2021/05/17 CivicPlus, LLCPage 1 of 1
DATE (MM/DD YYYY)
. 1%. � CERTIFICATE OF LIABILITY INSURANCE 05/18/2021
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 ONTACT Willie Towers Watson Certificate Center
NAMF,:
Willis Towers Watson Northeast, Inc. PHONE 1-877-945-7378 AIC N 1-B88-467-2376
c/o 26 Century Blvd
P.O. Box 305191 �PRES8• certificatesevillis.com
Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAIC#
INSURER A: Great Northern Insurance Company 20303
INSURED INSURERB: Federal Insurance Company 20281
CivicPluo, LLC
302 S 4th Street, Suite 500 INSURERC: WestchesterSurplusLinea Insurance Compan 10172
Manhattan, KS 66502 I INSURER D :
COVITRAC.FS r 1=RTIFlrATF FJIISARRR• W20947649 RMnclnnl nil IaeQco-
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.
LR TYPE OF INSURANCE ADDL 5UBRj pOL[CY EFF POLSCY EXP
POLICY NUMBER MIWLI Y YY At YYYY LIMITS
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
CLAIMS -MADE ! "' f OCCUR
_PREMISES_(�noccurrcarcm)�
$ 2,000,000
A
MED EXP (Any one ersan)
$ 10,000
Y 3602-53-12 05/17/2021
05/17/2022
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000 000
GENT AGGREGATE LIMIT APPLIES PER:
X 1 L. JEo i J
f
POLICY LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
I OTHER:
$
AUTOMOBILE
—
LIABILITY
QWBINED SINGLE LIMIT
[ a acadenll
$ 1, 000, 000
$
X
ANY AUTO
BODILY INJURY (Per person)
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
1
7358-87-92
05/17/2021
05/17/2022
BODILY INJURY (PeraccldenPq
$
HIRED NON -OWNED
P1I 1ITYOAMAAGE
$
AUTOS ONLY AUTOS ONLY
_&r. accident)
$
UMBRELLA LIAB OCCUR
EACHOCCURRENCE
$
AGGREGATE
$
EXCESS`LIAO 0LAIMS_MADE
jLI
- — —
-
DED i 1 nETENTiON$
$
WORKERS COMPENSATION
X OTH-
AND EMPLOYERS' LIABILITY Y / N
TAT
E.L. EACH ACCIDENT
$ 1,000,000
B
ANYPROPRIETOR.!PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
NIA
( 22 ) 7174-92-49 05/17/2021
05/17/2022
-
(Mandatory In NH)
E.L. DISEASE • EA EMPLOYEE
$ 1,000,00a
II yyes, descfiW under
E.L. DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS below
$ 1,000,000
C
F15611984 002
04/30/2021
04/30/2022
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached II more space is required)
RE: Menifee, CA
City of Menifee, its officers, agents and employees are included as Additional Insureds as respects to General
Liability.
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
AUTHORIZED REPRESENTATIVE
29844 Haun Road
Menifee, CA 92586
01988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
sR ID: 21110780 BATCH: 2098802
2 of 2 3566
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At -'C JOL), CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
�r 05/20/2021
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: 11 the certificate holder Is an ADDITIONAL INSURED, the policy(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 CONTACT Willis Towers Watson Certificate Center
NAME:
Willis Towers Watson Northeast, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378
c/o 26 Century Blvd A!C a:
P.O. Box 305191 ¢02 esertilicatea@willia.com
Nashville, TN 372305191 USA INSURE $ AFFORDING COVERAGE j MAICB
INSURERA: Great Northern Insurance Company 20303
INSURED CivicPlus, LLC iNSURERB: Federal Insurance Company 20281
302 S 4th Street, Suite 500 INSURER C: Westchester Surplus Linea Insurance Compare 10172
Manhattan, KS 66502 1INSURER D:
INSURER F
COVERAGES r..PRTIFIr ATIP NIIIIARFR• W20959918 DC119CI^?0 A111RAIMIrD.
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 CLAIMS.
POLICY
kLTH TYPEOFINSURANCE hnPLSL18R POLICYNUMB[R MARMD(YPLICYYYY I MMfOO Yyl LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
CLAIMS MADE D7X OCCUR
PREMISES n _ rr __
$ 2,000,000
A
MED EXP (Any one arson)
$ 10,000
PERSONAL& ADV INJURY
$ 1,000,000
Y 3602-53-12 05/17/2021
05/17/2022
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
X I POLICY El FI
_
JEI° LOC
PRODUCT$ - COMP/OP AGO
$ 2,000, 000
$
OTHER:
AUTOMOBILE
LIABILITY
Ili,., 3kNE0SINGLE LIMIT
..irk-a...a5�?d4��)i. --
$ 1,000,000
X
ANY AUTO
BODILY INJURY (Per person)
$
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
7358-87-92 05/17/2021
05/17/2022
BODILY INJURY (Per accident)
$
HIRED NON -OWNED
PROPS YDANIAOE
$
AUTOS ONLY AUTOS ONLY
Lper poueng—
$
UMBRELLA LIAB OCCUR
Id
EACH OCCURRENCE
$
EXCESS LIAR CLAIMS -MADE
AGGREGATE
$
F_1
-
DED RETENTION$
X
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
TAT 7 ER
E.L. EACH ACCIDENT $ 1,000,00a
B ANYPROPRIETOR/PARTNERIEXECUTIVE
OFFICER/MEMBEREXCLUDED? N/A
( 22 ) 7174-92-49 05/17/2021
05/17/2022
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE$ 1,000,000
If as. describe under
DESCRIPTION OF OPERATIONS bekow
E.L. DISEASE • POLICY LIMIT $ 1,000,000
C Cyber Liability P15611984 002 04/30/2021 04/30/2022 Each Claim/Aggregate $5,000,000
Technology Errors and Omissions .Aggregate/ dad $5,000,000/$25,00
I
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
This Voids and Replaces Previously Issued Certificate Dated 05/18/2021 WITH ID: 1420947649.
RE: Menifee, CA
City of Menifee, its officers, agents and employees are included as Additional Insureds as respects to General
Liability.
G0MPil.r LLH 1 MAN
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
AUTHORIZED REPRESENTATIVE
29844 Haun Road
Menifee, CA 92586
® 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
sR %D: 21120155 sATCH: 2101683
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