Loading...
2019/05/31 SCG-Spicer Consulting Grp, LLC Certficiate of Liability Insurance (5)' 7 •� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) O6M 212019 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 sj. PRODUCER CONTACT ISU Insurance Services Cormarc Tasman NAME: Helena Orosco 25220 Hancock Ave, Suite 200 PHONE 951 290-5040 FAX No): 851 278 0664 Murrieta, CA 92562 Apppesa, holana@ltucormiirc.com License #: OE63467 INSURER AFFORDING COVERAGE NAIC # INSURER A: Travelprs CaSlfalty Inn C.'n INSURED INSURERB: N r In r n Company SCG-SPICER CONSULTING GRP LLC INSURERC: Lloyd's of London DBA SPICER CONSULTING GROUP 41619 MARGARITA RD, STE 101 INSURERD: TEMECULA, CA 92591 INSURER E: INSURER F: CAVFRArZFA rFRTIFICATF NHIIIARFR• nnnAAAAtk_7COAC oovrcrnwl uurn�oeo. 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 POIJCY EFF POLTCY EXP LTR TYPE OF INSURANCE INSD I WVD I POLICYNUMBER (MMfDDNyM INNAMMYY)LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE %( OCCUR Y 680-2H870106 05/31/2019 05131/2020 EACH OCCURRENCE $ 2,000,000 PR6MISES_jEtl'encel $ 300,000 _ •MED EXP fAny oneperson $ 5,000 PERSONAL & AOV INJURY $ 2,000,000 GRNL AGGREGATE LIMIT APPLIES PER: X POLICY JE T ❑ LOC GENERAL AGGREGATE $ 4,000,000 PRODUCTS-COMP/OP AGG $ 4,000,000 $ OTHER: A AUTOMOBILE LIABILITY 680-2H870106 05/3112019 05/3112020 CO"ME DSINi3LELrN1T S 1 0 0 QJD_0_0 ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED NON -OWNED AUTOS ONLY AUTOS ONLY •ry {2AM11LiE $ UMBRELLA LIAB H.00CUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE AED RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORPARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A Y SCWC994693 10/07/2018 10107/2019 X TAT T ORH 1 000 000 E.L EACH ACCIDENT • $ 1:000:000 E.L DISEASE- EA EMPLOYEE $ 1,000,000 E.L DISEASE- POLICY LIMIT $ C Prof Lia MPL175558019 05131/2019 05/3112020 Limit 2,000,000 retro date 5/31116 Retention ' 10,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD f 01, Additional Remarks Schedule, maybe attached if more space Is required) RE: On -Call Municipal Finance Consulting Services. City of Menifee, its officers, employees, agents and authorized volunteers are named as additional insured in respects to General Liability coverage is Primary and Non -Contributory per CGD1050494. Waiver of Subrogation applies to Work Comp per WC040306. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Menifee MENI297 ACCORDANCE WITH THE POLICY PROVISIONS. 29844 Haun Road Menifee, CA 92586 AUTHORIZED REPRESENTATIVE S � ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by ORO on June 12, 2019 at 01:12PM COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED (SECTION II) is amended in a written contract for this insurance to to include as an insured any person or organiza- apply on a primary or contributory basis. tion (called hereafter "additional insured") whom 3. This insurance does not apply: you have agreed in a written contract, executed prior to loss, to name as additional insured, but a. on any basis to any person or organization only with respect to liability arising out of "your for whom you have purchased an Owners work" or your ongoing operations for that addi- and Contractors Protective policy. tional insured performed by you or for you. b. to "bodily injury," "property damage," "per- t. With respect to the insurance afforded to Addi- sonal injury," or "advertising injury" arising tional Insureds the following conditions apply: out of the rendering of or the failure to render a. Limits of Insurance —The following limits of any professional services by or for you, in- liability apply: cluding: 1. The limits which you agreed to provide; 1. The preparing, approving or failing to or prepare or approve maps, drawings, opinions, reports, surveys, change or- 2. The limits shown on the declarations, ders, designs or specifications; and whichever is less. 2. Supervisory, inspection or engineering b. This insurance is excess over any valid and services. collectible insurance unless you have agreed CG D1 05 04 94 Copyright, The Travelers Indemnity Company, 1994. Page 1 of 1 Includes Copyrighted Material from Insurance Services Office, Inc. WORKERS COMPENSATION: AND EMPLOYERS LIABILITY INSURANCE POLICY' WC 04 03 06 (Ed. a-84) WAIVER OF OUR MIGHT TO RECOVER FROM OTHERS ENIDO EMENT—CALIFOWA We have the rQht to recover our payments from anyone liable for -an injury covered by this polity_ 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 cabtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged In the work described M the Schedule. addiliVII&l fx ma luirt fur tfris aiE€fexat:�r3 ril atmll bu _1-_02_% of Vim California wurkers' INX11I7f"f1Sat3111:F paerr:fiuiil soterwise ciae on such. retnuneration: :Schedule Person or Organization ,iOk} QeSG31plIDtl. R"et Waiver - Any pewn or urannintion for whom the Al CA Operations:: Nattfcd Insured hQs agreed �' wrrtt�xl c�ntTact t� tarnish tlus Nyulyer- Tli1s ndti:�sc rye irl rhz�n e 4g the pallvy to v:+hkh-li 1. a acbed'and is e€iecs,"nre ssrr €lie etntA .l�siAe tl urtrt s a lhec rqe sf ;te e1 :(I ne Int.0 rrsatfon balow ss f"wteu oinry wtten arts enoorse ont rs-1ssiaod subsequenr:t6 preparanbn air the polley.t Er &rW.mkgRt Iwfi53 D j,- nsired: 1'�lary.lsfa. $01VC994693 Insuranee Cta y CiUtinieC$igrt�ii E3 { € adormnonYt No. 9:!�9.$ by 31ta Wotuevrof 110m. pcn�ation Inauraft-m rlm 1119 ryurauu of:0alifomim All 094o. rotporved CI CW A021011 CERTIFICATE OF INSURANCE This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been Issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terns, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holder. CITY OF MENIFEE ATTN: DEPARTMENT OF FINANCE 29844 HAUN RD MENIFEE, CA USA 925866539 Named Insured: SPICER CONSULTING GROUP LLC 41619 MARGARITA RD STE 101 TEMECULA CA 92591-2986 Automobile Liability Insurer Name: Allstate Insurance Company PoftNwber 648827849 1 —Any Auto 2 - Owned Autos Only 3 - Owned Priv. Pass. Autos Only 4 - Owned Autos Other Than Priv_ Pass. Autos Only 5 - Owned Autos Subject to No Fault 6 - Owned Autos Subject to a Compulsory UM Law :x 7 - Specifically Described Autos 8 - Hired Autos Only x 9 — Nonowned Autos Only Policy Effective Date: 0 9-14 -2 018 Policy Expiration Date: 0 9-14 - 2 019 Limitsof $1, 000, 000 1 Combined Single Limit (each accident) Insurance: BI Per Person I BI Per Accident PD Per Accident Description of Operations/ Locations/ Vehicles/ Endorsements/Special Provisions Interested Party Type: Additional Insured - Municipality THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer. ADRIANA CUEVAS Authorized Representative: Date: 05-24-19 Cl CW A021011 Includes copyrighted material of Insurance Services Office, Inc., with its permission Allstate Insurance Company Insured Full Copy Page 1 of 1 POLICY NUMBER: 648827849 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: SPICER CONSULTING GROUP LLC Endorsement Effective Date: 0 5— 2 4— 2 019 SCHEDULE Name Of Person(s) Or Organ¢ation(s): CITY OF MENIFEE ATTN: DEPARTMENT OF FINANCE 29844 HAUN RD MENIFEE, CA USA 925866539 J Information required to complete this Schedule, if not shown above, will be shown in the Declarations Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Insured Full Copy Page 1 of 1 CHUBB0 F SUNG COMPANY Workers' Compensation CE AM ERICAN INSURANCE COMPANY NCCI CARRIER CODE and Employers Liability 12165 Insurance Policy _ Information Page POLICY NUMBER ❑X New ❑Renewal F1 Rewrite Symbol: WLR Number: C6 56 25 87 8 PREVIOUS POLICY NO. L ] Individual ❑ Partnership Association Symbol: Number:_ ❑X Corporation ❑ Joint Venture Other Legal Entity Item 1. [RINET GROUP, INC. Named L/C/F SCG SPICER CONSULTING GROUP LLC Insured 9000 TOWN CENTER PARKWAY BRADENTON FL 34202 Mailing Address I Inter/Intrastate ID No.: Federal Employer ID No.: 953359658 Employer's ID No.: PIIC CODE: 6282 For other named insured see Extension of Information Page — Schedule of Named Insured, WC 99 99 99 A For other workplaces see Extension of Information Page — Schedule of Other Workplaces, WC 99 99 99 B Item 2. Policy period: From 12-16-2018 To 07-01-2019 12:01 A.M.. standard time at the named insured's address. Item 3A. Workers' Compensation Insurance: Part One of the policy applies to the Workers' Compensation Law of the states listed here: CA Item 36. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 2,000,000 Bodily Injury by Disease $ 2,000,000 Bodily Injury by Disease $ 2,000,000 Item 3C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: ALL STATES EXCEPT ND,OH,WA,WY, AND STATES DESIGNATED IN ITEM &A each accident policy limit each employee Item 3D. This Policy includes these endorsements and schedules: See schedule of Forms and Endorsements WC999999D Item 4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. SEE EXTENSION OF INFORMATION PAGE —CLASSIFICATIONS If indicated here, interim adjustments of premium will be made: ❑ Semi -Annually ❑ Quarterly ❑ Monthly PRODUCER NAME AND MAILING ADDRESS USI INSURANCE SERVICES NATIONAL INC 2601 SOUTH BAYSHORE DRIVE 16TH FLOOR SUITE 1600 COCONUT GROVE FL 33133 PRODUCER CODE: Z05455 56-1882208 DAU MARKETING OFFICE: DALLAS BRANCH Minimum Premium collected in CA $ Total Estimated Premium $ Deposit Premium $ ISSUE DATE: 12/27/2018� Authorized Representative WC 00 00 01A (05/88) Copyright 1987 National Council on Compensation Insurance INSURED COPY