2018/01/24 Innovative Document Solutions Certificate of Liability InsuranceAC ROB CERTIFICATE OF LIABILITY INSURANCE
DATE(M/Y)
11 /30/20182018
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
City of Menifee
CONTACT Anna Liera
NAME:
R. David Bulen Insurance Agency City Clerk
HONE Ezt : (951) 674-0675 (Aic,No): (951) 674-2375
P.O. Box 115
E-MAILESS: anna@bulen.com
ADDR
DEC 0 7 2018
INSURER(S) AFFORDING COVERAGE
NAIC #
Lake Elsinore CA 92531-0115
INSURER A: AMCO Insurance Company
19100
INSURED
INSURER B : Preferred Employers Ins. Co.
10900
Heitritter, Kevin, DBA: Innovative DocP"f�iVll}t6ns
INSURER C : Nationwide Mutual Insurance Company
23787
26855 Jefferson Ave
INSURER D :
Suite F
INSURER E :
Murrieta CA 92562
INSURERF:
COVERAGES CERTIFICATE NUMBER: CL18113026147 RFVICInM 11J IIURFR-
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.
IL7q
TYPE OF INSURANCE
AUULbUdH
INSD
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY)(MM/DDNYYY)
POLICY EXP
LIMITS
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
EACH OCCURRENCE
$ 1,000,000
PREMISES Ea occurrence
$ 300,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
A
Y
ACP7841746108
01/24/2018
01/24/2019
GEN'L
AGGREGATE LIMIT APPLIES PER:
PROX POLICY ❑ JEC
JECT LOC
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
C
OWNED SCHEDULED
AUTOS ONLY AUTOS
BA7841746108
01/24/2018
01/24/2019
BODILY INJURY Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
CLAIMS -MADE
E=1
RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETORIPARTNER/EXECUTIVE M
OFFICER/MEMBEREXCLUDED?
N/A
WKN146463-7
04/01/2018
04/01/2019
PER OTH-
X STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of Menifee and its officers, employees, agents, and authorized volunteers are named as Additional Insured in regards to General Liability per the
attached PBO447 11/14. Insurance is Primary and Non Contributory. '30-day notice of cancellation, except for 10-day notice of cancellation for
nonpayment of premium.
VC
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Menifee ACCORDANCE WITH THE POLICY PROVISIONS.
29714 Haun Road
AUTHORD:ED REPRESENTATIVE
Menifee CA 92586
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
BUSINESSOWNERS
PB 04 4711 14
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - VENDORS
This endorsement modifies insurance provided under the following:
PREMIER BUSINESSOWNERS LIABILITY COVERAGE FORM
A. The following is added to Section II. WHO IS AN
INSURED:
Any person or organization (referred to
throughout this endorsement as vendor) shown in
the Schedule of this endorsement is also an
insured, but only with respect to "bodily injury" or
"property damage" arising out of "your products"
shown in the Schedule of this endorsement which
are distributed or sold in the regular course of the
vendor's business, subject to the following
additional exclusions:
However:
1. The insurance afforded to such vendor only
applies to the extent permitted by law; and
2. If coverage provided to the vendor is
required by a contract or agreement, the
insurance afforded to such vendor will not
be broader than that which you are required
by the contract or agreement to provide for
such vendor.
B. With respect to the insurance afforded to these
vendors, the following additional exclusions
apply:
1. The insurance afforded the vendor, including
any duty we have to defend "suits", does not
apply to:
a. "Bodily injury" or "property damage" for
which the vendor is obligated to pay
damages by reason of the assumption
of liability in a contractor agreement.
This exclusion does not apply to liability
for damages that the vendor would have
in the absence of the contract or
agreement;
b. Any express warranty unauthorized by
you;
c. Any physical or chemical change in the
product made intentionally by the
vendor;
d. Repackaging, unless unpacked solely
for the purpose of inspection,
demonstration, testing or the
substitution of parts under instructions
from the manufacturer, and then
repackaged in the original container;
PB 04 4711 14
e. Any failure to make such inspections,
adjustments, tests or servicing as the
vendor has agreed to make or normally
undertakes to make in the usual course
of business, in connection with the
distribution or sale of the products;
f. Demonstration, installation, servicing or
repair operations, except such
operations performed at the vendor's
premises in connection with the sale of
the product; or
g. Products which, after distribution or sale
by you, have been labeled or relabeled
or used as a container, part or
ingredient of any other thing or
substance by or for the vendor.
h. "Bodily injury" or "property damage"
arising out of the sole negligence of the
vendor for its own acts or omissions or
those of its employees or anyone else
acting on its behalf.
HOWEVER, this exclusion does not
apply to:
(1) The exceptions contained in Sub -
Paragraphs d. or f.; or
(2) Such inspections, adjustments, tests
or servicing as the vendor has
agreed to make or normally
undertakes to make in the usual
course of business, in connection
with the distribution or sale of the
products.
2. This insurance, including any duty we have to
defend `suits", does not apply to any insured
person or organization from whom you have
acquired such products, or any ingredient,
part or container entering into, accompanying
or containing such products.
C. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III. LIMITS OF INSURANCE AND
DEDUCTIBLE:
If coverage provided to the vendor is
required by a contract or agreement, the most we
will pay on behalf of the vendor is the
amountof insurance:
Includes copyrighted material of Insurance Services Office, Inc., with its permission
Page 1 of 2
ACP BPR 7831746108 AGENT COPY 47 05300
PB 04 47 11 14
1. Required by the contract or agreement; or This endorsement shall not increase the
2. Available under the applicable Limits Of applicable Limits Of Insurance shown in the
Insurance shown in the Declarations; Declarations.
whichever is less.
All terms and conditions of this policy apply unless modified by this endorsement.
SCHEDULE
Your Products:
COPIERS
Flame Of Person Or Organization (Vendor):
City of Menifee and its officers, employees, agents, and authorized volunteers
29714 Haun Road, Menifee CA 92586.
Page 2 Of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. PB 04 47 1114
ACP BPR 7831746108 AGENT COPY 47 05301