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DATE (MM/DDIYYYY) AC®R" CERTIFICATE OF LIABILITY INSURANCE ilka / 12 / 14 / 2018 THIS CERTIFICATE IS ISSUED ASA 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 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 CONTACT NAME: Catherine Montoya Milestone Risk Management & Insurance Services IPA Ext : ( 949 ) 652 - 0909 q/c, NO : (999) 852-1131 License No . OB72766 E-MAIL cmontoya@milestonepromise . com ADDRESS: 8 Corporate Park , Suite 130 INSURERS AFFORDING COVERAGE NAIC # Irvine CA 92606 INSURERA : Everest Indemnity Insurance 10851 INSURED INSURERB : West American Insurance Company 44393 Wayne Perry , Inc . INSURER c : Everest National Ins . Co . 10120 8281 Commonwealth Ave . INSURERD : Ohio casualty Insurance Company 24074 INSURER E Buena Park CA 90621 INSURER F : COVERAGES CERTIFICATE NUMBER: 18 - 19 CITY 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ADDL SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EFlML00079-181 EACH OCCURRENCE $ 1 , 000 , 000 DAMAGE TO RENTE A CLAIMS-MADE ❑X OCCUR PREMISES Ea o currence $ 300 , 000 X Contr , Pollution Liab . $ 1 , 000 , 000 Each Occurrence 12/31 /2018 12 /31 /2019 MED EXP (Any one person) $ 25 , 000 '.. X Prof . Liab - Claims Made $ 1 , 000 , 000 Each Claim PERSONAL BADVINJURY $ 1 , 0001000 GEMLAGGREGATE LIMITAPPLIES PER: Each Subject to $2 , 000 , 000 GENERALAGGREGATE $ 21000 , 000 POLICY F�X] PRO ❑ LOC Policy Aggregate PRODUCTS - COMP/OPAGG $ 21000 , 000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000 , 000 Ea accident B X ANYAUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BAA ( 19 ) 59235968 12 /31 /2018 12/31 /2019 BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10 , 0001000 A X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10 , 000 , 000 DED I X I RETENTION $ 0 EFICU00052 -181 12 /31/2018 12/31 /2019 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTEI ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N / A E.L. EACH ACCIDENT $ 1 , 0001000 OFFICER/MEMBER EXCLUDED? C (Mandatory in NH) CA10003737 - 181 12 /31 /2018 12 /31 /2019 E.L. DISEASE - EA EMPLOYEE $ 1 , 0001000 If yes, describe under - DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 11000 , 000 D Installation Floater B14059216368 12/31 /2018 12 /31/2019 Limit / Deductible $ 250K / $2 , 500 D Rented/Leased Equipment BM059216368 12/31 /2018 12 /31 /2019 Limit / Deductible $ 150k / $2 , 500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) RE : Costco Roadway Improvements - 525 Alakawa St . , Honolulu , HI 96817 - Add 1 Additional Lane for 350 ' From the Shopping Center Entrance Eastbound to Facilitate a Left Hand Turn Pocket Into the Gas Station . Certificate holder is named as an additional insured per the attached endorsement . E CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City & County of Honolulu THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn : DPP Permit Center ( CEB ) ACCORDANCE WITH THE POLICY PROVISIONS . 650 S . King St . Honolulu , HI 96813 AUTHORIZED REPRESENTATIVE Catherine Montoya / CAM CCZ � /�� • cru _ %Jlc� Z %9 �c © 1988-2014 ACORD CORPORATION . All rights reserved . ACORD 25 (2014/01 ) The ACORD name and logo are registered marks of ACORD INS025 (201401)