2017/10/01 County of Riverside Certficiate of Insurance or Self-InsuranceRIVCO HR
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BRENDA DIEDERICHS,
Asst County Executive Officerl
Human Resources Director
CERTIFICATE OF INSURANCE OR SELF-INSURANCE
THIS IS TO CERTIFY THAT THE SELF -INSURED COVERAGE LISTED BELOW IS CURRENTLY IN EFFECT 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 THIS CERTIFICATE DESCRIBED HEREIN IS SUBJECT TO ALL THE
TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH CERTIFICATE.
COVERAGE PROVIDED IS SUBJECT TO THE TERMSAND CONDITIONS OF THE EXCESS POLICY
Type of Coverage
Company and
1,
Policy Period
Limits of Liability
Policv Number
Bodily Injury/Property Damage
Commercial
07/01/2018
$1,000,000 Combined
X]
General Liability
Including Vehicle
Self -Insured
to
Single Limit Per
Occurrence with No
Liability
07/01/2019
07/01/2018
Aggregate Limit
$2,000,000 Combined Single
Workers'
X]
F
Compensation
& Employers'
Permissibly
Self -Insured
to
Limit Per Occurrence with
No Aggregate Limit
Liability
07/01/2019
Medical Malpractice
10/01/2017
(Professional
Self -Insured
F-1
Liability)
to
10/01/2018
'rhe County of Riverside certifies that the above self -insured program is in effect as respect to: City of Menifee is
working on setting up a Active Transportation Program (ATP) agreement with Riverside County.
Certificate Holder
Cancellation
City of Menifee
In the event of cancellation of the self-insurance program or policy
Attn: Margarita Cornejo
designated below, it is the intent of the County of Riverside to mail
29714 Haun Road
:30 days' prior notice thereof.
Menifee, CA 92586
This certificate is not valid unless signed by an authorized representative of the County of Riverside, Risk Management Division
Date: September 20, 2018
cc: Teresa Diaz, Contracts and Grants Analyst @ RUHS — PH Procurement
CEDP.O.Boxl2lO,Pjverside,CA92502 t,,(951)955-3540 jc.�1(951)955-4027 (qr1skmgmt.rc-hr.corn