2020/01/01 Habitat for Humanity Inland Valley Certificate of Liability Insurance (3)DATE (MMIDDNYYY)
� CERTIFICATE OF LIABILITY INSURANCE
12/1612019
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
Arthur J. Gallagher & Co. PHONE FAX
Insurance Brokers of California, Inc. LIC# 0726293 A'c "
1255 Battery Street #450 oRs:
San Francisco CA 94111 1 INSURERS) AFFORDING COVERAGE NAIC p
INSURER A: NonProfits' United Workers' Compensation Group
INSURED NONPUNI-01 INSURER B : Great American E&S Insurance Company 37532
Habitat for Humanity Inland Valley
27475 Ynez Road #390 INSURERC: Safety National Casualty Corporation 15105
Temecula, CA 92591 INSURERD:
INSURER E :
INSURER F :
COVERAGES r.FRTIFI( ATF NI1MRFR•A;-00171n7 R1=V1A1nN NIIMRFR-
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,
ILTRNS TYPE OF INSURANCE ADT7L�UBRI POLICY NUMBER MM01DD/YYYY 1poL1 DNYYY LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
CLAIMS -MADE 17 OCCUR
F.
DAMAGE TO RENTED
EM,r?_E S t9AMnwQ)
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
---i PRO- ' 1.
POLICY U JECT LOC
PRODUCTS - COMP/OP AGG
$
$
OTHEIII:
AUTOMOBILE LIABILITY
NGLE LIMIT
$
ANY AUTO
BODILY INJURY (Per person)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
5
UMBRELLA LIAR OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR CLAIMS -MADE
DED F7 RETENTIONS
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNERIEXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
NIA
NPU-WCG 001-2020
1/112020
111/2021
X STATUTE FJ3
E.L. EACH ACCIDENT
EL DISEASE - EA EMPLOYEE
$ 500,000
$ 600,000
II as, describe under
DESCRIPTION OF OPERATIONS below
EL. DISEASE- POLICY LIMIT
$ 500.000
B
C
XSWC - Buffer Layer
XSWC
12032019-00
SP4061660
1/11202/1
1/1/2020
111/2021
11112021
X$ of $500.000
XS of $750.000
XS of S750-000
250,060 (EL & WC)
2,000,000 (EL)
Statutory (WC)
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
CDBG Grant
CERTIFICATE HOLDER CANCELLATION
CITY OF MENIFEE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
FINANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Menifee DEC 2015 29714 Haun Road ORIZEDREPRESENTATIVE
Menifee CA 92586 r
RECEIVED
m 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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