2018/03/09 Social Work Action Group Certficiate of Liability InsuranceA� o CERTIFICATE OF LIABILITY INSURANCE DATE
;MMIDD$ )
1/13/1
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
PRODUCER
'
NAME::
PHONE
888-202-3007
Hiscox Inc.
E-MAIL
ADDRESS:
contact@hiscox.
520 Madison
Avenue, 32nd Floor
INsuRErs(E
New York, NY
10022
INSURER A:
HIBCOx Insurar
Company
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
70200
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,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDLSUBR
INSR
Won
POLICY NUMBER
POLICY
MMIDDIYYYY)
EFF
POLICY EXP
flMMIDD/Y1'YY
LIMITS
GENERAL
LIABILITY
EACH OCCURRENCE
$
COMMERCIAL GENERAL LIABILITY
DAMAGE
PREMISES
TO RENTED
Ea occurrence
$
CLAIMS-MADE1:1 OCCUR
MED EXP(Any one person)
$
PERSONAL &ADV INJURY
$
GENERAL AGGREGATE
$
GENL
AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$
POLICY PEO LOC
I
F
1
$
AUTOMOBILE
LIABILITY
COMBINED
Ea accident)
SINGLE LIMIT
$
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
PeraccciOERd nDAMAGE
$
HIREDAUTOS AUTOSY�ED
$
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED
I
I RETENTIONS
1
$
WORKERS COMPENSATION
WC STATU-
OTH-
A
AND EMPLOYERS' LIABILITY
ANY PROPRIETOWPARTNERIEXECUTIVE YIN
OFFICER/MEMBER EXCLUDED? N
(Mandatory In NH)
N/A
UDC-0000141WCOD
03/09/18
03/09/19
IQBY
LIMITS
OR
E.L. EACH ACCIDENT
$ 110000000
E.L. DISEASE - EA EMPLOYE
$ 1,0001000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
$ 7,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mare space is required)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
29714 Haun Rd ACCORDANCE WITH THE POLICY PROVISIONS.
Menifee, CA 92586
AUTHORIZED REPRESENTATIVE / t
010/05) @ 1988-2010 ACORD CORPORATION, All rights reserved.
The ACORD name and logo are registered marks of ACORD