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2017/09/01 Lew Edwards Group Certificate of Liability InsuranceLEWEDWA-01 GHODGES '4 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) F031,22/2018 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 Cumbre Insurance Services, LLC 1318 Redwood Way Suite 200 CONTACT Gail Hodges PHONE FAX (A/C, No, Ext): (707) 992-3743 (A/C, No),(415) 899-8668 AI DRIEss: hodgesg@cumbreins.com Petaluma, CA 94954 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Underwriters at Lloyd's, London 15792 INSURED INSURER B: Ohio Security Insurance Company 24082 INSURER c: Republic Indemnity Company of America 22179 Lew Edwards Group INSURER D : 2301 Mastlands Drive Oakland, CA 94611 INSURER E : INSURER F : COVFRAGFS CFRTIFIrATP All IMRFR• DCvlelnrJ nu tneDOD. 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 TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDDIYYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X LBW562434R1 02/06/2018 02/06/2019 EACH OCCURRENCE S 1,000,000 DAMAGE AMA PREMISES R NToccU ante S 100,000 MED EXP (Any oneperson) S 5,000 PERSONAL & ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECT LOC GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMP/OP AGG S $ OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 S X BODILY INJURY Per person)S ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X BAS57306007 09/01/2017 09/01/2018 BODILY INJURY Per accident S Pe, accitlentDAMAGE S AUTOS ONLY A�TOS ONL� S UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAB DED I I RETENTION $ S C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A X 16644913 09/21/2017 09/21/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT 1,000,pOQ S E.L. DISEASE - EA EMPLOYE S 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ C Errors & Omissions W1613213160401 09/30/2017 09/30/2018 IPER CLAIM 2,000,000 C CLAIMS MADE W1662B160401 09/30/2017 09/30/2018 AGGREGATE 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CITY OF MENIFEE, ITS OFFICERS, EMPLOYEES, AGENTS AND AUTHORIZED VOLUNTEERS ARE HEREBY NAMED AS ADDITIONAL INSURED'S WITH RESPECTS TO LIABIITY ARISING FROM THE NAMED INSURED'S OPERATIONS PER BW 000 859 08/2012. COVERAGE IS PRIMARY AND NON-CONTRIBUTORY PER AUTOMOBILE ADDITIONAL INSURED PER BW 001 3971004. CA 8810 01 13, PRIMARY & NON CONTRIBUTORY PER CA 00 0103 06. WORKER'S COMPENSATION WAIVER OF SUBROGATION PER WC 00 03 13 04-84. PROFESSIOAL LIABILITY RETRO-ACTIVE DATE 9/30/2009. PROFESSIONAL LIABILITY RETENTION $ 5,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY ACCORDANCE WITH THE POLICY PROVISIONS. Gina Gonzalez - Economic Development Manager 29714 Haun Road Menifee, CA 92586 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD