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2019/04/01 Innovative Document Solutions Certificate of Liability Insurance DocuSign Envelope ID:B45AF343-990B-40D1-AFCD-2DE8C77FB97D DATE(MM/DD/YYYY) Aco CERTIFICATE OF LIABILITY INSURANCE ��, o2/os/2o2o THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 Tina Acevedo NAME: Bulen&Associates Insurance Services A No Ext: (951)674-0675 C.No): (951)674-2375 40750 Symphony Park Ln. E-AIL tinaa@bulen.com Suite 101 INSURER(S)AFFORDING COVERAGE NAIC# Murrieta CA 92562 INSURER A: Nationwide Mutual Insurance Co 23787 INSURED INSURER B: Preferred Employers Ins.Co. 10900 Innovative Document Solutions INSURER C: 26855 Jefferson Ave Ste F INSURER D: Suite F INSURER E: Murrieta CA 92562-8966 INSURER F: COVERAGES CERTIFICATE NUMBER: CL202632726 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 INSD WVD POLICY NUMBER MM/ EFF Do MMIDPOLDY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx_] OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 5,000 A Y Y ACP7851746108 01/24/2020 01/24/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO ❑LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT OTHER: Additional Insured $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED ACP7851746108 01/24/2020 01/24/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Uninsured motorist $ 3,500 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DIED I I RETENTION$ $ WORKERS COMPENSATION SPER OTH- AND EMPLOYERS'LIABILITY TATUTE ER YIN 1,000,000 ANY CERIMEMB R/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBEREXCLUDED? � NIA WKN146463-8 04/01/2019 04/01/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Menifee,its officers,agents and employees named as additionally insured and the City of Menifee listed as the named as Certificate Holder in regards to Workers Compensation*30-day notice of cancellation,except for 10-day notice of cancellation for nonpayment of premium. 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. 29844 Haun Road AUTHORIZED REPRESENTATIVE Menifee CA 92586 �� �1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) ) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:B45AF343-990B-40D1-AFCD-2DE8C77FB97D BUSINESSOWNERS PB 04 4711 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - VENDORS This endorsement modifies insurance provided under the following: PREMIER BUSINESSOWNERS LIABILITY COVERAGE FORM A. The following is added to Section II. WHO IS AN e. Any failure to make such inspections, INSURED: adjustments,tests or servicing as the Any person or organization(referred to vendor has agreed to make or normally throughout this endorsement as vendor)shown in undertakes to make in the usual course the Schedule of this endorsement is also an of business,in connection with the insured, but only with respect to"bodily injury"or distribution or sale of the products; "property damage"arising out of"your products" f. Demonstration,installation, servicing or shown in the Schedule of this endorsement which repair operations,except such are distributed or sold in the regular course of the operations performed at the vendor's vendor's business,subject to the following premises in connection with the sale of additional exclusions: the product; or However: g. Products which, after distribution or sale 1. The insurance afforded to such vendor only by you, have been labeled or relabeled applies to the extent permitted by law; and or used as a container, part or 2. If coverage provided to the vendor is ingredient of any other thing or required by a contract or agreement,the substance by or for the vendor. insurance afforded to such vendor will not h. Bodily injury or property damage be broader than that which you are required arising out of the sole negligence of the by the contract or agreement to provide for vendor for its own acts or omissions or such vendor. those of its employees or anyone else B.With respect to the insurance afforded to these acting on its behalf. vendors,the following additional exclusions HOWEVER, this exclusion does not apply: apply to: 1. The insurance afforded the vendor, including (1) The exceptions contained in Sub- any duty we have to defend "suits", does not Paragraphs d. or f.; or apply to: (2) Such inspections,adjustments,tests a. "Bodily injury"or"property damage"for or servicing as the vendor has which the vendor is obligated to pay agreed to make or normally damages by reason of the assumption undertakes to make in the usual of liability in a contract or agreement. course of business,in connection This exclusion does not apply to liability with the distribution or sale of the for damages that the vendor would have products. in the absence of the contract or 2. This insurance,including any duty we have to agreement; defend "suits", does not apply to any insured b. Any express warranty unauthorized by person or organization from whom you have you; acquired such products,or any ingredient, c. Any physical or chemical change in the part or container entering into, accompanying product made intentionally by the or containing such products. vendor; C. With respect to the insurance afforded to these d. Repackaging,unless unpacked solely additional insureds,the following is added to for the purpose of inspection, Section III. LIMITS OF INSURANCE AND demonstration,testing or the DEDUCTIBLE: substitution of parts under instructions If coverage provided to the vendor is from the manufacturer,and then required by a contract or agreement,the most we repackaged in the original container; will pay on behalf of the vendor is the amount of insurance: PB 04 47 11 14 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 1 Of 2 ACP BPR 7851746108 INSURED COPY 47 24826 DocuSign Envelope ID:B45AF343-990B-40D1-AFCD-2DE8C77FB97D PB 04 47 11 14 1. Required by the contract or agreement;or This endorsement shall not increase the 2. Available under the applicable Limits Of applicable Limits Of Insurance shown in the Insurance shown in the Declarations; Declarations. whichever is less. All terms and conditions of this policy apply unless modified by this endorsement. SCHEDULE Your Products: COPIERS Name Of Person Or Organization (Vendor): CITY OD MENIFEE AND ITS OFFICERS, EMPLOYEES, AGENTS, AND AUTHORIZED VOLUNTEERS 29714 HUAN ROAD MENIFEE CA 925860000 Page 2 Of 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PB 04 47 11 14 ACP BPR 7851746108 INSURED COPY 47 24827 DocuSign Envelope ID:B45AF343-990B-40D1-AFCD-2DE8C77FB97D expstat.rpt Expenditure Status Report Page: 1 07/08/2020 9:33AM Periods: 0 through 14 City of Menifee 7/1/2020 through 6/30/2021 100 General Fund Adjusted Year-to-date Year-to-date Prct Account Number Appropriation Expenditures Expenditures Encumbrances Balance Used 100-4911 Menifee Police Department 100-4911-52502 Leased Equipment 20,000.00 0.00 0.00 0.00 20,000.00 0.00 Total General Fund 20,000.00 0.00 0.00 0.00 20,000.00 0.00 Grand Total 20,000.00 0.00 0.00 0.00 20,000.00 0.00 Page: 1 DocuSign Envelope ID:B45AF343-990B-40D1-AFCD-2DE8C77FB97D expstat.rpt Expenditure Status Report Page: 1 07/08/2020 9:35AM Periods: 0 through 14 City of Menifee 7/1/2020 through 6/30/2021 100 General Fund Adjusted Year-to-date Year-to-date Prct Account Number Appropriation Expenditures Expenditures Encumbrances Balance Used 100-4221 Non Departmental 100-4221-52502 Leased Equipment 162,400.00 0.00 0.00 0.00 162,400.00 0.00 Total General Fund 162,400.00 0.00 0.00 0.00 162,400.00 0.00 Grand Total 162,400.00 0.00 0.00 0.00 162,400.00 0.00 Page: 1