location(s) operations has been completed; or designated above. 2. That portion of "your work" out of which However: the injury or damage arises has been put 1. The insurance afforded to such additional to its intended use by any person or insured only applies to the extent permitted by organization other than another contractor or subcontractor engaged in performing law; and operations for a principal as a part of the 2. If coverage provided to the additional insured is same project. 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. CG 20 10 04 13 © ISO Properties, Inc., 2012 Page 1 of 2 POLICY NUMBER: 103GL00201601 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III — Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most applicable Limits of Insurance shown in the we will pay on behalf of the additional insured is Declarations. the amount of insurance: 1. Required by the contract or agreement; or CG 20 10 04 13 0 ISO Properties, Inc., 2012 Page 2 of 2 POLICY NUMBER: 103GL00201601 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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 Name Of Additional Insured Person(s) Or Organization(s): All persons or organizations as required by written contract with the Named Insured SCHEDULE Location and Description Of Completed Operations As designated in written contract with the Named Insured for Commercial Projects Only 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III — Limits Of Insurance: with respect to liability for "bodily injury" or "property dam -age" 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 insur-ance afforded to such additional insured will not not be broader than that which you are required by the contract or agreement to provide for such additional insured If coverage provided to the additional insured is re-quired 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 04 13 C Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 103GL00201601 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CARFEULLY. 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 (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. 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 CG 20 01 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 103GL00201601 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CARFEULLY. 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 The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any rights of recovery we may have against any person or organization because of payments we make for injury or damage resulting from your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard" if: a. you agreed to such waiver; b. the waiver is included as part of a written contract or lease; and c. such written contract or lease was executed prior to any loss to which this insurance applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U047-0310 Includes copyrighted material of ISO Properties, Inc., Page 1 of 1 with its permission. POLICY NUMBER: 103GL00201601 DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT - RESTRICTED FORM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: All projects during the policy period (If no entry appears above, information required to complete this endorsement will be shown in the Declara- tions as applicable to this endorsement.) A. For all sums which the insured becomes legally obligated to pay as damages caused by 'occurrences" Under SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, and for all medical expenses caused by accidents under SECTION I — COVERAGE C MEDICAL PAYMENTS, which can be attributed only to ongoing operations at a single designated con- struction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard", and for medical expenses under SECTION I — COVERAGE C MEDICAL PAYMENTS regardless of the number of: a. Insureds; Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY for damages or under SECTION I - COVERAGE C MEDICAL PAYMENTS shall reduce the Designated Construction Project General Aggregate Limit for that des- ignated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damages to Premises Rented to You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. 5. The most we will pay for the sum of all Designated Construction Project General Aggregate Limits combined and to which this insurance applies is $5,000,000. B. For all sums which the insured becomes legally obligated to pay as damages caused by `occurrences" Under SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE. UCG2503-1013 Includes copyrighted material of Insurance Services Office, Inc., 1996 Page 1 of 2 with its permission. LIABILITY, and caused by accidents under SECTION I — COVERAGE C MEDICAL PAYMENTS, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY for damages or under SECTION I — COVERAGE C MEDICAL PAYMENTS shall reduce the amount available under the General Aggregate Limit or the Products - Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. C. When coverage for liability resulting from the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard" will reduce the Products -Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of SECTION III — LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. UCG2503-1013 Includes copyrighted material of Insurance Services Office, Inc., 1996 Page 2 of 2 with its permission. POLICY NUMBER: 103GL00201601 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY EXCLUSION - DEDICATED INSURANCE PROGRAM(S) COMMERCIAL GENERAL LIABILITY COVERAGE A. SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions is amended and the following added: This insurance does not apply to: Dedicated Insurance Program(s) "bodily injury" or "property damage" arising out of either your ongoing operations or operations included within the "products -completed operations hazard" at any project(s) which is, or was subject to a "dedicated insurance program". This exclusion applies whether or not the "dedicated insurance program": 1. provides coverage identical to that provided by this Coverage Part; 2. provides coverage to one or more contractors; 3. provides multiple lines of coverage; 4. has limits adequate to cover all claims; or 5. remains in effect. B. SECTION V — DEFINITIONS is amended and the following added: "Dedicated insurance program" means wrap-up program(s), owner controlled insurance program(s), contractor controlled insurance program(s), or other job(s) or project specific policy / program(s) whether provided by you, or any other person or entity for which you are an insured. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U483-1115 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 f Ed.4-84? WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2_5% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver of Subrogation As respects to all CA jobs performed by the named insured during the policy period where by written contract a waiver of subrogation is required prior to the commencement of work. 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: 11/17/2018 Policy No. FLA002263-02 Endorsement No Insurance Company: Falls Lake Fire & Casualty Company Insured: Pacific West Industries, Inc. (A Corp) Countersigned By ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. STATE OF CALIFORNIA COUNTY OF RIVERSIDE } } ss } A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. On 2018, before me, Notary Public, personally appeared FRANK J. SPEVACEK, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity,, and that by his signature on the instrument the person or the entity upon behalf of which the person acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. Witness my hand and official seal. Notary Public [SEAL] 79295 Rose Dawn Lewis 7