2018/01/30 Central County United Way Certificate of Liability Insurance (3)'/ ) ®
A�RD CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
10/22/2018
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
DFI - DiGerolamo Family Insurance Services
2027 Hamner Ave
Norco, CA 92860
License #: OD26889
NAME:" Lucy Anderson
PnHC.N o E<t : (951)735-5335 ac Ne : (951)735-3758
E-MAIL
ADDRESS: Y luc dfiinsurance.com
INSURERS AFFORDING COVERAGE
NAIC #
INSURERA: Guide One Mutual Insurance Com an
15032
INSURED
Central County United Way
DBA United Communities Network
418 E Florida Avenue
Hemet, CA 92543
INSURERB: GuideCine Mutual Insurance Company
15032
INSURERC: State Compensation Insurance Fund
35076
INSURER D
INSURER E
INSURER F :
CERTIFICATE NUMBER: 00000000-1426331 REVISION NUMBER: 53
COVERAGES
THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
THIS IS TO CERTIFY
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
INDICATED. NOTWITHSTANDING
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
LTR
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MM/DDIYYYY
POLICY EXP
MWDDIYYYY
LIMITS
A
XI COMMERCIAL GENERAL LIABILITY
Y
01446927 CIt
1fl'/6'hensi
a(V01/2019
EACH OCCURRENCE
S 1,000,000
DAMAGE TO RENTED
PREMISES Eaoccunence
$ 1000OO
CLAIMS -MADE ❑X OCCUR
ity Clerk
MED EXP (Any one person)
$ 5,000
N
V 0 7 201
PERSONAL BADVINJURY
S 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 3000000
PRODUCTS -COMP/OP AGG
S 2,000,000
X POLICY ❑ JPECT LOC
S
etr�ived
B
OTHER:
AUTOMOBILE LIABILITY
Y
01788843
11/01/2018
11/01/2019(CEO
INE
accideD SINGLE LIMIT
S 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
S
OWNED SCHEDULED
X
PROPERTY DAMAGE
Per accident
S
AUTOS ONLY AUTOS
HIRED NON -OWNED
X X ONLY
S
AUTOS ONLY AUTOS
UMBRELLA LIAB OCCUR
I
I
I
I
I EACH OCCURRENCE _I
S
�
I EXCESS LIAB CLAIMS -MADE
I
AGGREGATE
S _
S
DED� RETENTIONS
_
X STATUTE EERH
_
C
WORKERS COMPENSATION
1542921-18
01/30/2018
01/30/2019
E.L. EACH ACCIDENT
S 1,000,000
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
N / A
E.L. DISEASE - EA EMPLOYE
S 1 ,000,000
(Mandatory in NH)
If yes, describe under
E.L.DISEASE-POLICY LIMIT
S 1,000,000
A
DESCRIPTION OF OPERATIONS below
Building Coverage
I
I
j
01446927
I
11/01/20111
11/01/2019
Building
435,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
Certificate Holder is named additional insured.
F-1L:A It H
City of Menifee
29714 Haun Road
Menifee, CA 92586
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
V-IJO0-Au IA HLVRLJ liVRrw1 11-1. i 1 .1y11.� ...�...
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
Printed by LMA on October 22, 2018 at 11:39AM
L DD DD MOHA L MURK') o0
DD EMNATEEDD PERSOH OR ORGAHEATMH
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s)
Information require to complete this chedule, if not shown above, will be shown In the Dec -Fa -rations.
Section II -- Who Is An Insured is amended to include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or
the acts or omissions of those acting on your behalf:
A. In the performance of your ongoing operations; or
B. In connection with your premises owned by or rented to you.
° ISO Properties, Inc., 2004 CG 20 26 07 04
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