2021/05/17 CivicPlus, LLC (3)Page 1 of 1
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
06/10/2021
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 cerllficate holder in lieu of such endorsement(s).
PRODUCER CONTACT Willis Towers Watson Certificate Center
Willis Towers Watson Northeast, Inc. PHONE NAME_ 1-877-945-7378 -CAI( 1-888-467-2378
c/o 26 Century Blvd A7C o:
P.O. Box 305191 E-DDR certificates®willis.com
Nashville, TN 372305191 USA INSURER( AFFDRDWGCOVERAGE NAIC#
INSURER A: Great Northern Insurance Company 20303
INSURED INSURER B: Federal Insurance Company 20281
CivicPlus, LLC
302 S 4th Street, Suite 500 INSURERC: Westchester Surplus Linea Insurance Compan 10172
Manhattan, KS 66502 INSURERD
INSURER E :
INSURER F :
COVERAGES rFRTiFl('ATF NiIMRFR• W21237816 OrWOZInu KitlAnn1~n.
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,
INSR ADDL SUBR
LTR TYPEOFtN3URANCE IN52. WYD
POLICY EFF POLICY EXP
POLICY NUMBER IMMIDDrYYYY) iMM13D'YYYv LIMITS
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
I$ 2,000,000
CLAIMS -MADE X j OCCUR
PREMISES_ Ea__ rr _: o
$ 2,000,000
A
MED EXP (Any one person]
$ 10,000
Y
3602-53-12 05/17/2021
05/17/2022 PERSONAL & ADV INJURY
$ 1,000,000
GENT AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
X
u JEo
POLIGY LJ LOC
PRODUCTS-COMP/OP AGG
$ 2,000,000
OTHER:
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
(Ea.ddPJi_ _
$ 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
PRO DAMAGE
AUTOS ONLY AUTOS ONLY
_LPeracciden�
.$
$
UMBRELLA LIAB H OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB CLAIMS -MADE
DED RETENTION$
$
WORKERS COMPENSATION
X
AND EMPLOYERS, LIABILITY Y /
ATUTE FA
$ 1,000,000
B ANYPROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED?
N / A
( 22 ) 7174-92-49 05/17/2021 05/17/2022 •
(Mandatory In NH)
E.L. DISEASE • EA EMPLOYEE
$ 1,000,000
II yes, describe under
DESCRIPTION OF OPERATIONS below
I E.L. DISEASE - POLICY LIMIT
$ 1,000,000
C 'Cyber Liability
F15611984 002 04/30/2021 04/30/2022 Each Claim/Aggregate
$5,000,000
Technology Errors and Omissions
Aggregate/ dad
$5,000,000/$25,00
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD
101, Additional Remarks Schedule, may be attached It more space Is required)
This: Voids and Replaces Previously Issued Certificate Dated 05/20/2021 WITH ID: W20959918.
RE: Menifee, CA
City of Menifee, its officers, agents and
employees are included as Additional Insureds as respects to
General
Liability.
L;LH i IFIGATE HOLDER CANCELLATION
City of Menifee
29844 Haun Road
Menifee, CA 92586
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
01988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
SR ID: 21197135 BATcx: 2125567
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C H U B B m Liability Insurance
Endorsement
Policy Period
Effective Date
Policy Number
Insured
Name of Company
Date Issued
This Endorsement applies to the following forms:
GENERAL LIABILITY
Who Is An Insured
Additional Insured -
Scheduled Person
Or Organization
Liability Insurance
MAY 17, 2021 TO MAY 17, 2022
MAY 17, 2021
3602-53-12 TPA
CIVICPLUS, LLC
GREAT NORTHERN INSURANCE COMPANY
JUNE 4, 2021
Under Who Is An Insured, the following provision is added.
Persons or organizations shown in the Schedule are niwre&; but they are insureds only if you are
obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by
this policy.
However, the person or organization is an hmred only:
• if and then only to the extent the person or organization is described in the Schedule;
• to the extent such contract or agreement requires the person or organization to be afforded
status as an ineared;
• for activities that did not occur, in whole or in part, before the execution of the contract or
agreement; and
• with respect to damages, loss, cost or expense for injury or daEnage to which this insurance
applies.
No person or organization is an insured under this provision:
that is more specifically identified under any other provision of the Who Is An Insured
section (regardless of any li rnitai ion applicable thereto).
• with respect to any assumption of liability (of another person or organization) by them in a
contract or agreement This limitation does not apply to the liability for damages, loss, cost or
expense for injury or damage, to which this insurance applies, that the person or organization
would have in the absence of such contract or agreement
Additional Insured - Scheduled Person Or Organization
Form W-02-2367 (Rev. 5-07) Endorsement
continued
Page 1
CHuaam
Liablifty Endorsement
(continued)
Under Conditions, the following provision is added to the condition titled Other Insurance.
Conditions
Other Insurance — If you are obligated, pursuant to a contract or aMenxnt, to provide the person or organization
Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case
Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person
Person Or Organization or organization,
Schedule
PERSONS OR ORGANIZATIONS THAT YOU ARE OBLIGATED, PURSUANT
TO A CONTRACT OR AGREEMENT, TO PROVIDE WITH SUCH INSURANCE
AS IS AFFORDED BY THIS POLICY.
All other germs and conditions remain unchanged.
Authorized Representative
Liability Insurance AddlBonai Insured- Scheduled Peron OrOrganizatlon
Form 6a02-2367 (Rev, 5-07) Endorsement
Intpage
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