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2019/01/01 Habitat for Humanity Inland Valley Certificate of Liability Insurance CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `•� 12/13/2018 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. NAio a-�--- ----- FAX —�--- - -- Insurance Brokers of California, Inc. LIC#0726293 Arc No: 1255 Battery Street#450 A DRIESS: San Francisco CA 94111 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:NonProfits'United Workers'Compensation Group INSURED NONPUNI-01 INSURERB:Safety National Casualty Corporation_ 15105 Habitat for Humanity Inland Valley -------- --- - ----j---- - - 27475 Ynez Road#390 INSURERC: Temecula,CA 92591 INSURERD: 1 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:1990717765 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. ----------------------------------------- LTR i TYPE OF INSURANCE ADDL,SUBR POLICY EFF 1 POLICY EXP - lNqD WVD POLICY NUMBER ! MM/DD/YYYY i MM/DD/YYYY LIMITS �COMMERCIAL GENERAL LIABILITY —1 LEACH OCCURRENCE $ —�—I CLAIMS-MADE [ OCCUR j DAMAGE TC RENTS PREMISES jEa occurrence) $ City of Menifee MED EXP(Any one person $ City Clerk PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ POLICY JEo I , LOC DEC 2 2018 PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO Received _(Ea accident)— _ I BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB J OCCUR I I EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE j AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION NPU-WCG 001-2019 111,2019 1/1/2020 IX I PER —��OTH- AND EMPLOYERS'LIABILITY STAT R UTE ANYPROPRIETOR/PARTNER+EXECUTIVE Y f N I--- — OFFICERiMEMBEREXCLUDED? N/A E.L.EACH ACCIDENT $500,000 (Mandatory In NH)If yes.describe under E.L.DISEASE.EA EMPLOYEE $500,000 — --- DESCRIPTION OF OPERATIONS below j E.L.DISEASE-POLICY LIMIT $500,000 B iExcessWokers'Comp SP4059671 1/1/2019 1/1/2020 Llmit Per Occurence Statutory E.L.Per Occ&Agg 2,000,000 XS of 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached II more space Is required) CDBG Grant CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Menifee ACCORDANCE WITH THE POLICY PROVISIONS. 29714 Haun Road Menifee CA 92586 AU�,HORIZEDREPRESENTATIVE I VV ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 2 of 2 3313 Arthur J. Gallagher&Co. Insurance Brokers of CA., Inc. 1255 Battery Street#450 San Francisco, CA 94111 3313 1 MB 0.421 3313 ��'I.II.II��'��IIII""II.III'�I'I'�Il�t"��I"I�IIIII111�1��'I'I CITY OF MENIFEE 29714 HAUN RD MENIFEE, CA 92586-6540 1 of 2 3313