2018/11/01 G&H Moving & Storage Company Certificate of Liability Insurance Ate-0 G&HMOVI-02 STI
CERTIFICATE OF LIABILITY INSURANCE DATEinUiooiYYYYI
19
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: M the cartiflcaro holder is aei ADDITIONAL INSURED,the policy(
must have ADDITIONAL INSURED Provisions or to endorsed-
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain POlfckm may FNWNe an endorsement. A statement on
this certiflcals does not confer rt hts to the certificate holder in lieu of such endorsements.
PRODUCER C ACT
TranaPFatection Service Company —-- - -- -- ---
—One Premier Drive ]Arc.No,Erg;(800)325." FAX 855 472-1290 Fenton,MO 63026
W6 rans.Protection@vanlfner.com
_ INSURERISI AFFORDING COVERAGE _ r1I_-
_
1RSURE6 INSURER A:Vanliner Insurance CD �21172
'
INSURER B: _
G&H Moving a Storage Company I aER c
1450 Mesa View Drive HEI -
Hemet,CA 92 543-1 539 INSURER D: -
11-4SURER E;
- INSURER i —
COVERAGE CERTIFI TE NUMBER: 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 LIMIT$SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
wsR -- --TYPE OF 015URANCE ADOLIsllegr POLICY NIateER I POLICY riF PDILiCY E1aP--- ---- `
A X COMWACIALOENERALLIAeiUTY I
LRI
CLAIMS UAOE . E �5E±9ct_ 1.000,000
x
— - occuR IPKTOM10200 111112018 111112010 D`UAI'ORENTED 100.000
°REJaSES Ma or&LlmsssI_. f _
.LIED FX?.fMx me�elsan�_ f}f_ 5,000
- T PEa9awi 4AOV rLURy I f 1,000,000
GEWL AGGREGATE LIMIT AP S PIER: l AOaxEGn7E ,f 2,000,000
X roucr LOC I —
OTHER PROD1LCTS Q9W)QPAGI J 2,000.000,
4 AUTOMOetLELLL&LtTY — �— cGMBIIfDSMGLELeer 1,000,000
X_ANYAUTO cOmBiasYL� -- _
_ MRT3488000 11/1/2018 11/112019 1,000,000 OWNED SCHEpIp.�p ..OBE LY IfUURY Y
AUTOS ONLY �µgJTµO.pg�, dwp AU%ONLY AUi08 SF[Y xO61ERTYUpR.,Y�IAFa+_� - _-
A X UNISAII LALl" X OCCUR - EACH NCE 21000.000
_ E]fCEaSLNa LCaAIKIISALTOE� UMT341115M 11I1Iz018 111112A19 f -il -
DED XIRETENrlovs 10,D00 AGGGATE. _ - - 2,000,OfN1
A WORKERS COMPENSATION -
ANOEMPLOYERf'WAa1LRY X PER pTTti
YIM ___STATUTE,__E$ 1,D00,000
y�nx�r PROartIE7B0E1LCARrNER'E%ECV7[VE � WCT34aa002 2!1l2018 271l2019
(M+Fa�tlitnry 11MM/R E%CLUDED7 I N l NfA EL EACH ACCIDENT _--�
dace under E.L.DI§EA,SE-EA EM1KiDYEL3_ 1.D00.000
5 RIPTg=OPERATONSE.L DI -POLICYA WhitCarg LegCGT3486000 11/1/201 tl 11f112019 Any Truck 200,000q Cargo �GT34a8000 111Mr2011!111M12019 Any Occur 250,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VI ICLE4{ACORD 101.Addab W RII So,. —he aRae4wd It nlan 21 N nqutred Chy of Menffee and its officers, employees.agents,and authorized volunteers 20714 Heun Road, MenHee CA 925�6 are included as additional Insureds per
attached form-
CERTIFICATE C112 _ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
29714 Haun Road, ACCORDANCE WITH THE POLICY PROVISIONS.
Menifee CA 92586.
AUTHORIZED REMSIRITATIVE
ACORD 25(2016103J &r 1988-2015 ACORD CORPORATION, All rights reserved-
The ACORD name and logo are TeglStered marks of ACORD
AGENCY CUSTOMER ID:GLHMOVI.02 _ STLCCL
.4coRo `�". '
11114 � ADDITIONAL REMARKS SCHEDULE Page 1 of 1
FPAGE
NFMED IN MED
ervice Company G a H Mwlnnpp a Storage company
-—--- .1l59 tNeaa Vrsw DrM
Harriet,CA 9251315M
-
wuccooe
SEE P 1 EFPRiCn oAW E 1
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM 18 A SCHEDULE TO ACORD FORM.
FORMNUMBER: ACORD25 FORMTITLE:gmj!l atiorL_ahUityinsurance
Hired
Included at S100,000 ACV Less Deductible
Hired/Non Owned Auto comprehensive Deductible$100
HiredlNon Owned Auto Collision Deductible$1000
ACORD 10112008)01) (b 2008 ACORD CORPORATION. All rights reserved,
The ACORD name and logo Are registered marks of ACORD
POLICY NUMBER: PKT0000102 00 COMMERCIAL GENERAL LIABILITY
VLCG2026 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following.
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Addttional Insured Person(s)Or Organization(s)
In this endorsement,"you"and"your"refer to the Named Insured shown in the declarations.
Any person or organization where required under written contract or agreement with the Named Insured
and not addressed by another Additional Insured endorsement more pertinent to the relationship.When
agreed under written contract between Named Insured and the Additional Insured,or other party in order
to fulfill a written contract between the Named Insured and this Additional Insured.(i)coverage for the
benefit of the Additional Insured shall be primary to and non-contributing with any maintained
by the Additional Insured for its own benefit;and/or(ii)subrogation against the Additional
Insured is waived
Coverage is only afforded to the additional insured as respect to liability arising out of the
Named Insured's sole negligence and only for an"occurrence"arising out of the named
insured's
"Work"and not for any other liability faced by the additional insured.
All other policy language remains unchanged.
Information required to complete this Schedule,if not shown above,will be shown in the Declarations.
Section 11-Who Is An Insured is amended to in-
clude as an additional insured the person(s)or organi-
zations)shown in the Schedule.but only with respect
to liability for"bodily injury", "property damage"or
"personal and advertising injury"caused, in whole or
in part,by your acts or omissions or the acts or omis-
sions of those acting on your behalf
A-In the performance of your ongoing operations;or
S. In connection with your premises owned by or
rented to you
VLCG2026 07 04 Includes copyrighted material of Insurance Services Office,Inc Page t of 1 ❑
With its permissbn