2018/01/01 Habitat for Humanity Inland Valley Certficiate of Workers' Comprensation Coverage CERTIFICATE OF WORKERS' COMPENSATION COVERAGE opt l88T2018
PRODUCER
Nonprofits'United Workers'Compensation Group THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY
610 Fulton Avenue,Suite 200 AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
Sacramento,CA 95825 Phone:(916)868-6231 THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE
Fax:(916)880-5251 COVERAGE AFFORDED BY THE POLICIES BELOW.
Arthur J.Gallagher&Co Insurance Brokers of California,Inc
1255 Battery Street#450
San Francisco,CA 94111 INSURERS AFFORDING COVERAGE
INSURED
INSURER A: NonProfits'United Workers'Compensation Group
Habitat for Humanity Inland Valley INSURER B: Safety National Casualty Corp [NAIL#151051
27475 Ynez Road#390
Temecula, CA 92591 INSURER C:
INSURER D:
INSURER E:
COVERAGES This Certificate is not intended to specify all endorsements,coverages,terms,conditions and exclusions of the policies shown.
THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE AFFILIATE MEMBER 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
COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS
SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF COVERAGE POLICY NUMBER POLICY POLICY LIMITS
LTR EFFECTIVE DATE EXPIRATION
DATE
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Anyone fire) $
CLAIMS MADE OCCUR MED EXPENSE(Any one person) $
GENERAL AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $
POLICY I PROJECT I LOC GENERAL AGGREGATE $
PRODUCTS-COMP/OP AGG $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Each accident) $
ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per person) $
HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Per accident) $
PROPERTY DAMAGE $
(Per accident) $
X PER OTHER
WORKERS'COMPENSATION STATUTE
A AND NPU-WCG 001-2018 1/1/18 1/1/19 E.L.EACH ACCIDENT $500,000
EMPLOYERS LIABILITY E.L.DISEASE—EA EMPLOYEE $500,000
OTHER
E.L.DISEASE—COVERAGE LIMIT $500,000
Limit Per Occurrence-Statutory
$ EXCESS Workers'Compensation SP 4057827 1/1/18 1/1/19 EL Per Occ&Agg $2,000,000 xs
of$500,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL/PROVISIONS
Evidence of Workers'Compensation Coverage: CDBG Grant
CERTIFICATE HOLDER CANCELLATION
NPUWCG-HHIv-012
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED
City of Menifee IN ACCORDANCE WITH THE POLICY PROVISIONS.
29714 Haun Road
Menifee,CA 92586
Based on ACORD 25(2014/01)