2021/01/01 Habitat for Humanity Inland Valley Certificate of Liability InsuranceArthur J. Gallagher & Co. Insurance Brokers of CA., Inc.
1160 Battery Street
Suite 360
San Francisco, CA 94111
6192 1 MB 0.436 6192
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CITY OF MENIFEE
29844 HAUN RD
MENIFEE, CA 92586-6539
We are providing you with a Certificate of Insurance confirming our client's coverage.
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e-mail in the future. Or, do you no longer require a certificate of insurance for our client? Please contact us at
COilpdateM,yEmajL00_A_JQ,com and provide the following information for processing:
1. Confirmation that a certificate of insurance is no longer required; or
2. E-mail address to send future certificates of insurance in lieu of U.S. Mail delivery
3. Insured Code found in the Insured section on the enclosed certificate. An example of this code is XXXXXX-01
4. This Certificate Number: 715646928
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ACoka"'R CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYYy
12/8/2020
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(s).
PRODUCER CONTACT
Arthur J. Gallagher & Co. PHONE
Insurance Brokers of California, Inc. LIC# 0726293
1255 Batter Street #450 ADW
y _�1DpRESS.
San Francisco CA 94111 INSURERS AFFORDING COVERAGE NAIC #
_ I
NSURER Nonprofits' United Workers' Compensation Grou
INSURED NONPUNI-01Safety National Casual Cor oration 15105
Habitat for Humanity Inland Valley
27475 Ynez Road #390 Response Indemni Com an of California 10970
Temecula, CA 92591
INSURER F :
COVERAGES CERTIFICATE NUMBER-71rridrg2R RFVICIAN NIIMRI=R-
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.
N�SR TYPE OF INSURANCE ADDL,SUER, PBLICCY EFFF P01 IC❑YY El[p
LTR i POLICY NUMBER IN �Y YY• MNtrDDrYYYY LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
CLAIMS -MADE DOCCUR
PAEMISES.IF.a15-
pocurrance) __
$
$
MED EXP (Any one person)
PERSONAL & ADV INJURY
$
GEN'LAGGREGATE LIMIT APPLIES PER:
POLICY1 JECT u PRO II II LOG
�l
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
$
$
$
OTHER,
AUTOMOBILE LIABILITY
ANY AUTO _
OWNED SCHEDULED
AUTOS ONLY AUTOS
COMBINEOSINGL LIMIT
_(En Are l)._
BODILY INJURY (Per person)
$
—
$
BODILY INJURY (Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PRO P> RTYpAMAGE
-(Per 0 r_rdan()
$ f
$
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
$
$
EXCESS LIAR CLAIMS -MADE
AGGREGATE
-$—--
__DE
D RETENTION$
A WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED?
NIA
NPU-WCG 001-2021
11V20211
111/2022
iX PER
STATUTE EA
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEE
$ 500,000
(Mandatory In NH)
If yes, describe under
E.L. DISEASE POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS below
C XSWC - Buffer Layer
B XSWC
ABL1000013.00
SP4064079
1/112021
1/112021
111/2022
1/1/2022
XS of $500.000
XS or $750.000
XS of $750-000
$,250,000 (EL & WC)
$2,000,000 (EL)
Statutory (WC)
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Menifee
29844 Haun Road AU 1101111ED REPRESENTATIVE
Menifee CA 92586
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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