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2018/12/31 Local Government Commission Certificate of Liability Insurance (3)LOCAL-1 OP ID ACVR� CERTIFICATE OF LIABILITY INSURANCE DATE 2712IY /7lz a18 12s 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 endorsements . PRODUCER 916-739-0254 CO NANTACT ME: Wasserman 8r Associates PHONE 916-739-0254 WAX 916-733-0622 Insurance Brokers, Inc. (A/C, No, Ext): Arc, No PO Box 19970 NaIL Sacramento, CA 95819-3915 Rick Wasserman IN S AFFORDING COV NAIC # INSURER A: Oak River Insurance Co 34630 INSURED Local Government Commission INSURER B : Landmark American Insurance Co 980 9th Street, Ste. 1700 Sacramento, CA 95814 INSURERC: INSURER D.- COVERAGES CE0=k1ICInAI All IAP1RCG• 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 TYPE OF INSURANCE ADDL Ma SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY City of Menir '(; H OCCURRENCE p AMAGE TO RENTED CLAIMS -MADE OCCUR City Clerk REMISES [Ee nacun@ $ MED EXP (Any one RIMM $ PERSONAL &ADV INJURY $ JAN 07 20111 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY ❑ %?T E LOC GENEPALAGGREGATE $ PRODUCTS - COMP/OP A G OTHER: Received AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT BODILY INJURY Werperson) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident (PRarac denDAMAGE AUTOS ONLY AUUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY YIN EL. EACH ACCIDENT 1>000>000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y LOWC011829 01/01/2019 01/01/2020 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A E_L,DISEASE- EAEMPLOY $ 1'000'000 If yes, describe under DESCRIPTION OF OPERATIONS below 1 E - P LI Y LIMIT 1 000,000 B Professional Liab LHR836474 12/31/2018 12/31/2019 Aggregate 2,000,000 Ded $1,000 per cl Ea Claim 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) *30 Days Notice to Certificate Holder applies except For Non -Payment of Premium which is 10 days. RE: City of Menifee Active Transportation Plan. Waiver oil Subrogation applies in Favor of the City of Menifee and its officers, employees, agents, and authorized volunteers with respect to the Workers Compensation per form WC 99 04 10B attached. MENIF-2 City of Menifee 29714 Haun Road Menifee, CA 92586 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 7 0,1 AC:UKU 25 (Zo16/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0410B (Ed. 9-14) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS We have the right to recover our payments from anyone Ilable for an injury covered by this policy. We will not enforce our right agalnst the person or organization named In the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) The additional premium for this endorsement shall be 2% of the total manual premium otherwise due on such remuneration. The minimum premium for this endorsement Is $350. This agreement shall not operate directly or Indlrectly to benefit anyone not named In the Schedule. SCHEDULE BLANKET WAIVER Person/Organization Blanket Waiver — Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description All CA Operations Waiver Premium This endorsement changes the policy to which it Is attached and is effective on the date issued unless otherwise stated. (The Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective 01/01/2019 Policy No. LOWC011829 Endorsement No. Insured LOCAL GOVERNMENT COMMISSION Insurance Company Oak River Insurance Company Countersigned by WC 99 0410B (Ed. 9-14) Premium $