Loading...
2019/04/01 Habitat for Humanity Inland Valley Certificate of Liability Insurance (4)� .decoun CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/riri) �.� FoB/16/2019 FTHIS 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 CONTACI NAME: Lockton Affinity, LLC Lockton Affinity, LLC wCNNo ad;888-553-9002 LAIC, �;913-652-3967 E-MAIL P. O. Box 873401 ADORE": _ Kansas City, MO 64187-3401 INSURERS AFFORDING COVERAGE NAIL# _ INSURER A: Ace American Insurance Co. 22667 INSURED INSURER B:Ace Property and Casualty 20699 Habitat for Humanity Inland Valley INSURER C 27475 Ynez Rd #390 INSURERD: Temecula, CA 92591-4612 INSURERE: INSURER F: COVERAGES CFRTIFICATF NIIMRFR- DFVIClIn IV rdIIMRCD- 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/OplYri MM/DD/YYY LIMITS A X COMMERCIAL GENERAL LIABILITY y GL1064456-19 04/01/2019 04/01/2020 EACH OCCURRENCE $ 1 , 000 , 000 CLAIMS -MADE JX JOCCUR PREMISES a occurrence $ 1 , 000 , 000 MED EXP (Any one person) $ 0 PERSONAL 8 ADV INJURY $ 1 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLPRO- ICY JECT LOG GENERAL AGGREGATE s2,000,000 PRODUCTS- COMP/OP AGG $ 2,000,000 $ ¢TF FR: AUTOMOBILE LIABILITY %MBINEDStNGLE LIMIT axident $ BODILY INJURY (Per person) $ ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS H BODILY INJURY Per accident ( ) $ HIRED AUTOS NON -OWNED AUTOS F PROPERTY DAMAGE Para - en $ $ - B X UMBRELLA LIAB X OCCUR - UM1064456-19 04/01/2019 04/01/2020 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1 , 000 , 000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $ 10 000 $ WORKERS COMPENSATION 1 PER AND EMPLOYERS LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ N / A . STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOY $ (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of Menifee, its officers, agents and employees are named as additionally insured per written contract in regards to general liability. I k MULULK 1064456 City of Menifee I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 29844 Haun Road AUTHORIZ EPRESENTATIVA Menifee, CA 92586 *w� ACORD 25 (2014/01) 31777270 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1064456 DAT CERTIFICATE OF WORKERS' COMPENSATION COVERAGE Aug 15, 2019 PRODUCER Nonprofits' United Workers' Compensation Group 610 Fulton Avenue, Suite 200 Sacramento, CA 95825 Phone: (916) 868-6231 Fax: (916) 880-5251 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. Arthur J. Gallagher & Cc Insurance Brokers of California, Inc 1255 Battery Street #450 San Francisco, CA 94111 INSURERS AFFORDING COVERAGE INSURED INSURER A: NonProfits' United Workers' Compensation Group Habitat for Humanity Inland Valley 27475 Ynez Road #390 INSURER B: Safety National Casualty Corp [NAIL # 151051 INSURER C: Temecula, CA 92591 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. NSR ILTR 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 I PROJECT I LOC GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO $ (Each accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS $ (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS $ (Per accident) PROPERTY DAMAGE $ $ (Per accident) WORKERS' COMPENSATION X I PER STATUTE OTHER E L. EACH ACCIDENT $ 500,000 A AND NPU-WCG 001-2019 1/1/19 1/1/20 E.L DISEASE - EA EMPLOYEE $ 500,000 EMPLOYERS LIABILITY E.L. DISEASE -COVERAGE LIMIT $ 500,000 g OTHER EXCESS Workers' Compensation SP 4059671 1/1/19 1/1/20 Limit Per Occurrence - Statutory EL Per Occ & Agg $2,000,000 xs of $500.000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAUPROVISIONS CERTIFICATE HOLDER CANCELLATION NPUWCG-HHIV-015 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 29844 Haun Road. _ Menifee, CA 92586 Based on ACORD 25 (2014/01) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 42 POLICY NUMBER POLICY CHANGES COMPANY G24962842 007 EFFECTIVE ACE American Insurance Company 08/16/2019 NAMED INSURED AUTHORIZED REPRESENTATIVE Habitat For Humanity Purchasing Group Inc. Lockton Affinity, LLC COVERAGE PARTS AFFECTED Commercial General Liability Coverage Part CHANGES Endorsement MS-19249 (02/13) - Who Is An Insured and Primary Non Contributory Insurance — Scheduled Person Or Organization is added per the attached in favor of: City of Menifee, its officers, agents and employees 29844 Haun Road Menifee, CA 92586 Authorized Representative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 ❑ Copyright, ISO Commercial Risk Services, Inc., 1983 AFFILIATE# 1064456 WHO IS AN INSURED, and PRIMARY, NON CONTRIBUTORY INSURANCE — SCHEDULED PERSON OR ORGANIZATION Named Insured Endorsement Number Habitat For Humanity Purchasing Group, Inc. 191 Policy Symbol Policy Number Policy Period Effective Date of Endorsement G24962842 007 [4/1/2019 to 4/1 /2020 08/16/2019 Issued By (Name of Insurance Company) ACE American Insurance Company of the information is to be completed only when this endorsement is issued THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM EMPLOYEE BENEFITS LIABILITY COVERAGE FORM STOP GAP -EMPLOYERS LIABILITY COVERAGE FORM Who Is An Insured Additional Insured- Scheduled Person or Organization Persons or organizations shown in the schedule are "insureds" but they are "insureds" only if you are obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by this policy. However, the person or organization is an "insured" only: • If an then only to the extent the person or organization is described in the Schedule; • To the extent such contract or agreement requires the person or organization to be afforded status as an "insured"; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies No person or organization is an "insured" under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). • With respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. Authorized Representative MS-19249 (0213) Page 1 of 2 AFFILIATE # 1064456 Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions: Other Insurance — Primary, Non Contributory Insurance — Scheduled Person or Organization If you are obligated, pursuant to a contract or agreement, to provide the person or organization shown in the Schedule with primary insurance such as is afforded by this policy, then in such case this insurance is primary and we will not seek contribution from insurance available to such person or organization. Schedule: City of Menifee, its officers, agents and employees 29844 Haun Road Menifee, CA 92586 Authorized Representative MS-19249 (0213) Page 2 of 2 AFFILIATE # 1064456