Loading...
2019/04/01 Habitat for Humanity Inland Valley Certificate of Liability Insurance arnKr� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 08/16/2019 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 CONTACT NAME: Lockton Affinity, LLC Lockton Affinity, LLC _� o Wt•BBB-553-9002 jA�,Ny.913-652-3967 E-MAIL P. O. Box B73401 ADDRESS:_ Kansas City, MO 64187-3401 INSURERS AFFORDING COVERAGE NAIC# INSURER A:Ace American Insurance Co. .22667 INSURED INSURER B:Ace Pro erty and Casualty .20699 Habitat for Humanity Inland Valley INSURER C: 27475 Ynez Rd #390 INSURERD: Temecula, CA 92591-4612 INSURERE_ INSURER F. COVERAGES CERTIFICATE 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 Y 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. ILTR TYPE OF INSURANCE NSRAD POLICY NUMBER MMIOD MI41LICYEFF L1 LIMY LIMITS A X COMMERCIAL GENERAL LIABILITY y GL1064456-19 04/01/2019 •04/01/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR 171WAS TO-REM rrercee Ely $1,000,000 MED EXP(Any one person) $0 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY j LOC PRODUCTS-COMP/OP AGG s2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acclden ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS AUTO-OWNED pROp nDAMAGE $ B X UMBRELLA LIAB NX OCCUR UM1064456-19 04/01/2019 04/01/2020 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED I X I RETENTION$10 000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ NIA F.L.EACH ACCIDENT $ (Mandatory in NH) E-L,DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Menifee, its officers, agents and employees are named as additionally insured per written contract in regards to general liability. CERTIFICATE HOLDER CANCELLATION 1064456 City of Menifee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 29844 Haun Road AUTHORIZ EPR NTATIV�� .E Menifee, CA 92586 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 31777270 1064456 DATE CERTIFICATE OF WORKERS' COMPENSATION COVERAGE Aug 15,2019 PRODUCER NonProfits'United Workers'Compensation Group THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY 610 Fulton Avenue,Suite 200 AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. Sacramento,CA 95825 Phone:(916)868-6231 THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE Fax:(916)880-5251 COVERAGE AFFORDED BY THE POLICIES BELOW. Arthur J.Gallagher&Co Insurance Brokers of California,Inc 1255 Battery Street#450 INSURERS AFFORDING COVERAGE San Francisco,CA 94111 INSURED INSURER A: NonProfits' United Workers' Compensation Group Habitat for Humanity Inland Valley INSURER B: Safety National Casualty Corp [NAIC#15105] 27475 Ynez Road#390 Temecula, CA 92591 INSURER C: INSURER D: INSURER E: COVERAGES This Certificate is not intended to specify all endorsements,coverages,terms,conditions and exclusions of the policies shown. THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE AFFILIATE MEMBER 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 COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY INSR TYPE OF COVERAGE POLICY NUMBER POLICY EFFECTIVE DATE EXPIRATION LIMITS DATE GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ CLAIMS MADE OCCUR MED EXPENSE(Any one person) $ GENERAL AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ POLICY I PROJECT I LOC GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Each accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) $ X S PER OTHER TATUTE WORKERS'COMPENSATION A AND NPU-WCG001-2019 1/1/19 1/1/20 F-L EACH ACCIDENT $500,000 EMPLOYERS LIABILITY E,L.DISEASE-EA EMPLOYEE $500,000 E,L DISEASE-COVERAGE LIMIT $500,000 OTHER Limit Per Occurrence-Statutory B EXCESS Workers'Compensation SP 4059671 1/1/19 1/1/20 EL Per Occ&Agg $2,000,000 xs of$500,000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL/PROVISIONS CERTIFICATE HOLDER CANCELLATION NPUWCG-HHIV-015 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Menifee 29844 Haun Road. Menifee, CA 92586 ' Based on ACORD 25(2014101) r l DATE(MMIDD/YYYY) AC o"R" CERTIFICATE OF LIABILITY INSURANCE 64 � 8/15/2019 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 CONTACT Arthur J. Gallagher&Co NAME-- PHONE FAX Insurance Brokers of CA, Inc. LIC#0726293 LAIC.No.Ext1,E-MAIL —�- 1255 Battery Street, Suite 450 ADDRESS: San Francisco CA 94111 INSURERS AFFORDING COVERAGE NAIC# INSURERA:NonProfits'United Vehicle Ins Pool INSURED INSURER B: Habitat for Humnaity Inland Valley(2170) 41615 Winchester Road, Suite 214 INSURERC: Temecula, CA 92590 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1239768329 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR NSR TYPE OF INSURANCE 'AI?DLSVBR RUSE) vdvn POLICYNUMBER MM/ppY�l MPOLICY D Y EXP D/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR pII F Fa $ MED EXP(Any one person) $ PERSONAL BADVINJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY jEC LOC PRODUCTS-COMP/OP AGG $ OTHER: $ A AUTOMOBILE LIABILITY Y NPU10o0-19 7/1/2019 7/1/2020 COMBINED?INGLELIM $2.000,000 E�aOrJ n X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PR AMA $ AUTOS ONLY AUTOS ONLY Per accideN UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DIED I I RETENTION$ $ WORKERS COMPENSATION PER H- AND EMPLOYERS'LIABILITY Y/N STATUTE I I R ANYPROPRIETOR/PARTNER/EXECUTIVE E.L-EACH ACCIDENT $ OFFICE R/M EMBER EXCLUDED7 ❑ NIA (Mandatory in NH) E,L,DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E-L,DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Any Auto means any covered auto under the NPU Vehicle Insurance Program. ADDITIONAL INSURED(S):City of Menifee,its officers,agents and employees CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Meniee 29844 Haun Road AV HORIZEDRE.PRESENTATIVE Menifee CA 92586 T ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NoNPRoip UNITED COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NonProfits' United Vehicle Insurance Pool Automobile Liability Coverage ADDITIONAL COVERED PARTY ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The "Who is an Insured"section of your Automobile Liability Insurance is changed by adding the following: Who is covered includes any person or organization from whom you have leased an auto, from which you have received funding for your operations, or for who you provide services. These persons or organization are protected, if they require to be named, and you agree to name them, as an additional insured, if indicated on the attached Certificate of Coverage, but only with respect to liability arising out of the ownership, use, maintenance, loading or unloading of a covered auto. Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named on the certificate, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. Premium Payments: Those persons or organizations are not responsible for paying premiums for your coverage. Insured: As shown on the Certificate of Insurance attached. Policy Number: NPU1000-19 Effective Date: July 1, 2019 to July 1, 2020(or otherwise indicated) Authorized Representative: NPU-VIP 2019-2020 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 42 POLICY NUMBER POLICY CHANGES COMPANY G24962842 007 EFFECTIVE ACE American Insurance Company 08/16/2019 NAMED INSURED AUTHORIZED REPRESENTATIVE Habitat For Humanity Purchasing Group Inc. Lockton Affinity, LLC COVERAGE PARTS AFFECTED Commercial General Liability Coverage Part CHANGES Endorsement MS-19249 (02/13)-Who Is An Insured and Primary Non Contributory Insurance—Scheduled Person Or Organization is added per the attached in favor of: City of Menifee, its officers, agents and employees 29844 Haun Road Menifee, CA 92586 Authorized Representative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 ❑ Copyright, ISO Commercial Risk Services, Inc., 1983 AFFILIATE# 1064456 WHO IS AN INSURED, and PRIMARY, NON CONTRIBUTORY INSURANCE — SCHEDULED PERSON OR ORGANIZATION Named Insured Endorsement Number Habitat For Humanity Purchasing Group, Inc. 191 Policy Symbol Policy Number Policy Period Effective Date of Endorsement G24962842 007 4/1/2019 to 4/1/2020 08/16/2019 Issued By(Name of Insurance Company) ACE American Insurance Company Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM EMPLOYEE BENEFITS LIABILITY COVERAGE FORM STOP GAP-EMPLOYERS LIABILITY COVERAGE FORM Who Is An Insured Additional Insured-Scheduled Person or Organization Persons or organizations shown in the schedule are"insureds" but they are"insureds"only if you are obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by this policy. However, the person or organization is an "insured"only: • If an then only to the extent the person or organization is described in the Schedule; • To the extent such contract or agreement requires the person or organization to be afforded status as an "insured"; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies No person or organization is an "insured" under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). • With respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. Authorized Representative MS-19249(0213) Page 1 of 2 AFFILIATE# 1064456 Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions: Other Insurance—Primary, Non Contributory Insurance—Scheduled Person or Organization If you are obligated, pursuant to a contract or agreement, to provide the person or organization shown in the Schedule with primary insurance such as is afforded by this policy, then in such case this insurance is primary and we will not seek contribution from insurance available to such person or organization. Schedule: City of Menifee, its officers, agents and employees 29844 Haun Road Menifee, CA 92586 Authorized Representative MS-19249(0213) Page 2 of 2 AFFILIATE# 1064456