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2018/04/01 Habitat for Humanity Inland Valley Certificate of Liability Insurance10/17/2018 Lockton Affinity, LLC 888-553-9002 913-652-3967Lockton Affinity, LLC P. O. Box 873401 Kansas City, MO 64187-3401 Habitat for Humanity Inland Valley 27475 Ynez Rd #390 Temecula, CA 92591-4612 A X GL1064456-18 04/01/2018 04/01/2019 X 2,000,000 2,000,000 1,000,000 1,000,000 1,000,000 0 City of Menifee 1064456 Attn: Margarita Cornejo, Contract & Procurement Administrator Y 29714 Haun Road Menifee, CA 92586 The City of Menifee, its officers, agents and employees are named as additionally insured and the City of Menifee listed as the Certificate Holder in regards to CDBG Grant. X Ace American Insurance Co.22667 28720927 1064456 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 10/18/2018 Arthur J.Gallagher &Co. Insurance Brokers of CA,Inc.LIC #0726293 1255 Battery Street,Suite 450 San Francisco CA 94111 NonProfits'United Vehicle Ins Pool Habitat for Humanity Inland Valley 27475 Ynez Road #390 Temecula,CA 92591 817021781 A 1,000,000 X Y NPU1000-18 7/1/2018 7/1/2019 Any Auto means any covered auto under the NPU Vehicle Insurance Program. The City of Menifee,its officers,officials,employees,volunteers,agents,and representatives are included as additional insured. City of Menifee 29714 Haun Road Menifee CA 92586 NPU-VIP 2018-2019 Page 1 of 2 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NonProfits’ United Vehicle Insurance Pool Automobile Liability Coverage ADDITIONAL COVERED PARTY ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The “Who is an Insured” section of your Automobile Liability Insurance is changed by adding the following: Who is Covered includes any person or organization from whom you have leased an auto, from which you have received funding for your operations, or for who you provide services. These persons or organization are protected, if they require to be named, and you agree to name them, as an additional insured, if indicated on the attached Certificate of Coverage, but only with respect to liability arising out of the ownership, use, maintenance, loading or unloading of a covered auto. Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named on the certificate, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. Premium Payments: Those persons or organizations are not responsible for paying premiums for your coverage. Insured: As shown on the Certificate of Insurance attached. Policy Number: NPU1000-18 Effective Date: July 1, 2018 to July 1, 2019 (or otherwise indicated) NPU-VIP 2018-2019 Page 2 of 2 Authorized Representative: CERTIFICATE OF WORKERS’ COMPENSATION COVERAGE DATE Oct 18, 2018 PRODUCER NonProfits’ United Workers’ Compensation Group 610 Fulton Avenue, Suite 200 Sacramento, CA 95825 Phone: (916) 868-6231 Fax: (916) 880-5251 Arthur J. Gallagher & Co Insurance Brokers of California, Inc 1255 Battery Street #450 San Francisco, CA 94111 THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED Habitat for Humanity Inland Valley 27475 Ynez Road #390 Temecula, CA 92591 INSURER A: NonProfits’ United Workers’ Compensation Group INSURER B: Safety National Casualty Corp [NAIC # 15105] INSURER C: INSURER D: INSURER E: COVERAGES This Certificate is not intended to specify all endorsements, coverages, terms, conditions and exclusions of the policies shown. THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE AFFILIATE MEMBER 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 COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF COVERAGE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION DATE LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ CLAIMS MADE OCCUR MED EXPENSE (Any one person) $ GENERAL AGGREGATE LIMIT APPLIES PER: PERSONAL & ADV INJURY $ POLICY PROJECT LOC GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Each accident) $ ANY AUTO $ ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS $ HIRED AUTOS BODILY INJURY (Per accident) $ NON-OWNED AUTOS $ PROPERTY DAMAGE (Per accident) $ $ A WORKERS’ COMPENSATION AND EMPLOYERS LIABILITY NPU-WCG 001-2018 1/1/18 1/1/19 X PER STATUTE OTHER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE – EA EMPLOYEE $ 500,000 E.L. DISEASE – COVERAGE LIMIT $ 500,000 B OTHER EXCESS Workers’ Compensation SP 4057827 1/1/18 1/1/19 Limit Per Occurrence - Statutory EL Per Occ & Agg $2,000,000 xs of $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL/PROVISIONS Evidence of Workers’ Compensation Coverage: CDBG Grant CERTIFICATE HOLDER CANCELLATION NPUWCG-HHIV-012 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Menifee 29714 Haun Road Menifee, CA 92586 Based on ACORD 25 (2014/01)