2020/04/06 Debi McCluskey Companies, Inc. Certificate of Liability InsuranceDocuSign Envelope ID: E8BCOF28-CB38-432B-8D6A-9OB61853A62D
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CERTIFICATE OF LIABILITY
DATE (MM/DD/YYYY)
INSURANCE
08/06/2020
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELY
AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF I NSU RANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),
AUTHORIZED REPRESENTATIVE OR PRODUCER, ANDTHE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL I NSU RED provisions or be endorsed. If SUBROGATION IS WAIVED, subjectto 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
NAME: MATTHEW WELTY
CLIENT BENEFIT INSURANCE SERVICES
10769 WOODSIDE AVE, STE 103
PHONE
(A/C, NO, EXT): 858-569-1000
FAX
(A/C, NO): 888-795-2247
SANTEE, CA 92071
E-MAIL
ADDRESS. MATT@WELTYINSURANCEGROUP.COM
INSURER(S)AFFORDING COVERAGE
NAIL#
INSURED
INSURERA: The Hartford Accident & Indemnity Ins CO
22357
DE81 MCClUSKEY COMPANIES INC
INSURER B: The Hartford Underwriters Insurance Company
30104
INSURERC:
DBA DMC
INSURER D:
1499 POMONA RD STE C
INSURERE:
CORONA, CA 92882
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
REOUIREMENT TERM OR CONDITION OFANY 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.
INSR
LTR
TYPE OF INSURANCE
ADDTL
INSD
SUBR
WVD
POLICY NUMBER
POLICYEFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE OCCUR
DAMAGETORENTE❑
PREMISES (Ea Occurrence)
$ 1,000,000
MED EXP (Anyone person)
$ 10,000
PERSONAL&ADVINJURY
$ 1,000,000
A
Y
72SBWB86458
08/01/2020
08/01/2021
GEN'L AGGRFGATF HMITAPPLiES PER:
X POLICY PROJECT ❑ LOC
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS-COMP/OPAGG
$ 2,000,000
OTHER:
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Fa accident)
$ 1,000,000
X ANYAUTO
BO DI LY I NJU RY (Per person)
$
A
OWNEDAUTOS SCHEDULED
ON YAUTOS
72UEGHC2851
08/01/2020
08/01/2021
BODILYINJURY(Peraccident)
$
PROPERTY DAMAGE
(Peraccidert)
$
HIRFDAUTOS X NON -OWNED
X ONLY AUTOS ONLY
X
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
A
EXCESSLIAB
CLAIMS -MADE
72SBWBB6458
08/01/2020
08/01/2021
DEQ 1 1 RETENTION $ 10,000
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
PER
STATUTE
OTHER
$
B
ANY PROPRIETOR/PARTNER/ YIN
EXECUTIVE OFFICER/MEMBER
EXCLUDED? (Mandatory in NH) Y
N/A
72WEGAD3KHU
04/06/2020
04/06/2021
E.LFACHACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE 1,000,000
Ifyes, describe under DESCRIPTION OF
OPERATIONS below
E.L.OISEASE- POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CITY OF MENIFEE: FY18119 AS -NEEDED DOCUMENT SCANNING, INDEXING, AND QUALITY CONTROL SERVICES (BUILDING & SAFETY
DEPARTMENT). THE FOLLOWING ARE LISTED AS ADDITIONAL INSURED WITH RESPECT TO THE GENERAL LIABILITY; CITY OF MENIFEE AND ITS
OFFICERS, EMPLOYEES, AGENTS, AND AUTHORIZED VOLUNTEERS, COVERAGE IS PRIMARY AND NON-CONTRIBUTORY,
CERTIFICATE HOLDER CANCELLATION
CITY OF MENIFEE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
29844 HAUN RAOD
DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
MENIFEE, CA 92586
AUTHORIZED REPRESENTATIVE
ACORD 2S (2016/03)
31-1769 1 1-15
w - - y —
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