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2018/01/24 Innovative Document Solutions Certificate of Liability Insurance (4)Ae"Rv� DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCEF��• 11 /30/2018 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 CONTACT NAME: Anna Llera R. David Bulen Insurance Agency PHONE Ext : (951) 674-0675 PAX No _ (951) 674-2375 P.O. Box 115 ADDRESS. annagbulen.com 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 Document Solutions INSURER C : Nationwide Mutual Insurance Company 23787 26855 Jefferson Ave INSURER D : Suite F INSURER E: Murrieta CA 92562 INSURER F : COVERAGES CERTIFICATE NUMBER: CL18113026147 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. TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR PREMISES Eacccurrerlea $ 300,000 MED EXP fAny 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: GENERAL AGGREGATE $ 2,000,000 POLICY JE LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY N IN U i Ea acadenl $ 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 PROPERTY AMR (Pet aoddeni $ AUTOS ONLY AUTOS ONLY UMBRELLA LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED RETENTION $ $ WORKERS COMPENSATION PER x AND EMPLOYERS' LIABILITY YIN STATUTE ER E.L EACH ACCIDENT $ 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE N/A WKN146463-7 04/01/2018 04/01/2019 OFFICER/MEMBEREXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 It 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 PB0447 11/14. Insurance is Primary and Non Contributory. "30-day notice of cancellation, except for 10-day notice of cancellation for nonpayment of premium. CERTIFICATE HOLDER C,AhfrFI I ATIrIN1 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 AUTHORIZED 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 47 1114 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; 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 amount of insurance: PB 04 4711 14 , 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 1114 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 Name 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