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MJKCONS-01 GOETZC CERTIFICATE OF LIABILITY INSURANCE DATE 11 /30/ 2022 Y) 11 /30/2022 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 License # OE67768 CONTACT Elizabeth Lisek NAME : ICA Insurance Services PHONE FAX 130 Vantis (A/C, No, Ext) : ( 949) 680 -1783 52015 (AIC No) : (949) 297-5960 Suite 250 EMAILADDRESS : elizabeth . lisek@ioausa . com Aliso Viejo, CA 92656 INSURERS AFFORDING COVERAGE NAIC # INSURERA : Nautilus Insurance Company 17370 INSURED INSURER B : Key Risk Insurance Company 10885 Sunwest Engineering Constructors, Inc. INSURER C : State Compensation Insurance Fund of CA 35076 4780 Cheyenne Way INSURER D : Colony Insurance Company 39993 Chino, CA 91710 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS L D WVD M/DD/YYYY /DD Y A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 21000 , 000 CLAIMS-MADE OCCUR ECP202766215 12/1 /2022 12/1 /2023 DAMAGE TO RENTED 100 , 000 PREMISES Ea occurrence $ MED EXP (Any oneperson) $ 5, 000 PERSONAL & ADV INJURY $ 21000 ' 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4' 000 '000 POLICY 1 jE� F LOC PRODUCTS - COMP/OP AGG $ 4' 0001000 OTHER : Deductible : $5,000 PRODUCTS LIABIL $ Included B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 15000, 000 Ea accident $ X ANY AUTO BAP202766114 12/1 /2022 12/1 /2023 BODILY INJURY Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS AUT ODS ONLY AUU OOS ONLY Peer accideniDAMAGE $ A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 210001000 X EXCESS LIAB CLAIMS-MADE FFX202766314 12/1 /2022 12/1 /2023 AGGREGATE $ 210003000 DED RETENTION $ $ C WORKERS COMPENSATIONOTH- AND EMPLOYERS' LIABILITY YIN X STATUTE TUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 9243819-22 12/1 /2022 12/1 /2023 1 , 000 , 000 OFFICER/MEMBER EXCLUDED? a NIA E. L. EACH ACCIDENT $ (Mandatory in NH) E. L. DISEASE - EA EMPLOYEE $ 11000 ,000 If yes, describe under DESCRIPTIONOFOPERATIONS below E. L. DISEASE - POLICY LIMIT $ 190005000 A PL - Per Claim $1 MIL ECP202766215 12/1 /2022 12/1 /2023 Per Aggregate 23000, 000 D Excess Liability EX04281658 12/1 /2022 12/1 /2023 2nd Layer Limit 61000 ,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) Proof of Coverage Contractors Pollution Carrier: Nautilus - Policy #ECP202766215 Effective: 12/01 /2022 to 12/01 /2023 Aggregate : $4MIL - Each Claim : $2MIL - Ded : $5 ,000 Occurrence Basis CERTIFICATE HOLDER CANCELLATION 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 Z - kms ` r `_' / C Insured 's Verification ACORD 25 ( 2016/03 ) © 1988 -2015 ACORD CORPORATION . All rights reserved . The ACORD name and logo are registered marks of ACORD