2017/04/24 Stache, Inc. Certificate of Liability Insurance (3)CERTIFICATE OF LIABILITY INSURANCE =(;)4120/2018
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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 13ETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(ies) must 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
ceriificate holder in lieu of such endorsement(s).
PRODUCER 714 935 1100 714 935 1101 LtlNE: Bill Wallace
The Wallace Insurance Agency PHONE p3,; 714 935 1100 FAIc e:714 935 1101 _
1820 W Orangewood Ave #210 E-MAIL bill billwallacea enc com
Orange, CA 92868 PRODUCER
r_t izinuca In r.
INSURED
Stache, Inc.
DBA M&M Group
16872 Bolsa Chica St., Suite 204
Huntington Beach, CA 92649
CnVFRAnFA r_=0Trclrnre ell taanro.
COVERAGE I Npur,#
B: State Compensation Insurance Fund
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 WVTH 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,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILYR TYPE OF INSURANCE ADOLISUMB POLICYNUMBER MMILIi7gY Ph4f0,11LIDL 1D<P LIMITS
A
GENERAL LIABILITY
CAMIIIERCIALGFJRRI. LIABILITY
CLAIMS -MADE Z OCCUR
EACH OCCURRENCE
PR MISES lEa cccurrencat
S �QQ�
MED EXP An oneporson)
S
VBA514982
06/16/2017
06/16/2018
PER s ADV INJURY
S
_
S p
GENERAL AGGREGATE
GEN'LAUGREGATELIMITAPPLIESPER;
1/1 POUCY PRO- LOG
PRODUCTS -COMPIOPAGG
_
S
$
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ee accdent)
$
-
BODILY INJURY (Per person)
ALL OWNED AUTOS
S
BODILY INJURY (Per accident)
S
SCHEDULED AUTOS
PROPERTY DAMAGE
(Per eWdent)
S
HIRED AUTOS
NON -OWNED AUTOS
$
S
UMBRELLA LIAB L
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
S
AGGREGATE
E
DEDUCTIBLE
S
RETENTION S
- _
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/ EXCLUDE
OFFICER/MEMBEREXCLUDED? �
NIA
9135328
04/24/2017
04/24/2018
/ WC STATU• I OTH•
Y
E.L. EACH ACCIDENT
S 1,000 000
E.L. DISEASE - EA EMPLOYE
$1 ,000,000 _
S1,000,000
(Mandatory In NH)
If yea. descd6n under
DESCRIPTION OF OPERATIONS below
- POLICY LIMIT
:::,,tLISEASE
DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD 101, Additional RernarAe Schedule, U more a paco Is required)
Additional Insured: City of Menifee
City of Menifee
29714 Haun Rd
Menifee, CA 92576
4AIZVLLLJ�
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
U 19UH-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
COVINGTON SPECIALTY INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Additional Insured Person(s) or Organization(s):
Any person or organization whom you are required to add as an additional insured on this policy under a written
contract which is currently in effect or becoming effective during the term of the policy and executed prior to the
"bodily injury', "property damage", or "personal and advertising injury".
A. Section II —Who Is An Insured is amended to include as an additional insured the person(s) or organization(s)
shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and
advertising injury" caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insured(s) designated above.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted bylaw; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance
afforded to such additional insured will not be broader than that which you are required by the contract or
agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to "bodily injury" or "property damage" occurring after:
(1) All work, including materials, parts or equipment furnished in connection with such work, on the project
(other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s)
at the site of the covered operations has been completed; or
(2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by
any person or organization other than another contractor or subcontractor engaged in performing
operations for a principal as a part of the same project.
C. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III —
Limits of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on
behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
All other terms and conditions of this policy remain unchanged.
Policy No.: VBA514982
GBA 105003 0614