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2019/07/30 CVS Health Corporation Certificate of Liability InsuranceC)RbP EVIDENCE OF PROPERTY INSURANCE OBIATE(9M/DD/YYYY) THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. AGENCY (PHONEA/C_No_ Exti, COMPANY 1 I Marsh USA Inc, See attached for a list of additional insurers 99 High Street Boston, MA 02110 Attn: CVSCaremark.certrequest@Marsh I Fax: 212-948-5338 C N 101 226639-STORE-PROP-1 9- SUB CODE: INSURED CVS HEALTH CORPORATION ONE CVS DRIVE MC2180 WOONSOCKET, RI 02895 PROPERTY INFORMATION LOANNUMBER EFFECTIVE DATE EXPIRATION DATE 07/30/2019 07/30/2020 THIS REPLACES PRIOR EVIDENCE DATED: POLICY NUMBER lee Attached CONTINUED UNTIL TERMINATED IF CHECKED LOCATION/DESCRIPTION CVS Store #05267-01, Located: 26973 Newport Road, Menifee, CA 92584 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 EVIDENCE OF PROPERTY INSURANCE 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. CAVFRAAF INFORMATInN D=Dth c loci iocn I I DAcir I I ..n— I X I —11A. COVERAGE/PERILS I FORMS AMOUNT OF INSURANCE DEDUCTIBLE PERILS: "All Risk" of direct physical loss or damage to real property on a replacement cost basis. 50,000,000 500,000 Coverage Includes, but is not limited to fire, extended perils such as vandalism, malicious mischief, flood, and earthquake PROP COVERED: Real & Personal Property, Extra Expense, Improvements and Betterments, Structures in the Course of Construction, Newly Acquired Locations, Ordinance or Law and as more fully in the policy(ies). PROPERTY VALUATION: Real and Personal Property, Extra Expense, Improvements and Betterments Structures in the Course of Construction, Newly Acquired Locations and as more fully described in the policy(ies). The Perils of Terrorism and Mold are excluded. Plate Glass damages are covered. Rental Value is included on an actual loss sustained basis but only to the extent required by the lease. Other deductibles may apply as per policy terms and conditions. City of Manifee is/are named as an Additional Insured as their interests may appear, as respects the leased premises, but only to the extent required under the lease of the premises or under any other written contract or agreement. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ADDITIONAL INTEREST NYC-008645604.12 NAME AND ADDRESS City of (� ° I S c ' X ADDITIONAL INSURED LENDER'S LOSS PAYABLE u LOSS PAYEE City ty Clerk MORTGAGEE 05267-01 City of Manifee LOAN # Attn: City Manager 2974 Haum Road Menifee, CA 92586 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. R e c e M Yevgeniya Mulyamina ACORD 27 (2016/03) @ 1993-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101226639 LOC #: Boston ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY Marsh USA Inc NAMED INSURED CVS HEALTH CORPORATION ONE CVS DRIVE MC2180 WOONSOCKET, RI 02895 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 27 FORM TITLE: Evidence of Property Insurance PARTICIPATING INSURERS: Factory Mutual Insurance Company Policy No.1056042 Endurance Specialty Ins. Ltd Policy No. BPD10011544202 ' PICC Property and Casualty Co, Ltd, Policy No. A028201944030000000469 ACE American Ins, Co. Policy No, MAUD37869995 005 ' Allied World Assurance Co. Policy No. P010154/012 Lloyds (CGM/ASC/AGR/rALICHN/AFB/HIS/AMA/LIRMA) Policy No BOWPN1900276 Ironshore US Policy No. 003719001 Starr Surplus Lines Ins, Co, Policy No. SLSTPTY11212119 Hiscox Policy No. HNYPRP19746225 Liberty Mutual Fire Ins. Co. Policy # MQ2-L9L-423889-029 HDI Global Insurance Co. Policy # XPD1504802 Crum & Forster Specialty Ins- Co. Policy No. PPP-910567 Endurance American Specialty Ins. Co. Policy # ARP10011544402 Hallmark Insurance Company Policy # 73PRP19A260 Axis Surplus Lines Ins, Co. Policy No EAF632029-19 Everest Re Group, Ltd Policy No RP5CF00239-191 Lexington Insurance Company Policy No.11144874 RSUI Group Policy No. LHD909399 Swiss Re Policy No. ESP200423800 Hudson Specialty Insurance Company Policy No. HCS102846 ' Hamilton Re Ltd Policy No. PX19-4405-01 " Liberty Specialty Markets Agency Ltd Policy No. LSP0005455 ' Neon Underwriting Bermuda Ltd. Policy No. BNPD19AA694Z Boiler & Machinery $25,000,000 Limit / $250,000 Deductible AXA XL Insurance Policy No. US 00085771PR19A Equipment Breakdown: Coverage for Property Damage, Spoilage, Business Interruption, Extra Expenses, and Utility Interrupticq per policy terms and conditions BERMUDA" THE PROPERTY INSURANCE NUMBERS BPD10011544202, A028201944030000000469, LSP0005455, P010154/012, PX19-4405-01, AND BNPD19AA694Z PLACEMENTS WERE MADE BY MARSH GLOBAL BROKING (BERMUDA). MARSH USA INC. HAS ONLY ACTED IN THE ROLE OF A CONSULTANT TO THE CLIENT WITH RESPECT TO THIS PLACEMENT, WHICH IS INDICATED HERE FOR YOUR CONVENIENCE. EVIDENCE/CERTIFICATES OF INSURANCE Any evidence of insurance issued in connection with this policy, including electronic memorandums of insurance, shall be issued solely as a matter of convenience or information for the addressee(s), holder(s) or viewer(s) of said evidence of insurance, except where under written contract with a third party the Insured is required to provide property insurance for the benefit of a third party and include the interest of such third party under said property policy as either additional insured, loss payee or mortgagee pursuant to said contract. In such event, the interest of such third party as either additional insured, loss payee or mortgagee as its interest may appear shall be covered under this policy as of the inception date of this policy if the contract had been entered into by the Insured prior to the policy's inception date, or as of the date the Insured enters into contract with the third party if such date occurs subsequent to the policy's inception, subject otherwise to all of the policy's, terms, conditions and exclusion. Further, the inclusion of such additional interest(s) shall not increase this Company's limit of liability under this policy. It is also agreed that in the event of loss or damage to property insured under the Insured's property policy where the third party has an interest in said property per contract with the Insured as either additional insured, loss payee or mortgagee and is not otherwise specifically named under the policy or made known to the Company prior to loss, such interest will be notified to the ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101226639 _ LOC #: Boston Aca ADDITIONAL REMARKS SCHEDULE Page 3 of 3 16.� - AGENCY Marsh USA Inc NAMED INSURED CVS HEALTH CORPORATION ONE CVS DRIVE MC2180 WOONSOCKET, RI 02895 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 27 FORM TITLE: Evidence of Property Insurance Company on the date of the notice of loss per the policy's conditions or as soon as reasonably practicable thereafter Failure to timely notify the Company in such event will not relieve this Company of any liability for said additional interests, but will be corrected as soon as possible STANDARD MORTGAGEE CLAUSE Loss or damage, if any, under this policy, shall be payable to any mortgagee, (or trustee) as designated herein by endorsement or certificate of insurance, as interests may appear, under all Present or future mortgages upon the property herein described in which the aforesaid may have an interest as mortgagee(or trustee), in order of precedence of said mortgagees, and this insurance, as to the interest of the mortgagee or trustee only therein, shall not be invalidated by any act or neglect of the mortgagor or owner of the within described property, nor by any foreclosure or other proceedings or notice of sale relating to the property, nor by any change in the title or ownership of the property nor by the occupation of the premises for purposes more hazardous than are permitted by this policy; provided, that in case the mortgagor or owner shall neglect to pay any premium due under this policy, the mortgagee or trustee, shall, on demand, pay the same. Provided also, that the mortgagee (or trustee) shall notify the Companies of any change of ownership or occupancy or increase of hazard which shall come to the knowledge of said mortgagee, (or trustee) and, unless permitted by this policy, it shall be noted thereon and the mortgagee (or trustee) shall, on demand, pay the premium for such increased hazard for the term of the use thereof; otherwise this policy shall be null and void The Company reserves the right to cancel this policy at any time provided by its terms, but in such case this policy shall continue in force for the benefit only of the mortgagee (or trustee) for 90 days after notice to the mortgagee (or trustee) of such cancellation and shall then cease and the Companies shall have the right, on like notice, to cancel this agreement Whenever the Companies shall pay the mortgagee (or trustee) any sum for loss or damage under this policy and shall claim that, as to the mortgagor or owner, no liability therefore existed, the Companies shall, to the extent of such payment, be thereupon legally subrogated to all rights of the party to whom such payment shall be made under all securities held as collateral to the mortgage debt, or may, at its option, pay to the mortgagee (or trustee) the whole principal due or to grow due on the mortgage with interest accrued thereon to the date of such payments, and shall receive a full assignment and transfer of the mortgage and of all such other securities; but no subrogation shall impair the right of the mortgagee (or trustee) to recover the full amount of said mortgagee's (or trustee's) claim CANCELLATION A. This policy may be canceled at any time at the request of the Insured or it may be canceled by the Company by mailing to the Insured at Director of Risk Management One CVS Drive Woonsocket, RI 02895 and to the additional insureds/loss payees or mortgagee indicated on the certificates of insurance issued during the term of this policy, written notice stating when, not less than 90 days thereafter, such cancellation shall be effective. The earned premium shall be computed on a pro-rata basis. B The mailing of notice as aforesaid shall be sufficient proof of notice and the effective date and hour of cancellation stated in the notice shall become the end of the policy period Delivery of such written notice either by the Insured or by the Company shall be equivalent to mailing. C Cancellation shall not affect coverage on any shipment in transit on the date of cancellation. Coverage will continue in full force until such property is safely delivered and accepted at place of final destination. D.In the event of non-payment of premium this policy may be canceled by the Company by mailing to the Insured at the address shown in A above stating when, not less than 10 days thereafter, such cancellation shall be effective. Reinstatement of coverage shall be effective immediately upon receipt of premium by the Company. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD