2017/10/01 City of Menifee Certificate of Insurance or Self-Insurance �1y OF
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BRENDA DIEDERICHS,
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Human Resources Director
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CERTIFICATE OF INSURANCE OR SELF-INSURANCE
THIS IS TO CERTIFY THAT THE SELF-INSURED COVERAGE LISTED BELOW IS CURRENTLY IN EFFECT 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 THIS CERTIFICATE DESCRIBED HEREIN IS SUBJECT TO ALL THE
TERMS,EXCLUSIONS,AND CONDITIONS OF SUCH CERTIFICATE.
COVERAGE PROVIDED IS SUBJECT TO THE TERMS AND CONDITIONS OF THE EXCESS POLICY.
Type of Coverage Company and Policy Period Limits of Liability
Policv Number Bodily Injury/Property Damage
Commercial 07/01/2018 $1,000,000 Combined
General Liability Self-Insured Single Limit Per
X]
Including Vehicle to Occurrence with No
Liability 07/01/2019 Aggregate Limit
Workers' 07/01/2018 $2,000,000 Combined Single
F X
Compensation Permissibly Limit Per Occurrence with
&Employers' Self-Insured to No Aggregate Limit
Liability
07/01/2019
Medical Malpractice 10/01/2017
(Professional Self-Insured F-1
Liability) to
10/01/2018
The County of Riverside certifies that the above self-insured program is in effect as respect to: City of Menifee is
working on setting up a Active Transportation Program (ATP) agreement with Riverside County.
Certificate Holder Cancellation
City of Menifee In the event of cancellation of the self-insurance program or policy
Attn:Margarita Cornejo designated below, it is the intent of the County of Riverside to mail
29714 Haun Road :30 days'prior notice thereof.
Menifee,CA 92586
This certificate is not valid unless signed by an authorized representative of the County of Riverside, Risk Management Division
Date: September 20, 2018 J�ff�a� L. titer '
cc: Teresa Diaz, Contracts and Grants Analyst @ RUHS— PH Procurement
®P.O.Box 1210,Riverside,CA 92502 t,,(951)955,MQ jC.;q(951)955-4027 ®riskmgmt.rc-hr.com