2019/04/01 Innovative Document Solutions Certificate of Liability Insurance (5)ACOR" CERTIFICATE OF LIABILITY INSURANCE
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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
E- AIL tinaa@bulen.com
40750 Symphony Park Ln.
INSURER(S) AFFORDING COVERAGE
NAIC #
Suite 101
INSURER A: Nationwide Mutual Insurance Co
23787
Murrieta CA 92562
INSURED
INSURER B : Preferred Employers Ins. Co.
10900
INSURER C :
Innovative Document Solutions
INSURER D :
26855 Jefferson Ave Ste F
INSURER E :
Suite F
INSURER F :
Murrieta CA 92562-8966
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
PERSONAL & ADV INJURY
$ 1,000,000
A
Y
Y
ACP7851746108
01/24/2020
01/24/2021
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
X POLICY PRO ❑ LOC
JECT
PRODUCTS -COMP/OPAGG
$ 2,000,000
Additional Insured
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
ACP7851746108
01/24/2020
01/24/2021
BODILY INJURY (Per accident)
$
PROPERTYDAMAGE
Per accident
$
Uninsured motorist
$ 3,500
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
HCLAIMS-MADE
AGGREGATE
$
EXCESS LIAB
DIED I I RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBEREXCLUDED?
(Mandatory in NH)
NIA
WKN146463-8
04/01/2019
04/01/2020
SPER OTH-
TATUTE ER
E.L. EACH ACCIDENT
1,000,000
$
E.L. DISEASE- EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
1,000,000
$
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.
ER
City of Menifee
29844 Haun Road
Menifee
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
CA 92586�G%��_
ACORD 25 (2016103)
@ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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
INSURED:
Any person or organization (referred to
throughout this endorsement as vendor) shown in
the Schedule of this endorsement is also an
insured, but only with respect to "bodily injury" or
"property damage" arising out of "your products"
shown in the Schedule of this endorsement which
are distributed or sold in the regular course of the
vendor's business, subject to the following
additional exclusions:
However:
1. The insurance afforded to such vendor only
applies to the extent permitted by law; and
2. If coverage provided to the vendor is
required by a contract or agreement, the
insurance afforded to such vendor will not
be broader than that which you are required
by the contract or agreement to provide for
such vendor.
B. With respect to the insurance afforded to these
vendors, the following additional exclusions
apply:
1. The insurance afforded the vendor, including
any duty we have to defend "suits", does not
apply to:
a. "Bodily injury" or "property damage" for
which the vendor is obligated to pay
damages by reason of the assumption
of liability in a contract or agreement.
This exclusion does not apply to liability
for damages that the vendor would have
in the absence of the contract or
agreement;
b. Any express warranty unauthorized by
you;
c. Any physical or chemical change in the
product made intentionally by the
vendor;
d. Repackaging, unless unpacked solely
for the purpose of inspection,
demonstration, testing or the
substitution of parts under instructions
from the manufacturer, and then
repackaged in the original container;
e. Any failure to make such inspections,
adjustments, tests or servicing as the
vendor has agreed to make or normally
undertakes to make in the usual course
of business, in connection with the
distribution or sale of the products;
f. Demonstration, installation, servicing or
repair operations, except such
operations performed at the vendor's
premises in connection with the sale of
the product; or
g. Products which, after distribution or sale
by you, have been labeled or relabeled
or used as a container, part or
ingredient of any other thing or
substance by or for the vendor.
h. "Bodily injury" or "property damage"
arising out of the sole negligence of the
vendor for its own acts or omissions or
those of its employees or anyone else
acting on its behalf.
HOWEVER, this exclusion does not
apply to:
(1) The exceptions contained in Sub -
Paragraphs d. or f.; or
(2) Such inspections, adjustments, tests
or servicing as the vendor has
agreed to make or normally
undertakes to make in the usual
course of business, in connection
with the distribution or sale of the
products.
2. This insurance, including any duty we have to
defend "suits", does not apply to any insured
person or organization from whom you have
acquired such products, or any ingredient,
part or container entering into, accompanying
or containing such products.
C. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III. LIMITS OF INSURANCE AND
DEDUCTIBLE:
If coverage provided to the vendor is
required by a contract or agreement, the most we
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
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