2021/01/01 Disability Access Consultants, LLCAcor��. CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
03/10/2021
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 Cell Provo
NAME:
AssuredPartners of Minnesota LLC
IC,PHONE (651) 644-7200 FnAX
I C Nc , (651) 644-9137
EMAIL ceil.provo@assuredpartners.com
ADDRESS:
2361 Hwy 36 W
INSURERS AFFORDING COVERAGE
NAIC it
INSURERA: Continental Cas Co
20443
St. Paul MN 55113
INSURED
INSURER B : American Casualty Co Reading
20427
Disability Access Consultants, LLC
INSURERC: Transportation Ins Co
20494
2862 Olive Highway
INSURER D : The Hartford
00914
INSURER E : QBE Insurance Company
39217
Oroville CA 95965
INSURERF:
COVERAGES CERTIFICATE NUMBER: 21/22 Master21/22 Prof 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.
LTR
TYPE OF INSURANCE
iNSD
WVD
POLICY NUMBER
MMIDDIYYYY
MM DD//YYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
CLAIMS -MADE � OCCUR
A A N
PREMISES Ea occurrence
$ 1,000,000
MED EXP fAny oneperson)
$ 10,000
PERSONAL &ADV INJURY
$ 2,000,000
A
Y
B6020052587
01/01/2021
01/01/2022
GGEEN'LAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 4,000,000
POLICY ❑ jECr LOC
PRODUCTS-COMP/OPAGG
$ 4,000,000
Employee Benefits
$ 1,000,000
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
ac 'dent
$ 1,000,000
BODILY INJURY (Per person)
$
x
ANYAUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
Y
6020004782
01/01/2021
01/01/2022
BODILY INJURY (Per accident)
$
HIRED NON -OWNED
PROPERTY DAMAGE
Per aoGden!
$
AUTOS ONLY AUTOS ONLY
Medical payments
$ 5,000
^,
UMBRELLALIAB
OCCUR
EACH OCCURRENCE
$ 5,000,000
C
EXCESS LIAB
CLAIMS -MADE
Y
B6020052637
01/01/2021
01/01/2022
AGGREGATE
$ 5,000,000
DIED I RETENTION 5 0
$
WORKERS COMPENSATION
PER OTH-
AND EMPLOYERS' LIABILITY Y / N
STATUTE ER
E.L.EACH ACCIDENT
$ 1,000,000
D
ANY PROPRIETOR/PARTNER/EXECUTIVE
NIA
41WBAC5W3P
01/08/2021
01/08/2022
E. D LISEASE - EA EMPLOYEE
$ 1,000,000
OFFICER/MEMBEREXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICYLWT
$ 1,000,000
Professional Liability
E
130000005
03/13/2021
03113/2022
Limit
$5,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of Menifee ADA Self Evaluation and Transition Plan are listed as additional insured
U t K I ILA I t HULLJt-.K CANCLLLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Menifee and its officers, employees, agents ACCORDANCE WITH THE POLICY PROVISIONS.
29714 Haun Road
AUTHORIZED REPRESENTATIVE (�
Menifee CA 92586 A ,
69
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD