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2017/11/15 HDL Coren & Cone Certificate of Liability InsuranceHDLCO-1 OP ID: ALA ACO�O CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 1 10/31/2017 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 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 Partee Insurance Assoc.,lnc. License #0786033 584 S. Grand Avenue Covina, CA 91724-3409 Wayne M. Partee CIC, CWCA CONTACT NAME: PHONE FAX Alc No EXt : 626-966-1791 (A/C, No): 626-331-8132 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Ohio Security Insurance Co INSURED HdL Coren and Cone INSURER B:American Fire and Casualty Co 1340 Valley Vista Dr # 120 Diamond Bar, CA 91765 INSURER c:Twin City Fire Insurance Co. INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,00 CLAIMS -MADE T OCCUR X BZS66380327 11/15/2017 11/15/2018 P DREMISES Ea occurrAMAGETO...c.'ence S 2 000 � 00 MED EXP (Any one person) S 15,000 PERSONAL & ADV INJURY S Included GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 4,000,000 X POLICY ❑PRO- JECT ❑ LOC PRODUCTS-COMP/OPAGG S 4,000,000 S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000 000 BODILY INJURY (Per person) S A ANY AUTO BAS56380327 11/15/2017 11/15/2018 BODILY INJURY (Per accident) S ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident S S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE S 1,000,000 B EXCESS LIAB CLAIMS -MADE USA56380327 11/15/2017 11/15/2018 DED X RETENTIONS 10,000 S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A X XWS56380327 11/15/2017 11/15/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT s 1,000,000 E.L. DISEASE - EA EMPLOYE S 1,000,000 E.L. DISEASE - POLICY LIMIT S 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below C Professional Liab 72PGO260349 11/15/2017 11/15/2018 Agg Limit 2,000,000 Claims Made Form RETRO DATE 2/16/2003 Ded 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) *30 day notice of cancellation, 10 days for nonpayment. Certificate holder the City, its officers, employees and agents named as Additional Insured under the General Liability. Waiver of Subrogation as respects Workers Compensation. L"q;41I2W_11\IN11:Lai RRLPIGi CITYMEN 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. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 79 (Ed. 01-13) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. 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 obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while en- gaged in the work described in the Schedule. The additional premium for this endorsement is $ 100.00 Schedule Person or Organization City of Menifee, the City, its officers, employees and agents 29714 Haun Road Menifee, CA 92586 Job Description This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 11/15/2017 Endorsement No. 0009 Policy Effective 11/15/2017 Premium $100.00 State CA Policy No. XWS 56 38 03 27 Insured HDL COREN & CONE Insurance Company Ohio Security Insurance Company 19291 Countersigned by �= WC 99 06 79 (Ed. 01-13) © 2013 Liberty Mutual Insurance Includes copyrighted material of WCIRB,with its permission. POLICY NUMBER: BZS56380327 BUSINESSOWNERS BP 04 48 07 13 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): City of Menifee, the City, its officers, employees and agents 29714 Haun Road Menifee, CA 92586 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - Liability is amended as follows: A. The following is added to Paragraph C. Who Is An Insured: 3. Any person(s) or organization(s) shown in the Schedule is also an additional insured, but only with respect to liabil- ity for "bodily injury", "property dam- age" or "personal and advertising in- jury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your be- half in the performance of your ongoing operations or in connection with your premises owned by or rented to you. However: a. The insurance afforded to such ad- ditional insured only applies to the extent permitted by law; and b. If coverage provided to the addi- tional insured is required by a con- tract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such addi- tional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Paragraph D. Liability And Medical Expenses Limits Of Insurance: If coverage provided to the additional in- sured is required by a contract or agree- ment, the most we will pay on behalf of the additional insured is the amount of insur- ance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits Of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. BP 04 48 07 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1