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2018/11/15 HDL Coren & Cone Certificate of Liability InsuranceA� o® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 11/09/2018 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 Partee Insurance Associates, Inc. PTL Insurance Brokers, In P.O. Box 4155 pity of Menifee CA 91723 City Clerk CONTACT NAME: Richard Pedevillano AC IF O N Ex : (626) 967-9581 (,C No: (626) 967-1664 E-MAIL com ADDRESS: certificates@ptlinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Ohio Security Insurance Co. 34082 INSURED (714) 679-5000 NOV INSURER B: American Fire & Casualty Co. 24066 HDL Coren & Cone INSURERC:Twin City Fire Insurance Co. 29459 120 S. State College Blvd. INSURER D: Suite #200 Brea, CA 92821 ReCetVec1 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: Cert ID 4158 REVISION NUMBFR: 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 I TYPE OF INSURANCE ADDL INSD SUBR WVD POLICYNUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,000 CLAIMS -MADE Fx_1 OCCUR y BZS56380327 11/15/2018 11/15/2019 PREMISES(Ea occurrence) S 2,000,000 MED EXP (Any one person) S 15,000 PERSONAL BADVINJURY $ Included GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 4,000,000 X POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG S 4,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) S A ANY AUTO BAS(19)56380327 11/15/2018 11/15/2019 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S X HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY PROPERTY DAMAGE Per accide 0 is Is B X UMBRELLALIAB X OCCUR IISA(19)56380327 11/15/2018 11/15/2019 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION$ 10,000 Prod -Comp Ops $ 1,000,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N y XWS(19)56360327 11/15/2018 11/15/2019 X STATUTE OERH ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ NIA E.L.DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE -POLICY LIMIT $ 1,000,000 C Professional Liability 72PGO260349 11/15/2018 11/15/2019 Each Claim S 1,000,000 Aggregate $ 2,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of Menifee, its officers, employees and agents are named Additional Insured per End. attached with regard General Liability policy. With regard to Workers' Compensation policy, Waiver of Subrogation End. is attached. CERTIFICATE HOLDER CANCELLATION 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 s POLICY NUMBER: 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): Blanket 1340 Valley Vista Road, Suite 200 DIAMOND BAR, CA 91765 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section If - 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. SP 04 48 07 13 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. ©insurance Services Office, Inc., 2012 Page 1 of 1 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 $ Schedule Person or Organization 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 Endorsement No. 0008 Policy Effective 11/15/2018 Premium State Policy No. XWS (19) 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 WCIRBwith its permission.