2018/08/28 Western Fire Company, Inc. Certificate of Liability InsuranceACURQ®
L __
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
10/02/18
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 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
AL MINICOLA GENERAL INSURANCE
16811 HALE AVENUE, SUITE AMAIL°
IRVINE, CA 92606-5066
NAME:
PHONE 949 336-4343 (F
Ext: A/c N°:949 336-4347
ADDRESS:certsi@alminicola.com
INSURER(S) AFFORDING COVERAGE
NAICY
INSURER A:BERKLEY ASSURANCE COMPANY
39462
INSURED WESTERN FIRE COMPANY, INC.
INSURER B : EVANSTON INSURANCE COMPANY
35378
1401 E . OAKLAND AVENUE
INSURER C : PREFERRED PROFESSIONAL INSURANCE COMPANY
36234
HEMET, CA 92544
INSURERD:
INSURER E
INSURER F :
COVERAGES CFRTIFICATF NIIMRFR• *TTPDATF.T] CRRTTF'TCATR* RF\/ICInN NI IMRPP.
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
INSD
SUER
WVD
POLICY NUMBER
POLICY EFF
MM/DDNYYY
POLICY EXP
MM/DD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000, 000
CLAIMS-MADE � OCCUR
RhNIEU-
PREMISES ILIEa occurrence
$ 100,000
X
MED EXP (Anyone person)
$ 5,000
A
$ 2 , 0 0 0 DED .
Y
VUMD0000420
08/28/18
08/28/19
PERSONAL&ADVINJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY jE Loc
GENERAL AGGREGATE -
$ 2,000,000
CItY Of M eri Ife <'
PRODUCTS - COMP/OP AGG
$ 2,000,000
OTHER:
City Ciefi<
$
AUTOMOBILE
LIABILITY
OCT
COMBINED SINGLE LRMT-- Ea accident)$
BODILY INJURY (Per person)
$
ANYAUTO
O 9 2018
ALL OWNED SCAUTOS HEDULED
AUTOS
BODILY INJURY (Per accident)
$
PROPERTY-
er accident) -D MA E
$
NON -OWNED
HIRED AUTOS AUTOS
?deceived'
B
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
XOBW7806218
08/28/18
08/28/19
EACH OCCURRENCE
$ 2,000,000
X
AGGREGATE
$ 2,000,000
DED I I RETENTION $
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUDED? S�
(Mandatory in NH)
N/A
ON0812702
10/01/18
10/01/19
PER H-
STATUTE I X I ER
E.L.EACHACCIDENT
000 000
$ 1, ,
E.L. DISEASE - EA EMPLOYE
$ 1,0001000
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)
RE: ALL CALIFORNIA OPERATIONS OF THE NAMED INSIIRED. CITY OF MENIFEE AND ITS OFFICERS, EMPLOYEES, AGENTS AND
VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED WITH RESPEC TO GENERAL LIABILITY. PRIMARY/NON-CONTRIBUTORY WORDING
APPLIES TO GENERAL LIABILITY. WAIVER OF SUBROGATION APPLIES TO GENERAL LIABILITY AND WORKERS' COMPENSATION.
*EXCEPT 10 DAY NOTICE OF CANCELLATION FOR NONPAYMENT OR NONREPORTING*
—1111m;L9J41=1
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
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD25(2014/01) The ACORD name and loao are registered marks of ACORD
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WC ON 04 WS
(Ed. 02-18)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right
against 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.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work
described in the Schedule.
Blanket Waiver: The additional premium for this endorsement shall be 2% of the California workers' compensation premium
otherwise due on such remuneration, subject to a $ 250 minimum charge.
Specific Waiver: The additional premium for this endorsement shall be 5% of the California workers' compensation premium
otherwise due on such remuneration, subject to a $ 100 minimum charge.
Schedule
Person or Organization Job Description
Blanket Waiver of Subrogation As respects to all CA jobs performed by the named insured during the
policy period where by written contract a waiver of subrogation is
required prior to the commencement of work.
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:10/01/2018
Insured Western Fire Company, Inc.
Policy No.: ON08127 - 02 Endorsement No.:
Insurance Corn pa ny Preferred Professional Insurance Company
Countersigned By d-
Print Date: 10/1/2018