2020/07/01 Blackmore Co, LLC Certificate of Liability Insurance,4c Ro n� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/yYYY)
o7ro1/2020
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($).
PRODUC
ER I CONTACT Carrie Stubblefield CISR
G Parker Insurance Associates co'o r`�, t NAME:
James
PHONE (559) 222-7722 FAX,
Ne ; (559) 222-1724
IAJC. No License #0554959 'MAIL CarrieStubblefield@jgparker.com
_ ADDRESS:
P O BOX 3947 tNSURER S) AFFORDING COVERAGE NAIC #
Fresno
o_ INsuRERA: Evanston Insurance Company 35378
INSURED " INSURER e : Oregon Mutual Insurance Company 14907
Blackmore Co LLC INSURER C : XL Specialty Insurance Company 37885
Blackmore Equipment Co LLC INSURER D :
27840 Del Rio Rd INSURER E:
Temecula CA 92590 INSURERF:
COVERAGES rFRTIFIrOTF NIIMRFR• 20-21 GL BA IM LIMB l2=%1ICIf1kl k111111IR CD•
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.
INSR
LTR
TYPE OF INSURANCEWVD_POLICY
NUMBER
POLICY EFF
MM/DD/YYYY
POLICY XP
MMIDD/YYYY
LIMITS
x
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F OCCUR
EACHOCCURRENCE
$ 1,000,000
PREMISES (Ea occurrence)
$ 300,000
MED EXP (Anv one Derson)
$ 5,000
PERSONAL BADVINJURY
$ 1,000,000
A
MKLV5PBC002116
07/01/2020
07/01/2021
GEN'LAGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT 7 LOC
GENERAL AGGREGATE
$ 2,000,000
-PRODUCTS -COMP/OPAGG
$ 2,000,000
Per Project Aggregate
$ 10,000,000
OTHER;
AUTOMOBILE LIABILITY
GOMBINED SINGLE LIMIT
Ea accident)
$ 1,000,000
x ANYAUTO
BODILY INJURY (Per person)
$
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
CM0921413
07/01/2020
07/01/2021
BODILY INJURY (Per accident)
$
�I HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
H
PROPERTYDAMAGE
Peraccidanl
$
$
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 2,000,000
x4.ED
AGGREGATE
$ 2,000,000
A
EXCESSLIAB
CLAIMS -MADE
MKLV5EUL102601
07/01/2020
07/01/2021
I.
RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
N / A
PER OTH-
STATUTE ER
E L. EACH ACCIDENT
$
E. L. DISEASE - EA EMPLOYEE
$
(Mandatory in NH)
If yes, describe under
E L. DISEASE - POLICY LIMIT
$1,000 Deductible
$1,000 Deductible
$
$300,000
Per Schedule
DESCRIPTION OF OPERATIONS below
07/01/2020
07/01/2021
C
Rented/Leased Equipment
Scheduled Equipment
_
UM00089059MA20A
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
,,,r-mi Iri Ai r- nULLJCM CANCELLATION
City of Menifee
29714 Haun Rd
Menifee CA 92586
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD