2020/09/01 Commercial Transportation Serv Certificate of Liability InsuranceCOMM-35 QP DO
'4�QRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDm'YY)
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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 ri hts to the certificate hoider in lieu of such endorsements .
PRODUCER 626-795-9921 CROPCT
Supple -Merrill & Driscoll Inc. PHONE 62$-T95.9921 FAX 626-577-6656
Insurance Agents and Brokers _LC, No, Eat . AIC, No
P. O. Box 2408 E. 1hasm
Pasadena, CA 91102
Supple -Merrill & Driscoll Inc. IN ER AFFQRDINQ CQVERAGE NAIC
INSURERA:Arch Specialty Insurance Co 21199
INSURED INSURER B : State Compensation Ins. Fund
Commercial Transportation Sery
Din❑ Perugtno INSURER C: Evanston Insurance Company
702 S. Treanor Avenue
San Dimas, CA 91773 INSURER D :
INSURER F :
COVERAGES CE i E B I N BE
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,
INSR LTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FX] OCCUR
PLI0000133-01
09/01/2020
09/01/2021
EACH OCCURRENCE
S 1,000,000
DAMAGE TO RENTED
100,00
MED EXP (Any oneperson)
10,000
PERSONAL 8 ADV INJURY
$ 1,000,000
ENL AGGREa&rELIMITAPPLIESPER:
X POLICY Ppef LOC
n'rHl n
GENERAL A RE T
2,000,000
PRODUCTS - COMPIOP AGG
$ 2,000,000
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
yy Ep
AMS ONLY AUTOS OH4Y
COMBINED SINGLE LIMIT
BODILY INJURY JPerPerson)$
BODILY INJURY Per accident
PerOacEcRt nl AGE
$
C
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
IEZXS3029019
09/18/2020
09/01/2021
EACH OCCURRENCE
2,000,000
X
AGGREGATE
2,000,000
DIED I I RETENTION$
Follow
form GL
B
AND EMPLOYERS' LIABILITY COMPENSATION
ANYPROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yyes, descril:o under
DE SCRIPT[QNOFOPFRATI N below
N / A
1650779
09/0112020
09/01/2021
X PSTATUTE ER OTH-
E.L. EACH ACCIDENT
1,000,000
E.L. D! EASE - EA EMPLOYEE
1,000+000
I - POLICY LIMIT
1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Proof of insurance.
CITYOME
City Of Menifee
Ms. Wendy Welch
29714 Huan 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
ACORD 25 (2016103) C 1988-2016 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD