2021/01/01 Local Government Commission Certificate of Liability Insurance—^"M*l LOCAGOV-01 MHA
CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDTrrM
1/1112021
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 pollcy(les) 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 kRWCT
krroya Insurance Services - LA PHONE FAR
2900 W Broadway (AIc, No, ExQ: (323) 550-7900 {Arc, Nc):{323) 256-0B00
Las Angeles, CA 90041 bVEC4s: meaganhipprroyoins.COm
INSURED
Local Government Commission
980 9th Street, Suite 1700
Sacramento, CA 95814
COVERAGES
CERTIFICATE NUMBER:
INSURER F :
S AFFORDING COVERAGE I NAIC f
Insurance Alliance of California
Oak River Insurance Com
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
L
TYPE OF INSURANCE
ADflL
INSD
WVD
D
POLICY NUMBER
POLICY EFF
MA)D
POLICY EXP
MMiD
LIMBS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE T OCCUR
X
:202132800
1M/2021
1/1/2022
EACH OCCURRENCE
1,000,000
PR'A%E7oR=
500,0 00
$ 20,000
MED EXP fAny oneperson)
PERSONAL &ADV INJURY
1,006,000
GEN'L AGGREGATE L IM IT APPLIES PER:
GENERAL AGGREGATE
$ 3,000,000
X POLICY ❑ Tef LOC
PRODUCTS- COMP/OP AGG
3,000,000
OTHER:
A
AUTOMOBILE
LIABILITY
CEO e81�H SINGLE LIMIT
$ 1,000,000
BODILY INJURY Per. arson
$
AUTO
X
02132800
IM/2021
111/2022
BODILY INJURY Per accident
OWNED SCHEDULED
AUTOS ONLY AUUTTOpSy
IANY
X
�OaPRTY MAGE
$
AUTOS ONLY X AUTOS 0
A
X
UMBRELLA LIAR
X
OCCUR
EACH OCCURRENCE
1'000'000
AGGREGATE
$ I,600,000
EXCESSLtl1B
CLAIMS -MADE
02132800-UMB
11112021
111126.
X
DIED I I RETENTION$
$
B
'WORKERSCOMPENSATION
,AND EMPLOYERS' LIABILITY
ANYPROPRIErOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBEREXCLUDED?
(Mandatory In NH)
NIA
LOWC218335
11112021
1/1/2622
X PEA T ORH
E.L. EACH ACCIDENT
$ 1'000'000
E.L. DISEASE -EA EMPLOYEE
$ ' 0'00
Ifyes, describe under
DESCRIPTION OF OP IONS belowE.L.
DISEASE -PO ICY LIMIT
1000000
' '
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addltlonal Remark@ Schedule, maybe attached If more space Is required)
Professional Liability
Landmark American Insurance Company
Policy #LH R842068
Effective: 1 / 1/21-1 /1 /22
$2,000,000 Each Claim
$2.000,000 Aggregate Limit
$1,000 Deductible -Each Claim
SEE ATTACHED ACORD 101
City of Menlfee
29714 Haun Road
Sun City, CA 92586
ACORD 25 (2016103)
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
O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo am registered marks of ACORD
AGENCY CUSTOMER ID: LOCAGOV-01
LOC #: 1
ACC]R"
ADDITIONAL REMARKS SCHEDULE
AGENCY
Arroyo Insurance Services - LA
POLICY NUMBER
SEE PAGE 1
CARRIER
PEE PAGE 1
ADDITIONAL REMARKS
NAMED INSURED
Local Government Commission
980 9th Street Suite 1700
Sacramento, U 95814
NAIC CODE
5EE P 1 I EFFECTNE DATE:
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 FORM TITLE: Ceniftcate of Liability Insurance
Description of Operations/Locations/Vehicles:
Directors and Officers Liability
Arch Insurance Company
Policy #NFP0133662-01
Effective 111121-111122
$1,000,000 Each Claim
$5,000 Each Claim Deductible
Third Party Crime
The Hanover Insurance Company
Policy #BD3-D997018-00
Effecitve 7129119-7129122
$35,000 Each Claim
$5,000 Deductible -Each Claim
Workers Compensation, Employers Liability -Oregon
Continental Divide Insurance Company
Policy #LOWC218303
$1,000,000 Bodily Injury by Accident, Each Accident
$1,000,000 Bodily Injury by Disease, Each Employee
$1,000,000 Bodily Injury by Disease, Policy Limit
MHAHS
Page 1 of 1
10 Days Notice to Certificate Holder applies except for Non -Payment of Premium, which is 10 days. RE: City of Menifee Active
ransportation Plan. City of Menifee and its officers, employees, agents, and authorized volunteers are included as additional
isured including primary, non-contributory wording as respects General Liability coverage; Additional insured is included as
aspects Auto Liability Coverage; only as per attached endorsements.
ACORD 101 (2008/01) O 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
NONPROFITS
INSURANCE
ALLIANCE OF CALIFORNIA
A Head for Insurance. A Heart for Nonprofits.
POLICY NUMBER: 2021-32800
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED
PRIMARY AND NON-CONTRIBUTORY
ENDORSEMENT FOR PUBLIC ENTITIES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
A. Section II — WHO IS AN INSURED is amended to include:
4. Any public entity as an additional insured, and the officers, officials, employees, agents and/or volunteers
of that public entity, as applicable, who may be named in the Schedule above, when you have agreed in a
written contract or written agreement presently in effect or becoming effective during the term of this policy,
that such public entity and/or its officers, officials, employees, agents and/or volunteers be added as an
additional insured(s) on your policy, but only with respect to liability for "bodily injury", "property damage" or
"personal and advertising injury" caused, in whole or in part, by:
a. Your negligent acts or omissions; or
b. The negligent acts or omissions of those acting on your behalf;
in the performance of your ongoing operations.
No such public entity or individual is an additional insured for liability arising out of the sole negligence by
that public entity or its designated individuals. The additional insured status will not be afforded with
respect to liability arising out of or related to your activities as a real estate manager for that person or
organization.
B. Section III — LIMITS OF INSURANCE is amended to include:
8. The limits of insurance applicable to the public entity and applicable individuals identified as an additional
insured(s) pursuant to Provision A.4. above, are those specified in the written contract between you and
that public entity, or the limits available under this policy, whichever are less. These limits are part of and
not in addition to the limits of insurance under this policy.
C. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of
SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following:
4. Other Insurance
a. Primary Insurance
This insurance is primary if you have agreed in a written contract or written agreement:
(1) That this insurance be primary. If other insurance is also primary, we will share with all that
other insurance as described in c. below; or
NIAC-E61 0219 Page 1 of 2
�. ., •• v.
NONPROFITS
INSURANCE
�W ALLIANCE OF CALIFORNIA
A Head for Insurance. A Heart for Nonprofits
POLICY NUMBER: 2021-32800
(2) The coverage afforded by this insurance is primary and non-contributory with the additional
insured(s)' own insurance.
Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been
added as an additional insured or to other insurance described in paragraph b. below.
b. Excess Insurance
This insurance is excess over:
1. Any of the other insurance, whether primary, excess, contingent or on any other basis:
(a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for
'Your work;
(b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily
occupied by you with permission of the owner;
(c) That is insurance purchased by you to cover your liability as a tenant for "property damage"
to premises temporarily occupied by you with permission of the owner; or
(d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent
not subject to Exclusion g. of SECTION I — COVERAGE A — BODILY INJURY AND
PROPERTY DAMAGE.
(e) Any other insurance available to an additional insured(s) under this Endorsement covering
liability for damages which are subject to this endorsement and for which the additional
insured(s) has been added as an additional insured by that other insurance.
(1) When this insurance is excess, we will have no duty under Coverages A or B to defend the
additional insured(s) against any "suit" if any other insurer has a duty to defend the additional
insured(s) against that "suit". If no other insurer defends, we will undertake to do so, but we will
be entitled to the additional insured(s)' rights against all those other insurers.
(2) When this insurance is excess over other insurance, we will pay only our share of the amount of
the loss, if any, that exceeds the sum of:
(a) The total amount that all such other insurance would pay for the loss in the absence of this
insurance; and
(b) The total of all deductible and self -insured amounts under all that other insurance.
(3) We will share the remaining loss, if any, with any other insurance that is not described in this
Excess Insurance provision and was not bought specifically to apply in excess of the Limits of
Insurance shown in the Declarations of this Coverage Part.
c. Methods of Sharing
If all of the other insurance available to the additional insured(s) permits contribution by equal
shares, we will follow this method also. Under this approach each insurer contributes equal
amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever
comes first.
If any other the other insurance available to the additional insured(s) does not permit contribution by
equal shares, we will contribute by limits. Under this method, each insurer's share is based on the
ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers.
NIAC-E61 02 19 Page 2 of 2
POLICY NUMBER: 2021-32800 COMMERCIAL GENERAL LIABILITY
Named Insured: Local Government Commission CG 20 10 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s)
Location(s) Of Covered Operations
Any person or organization that you are required to
All insured premises and operations.
add as an additional insured on this policy, under a
written contract or agreement currently in effect, or
becoming effective during the term of this policy. The
additional insured status will not be afforded with
respect to liability arising out of or related to your
activities as a real estate manager for that person or
organization.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
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) at the location(s)
designated above.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted
by law; 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
location of the covered operations has been
completed; or
CG 2010 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 2
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.
CG 20 10 0413 0 Insurance Services Office, Inc., 2012 Page 2 of 2
..a .ti,. �:.. r. i
NONPROFITS
INSURANCE
ALLIANCE OF CALIFORNIA
A Mead jor Insurance. A Heartfor Nonprofits,
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE ONLY
In consideration of the premium charged, it is understood and agreed that the following is added as an additional
insured:
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
But only as respects a legally enforceable contractual agreement with the Named Insured and only for liability arising
out of the Named Insured's negligence and only for occurrences of coverages not otherwise excluded in the policy to
which this endorsement applies.
It is further understood and agreed that irrespective of the number of entities named as insureds under this policy, in
no event shall the company's limits of liability exceed the occurrence or aggregate limits as applicable by policy
definition or endorsement.
NIAC Al 03 91 Page 1 of 1
,❑NONPROFITS
INSURANCE
ALLIANCE OF CALIFORNIA
A !lead for Insurance. A Heart for Nonprofits.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE ONLY
In consideration of the premium charged, it is understood and agreed that the following is added as an additional
insured:
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
But only as respects a legally enforceable contractual agreement with the Named Insured and only for liability arising
out of the Named Insured's negligence and only for occurrences of coverages not otherwise excluded in the policy to
which this endorsement applies.
It is further understood and agreed that irrespective of the number of entities named as insureds under this policy, in
no event shall the comparr/s limits of liability exceed the occurrence or aggregate limits as applicable by policy
definition or endorsement.
Such insurance as is afforded by this endorsement for the additional insured shall apply as primary insurance. Any
other insurance maintained by the additional insured or its officers and employees shall be excess and non-
contributing with the insurance afforded by this endorsement.
NIAC Al 0413 Page 1 of 1
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