2020/09/28 Dennis Janda, Inc. (9)DATE (MMIDDmYY)
Ac�Rn CERTIFICATE OF LIABILITY INSURANCE
06/28/2021
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 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
Strachota Insurance en NAME; lielanee Pettis
A4 PHONE
27710 Jefferson Ave., Ste. Inc. . 100 {p,IG.,HA.kf[t}• (951) 676-2229 F c No:(951) 676-7391
Temecula CA 92590
INSURED
Dennis Janda Inc.
42164 Remington Avenue
Temecula CA 92590
E-MAIL
AOORE5Si malonea@strachota.com
INSURERJS3 AFFORDING COVERAGE NAIC M
INSURER A: Colony Insurance C 39993
INSURER B: California Automobile Ins Co. 38342
INSURER C: Ohio Security Insurance ComipaU 24082
INSURER D: Landmark American Insurance Co. 33138
INSURERE:
:
INSURFR F
rnVFRAnF:_Q rFRTIPIrATr- MIIMRFR• re + Tn 115149 RFVlS[6N NUMRFR:
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.
TNSR LTR TYPE OF INSURANCE POLICY NUMBER MM OW' EiF MUMD " LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE X OCCUR
y
103GLOO2584402
09/28/2020
09/28/2021
A A
p Eaoccunence
$ 100,000
MED EXP (Any one n)
$ excluded
PERSONAL &ADV INJURY
$ 1,000,000
L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2 000 000
PRODUCTS - COMP/OP AGG
S 2 000000
POLICY JECT LOC
�'OTHEft
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
..c�9GCldnnlr ...
$ 1• 000r 000
--- -- —
B
ANY AUTO
Y
BA040000055531
11/08/2020
11/08/2021
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
X ALL OWNED X SCHEDULED
AUTOS AUTOS
X NON -OWNED
X
PROPERTYUAMAGE
fpor nod
$
HIRED AUTOS AUTOS
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DIED I I RETENTION S
$
C
WORKERS COMPENSATION
XWS56173896
07/03/2021
07/03/2022
X STA STATUTEER
AND EMPLOYERS' LIABILITY Y i' N
E I- Ell';,; A=O.E. i'
1,000,000
ANY PROi'RIETORJPARTNERILXECUTNE
/M
OFFICEREMBER EXCLUDED? u
NIA
1,000,000
(Mandatory in NH)
E. L. DISEASE - EA EMPLOYEE
$
E L DISEASE - POLICY LIMIT
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
D Professional Liability
T-ERS40112
05/08/2021
05/00/2022Each
Claim $ 1,000,000
Aggregate $ 2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate Bolder is an Additional Insured with respects to the General Liability per the attached
CG20100413 endorsement. Also an Additional Insured with respects to the Commercial Automobile per
the attached MCAS5100017CA endorsement.
f r_DTIGIr•ATC t-tni n5r:17 rAfJrr-I 1 ATInNI
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
29714 Baun Rd.-
Menifee CA 92586
(O 1988-ZU14 AGUKLI GUKVUKA I IUIV. AH rlgnts reservcu.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: 103 GL 0025844-02
COMMERCIAL GENERAL LIABILITY
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) I Location(s) Of Covered Operations
All persons or organizations as required by written I As designated in written contract with the Named
contract with the Named Insured Insured
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
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.
CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2
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.
Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 04 13
TI11.5 ENDORSEM: NT CHANGES Tf� . POLICY, PLEASE REAP IT CAREFU-01
Business Auto Broadening Endorsement
This endorsement modifies Insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
I. NEWLY ACQUIRED OR FORMED ENTITY (BROAD FORM NAMED:INSURED)
II. EMPLOYEES AS INSUREDS
III. AUTOMATIC. ADDITIONAL INSURED
IV. EMPLOYEE HIRED AUTO LIABILITY
V. SUPPLEMENTARY PAYMENTS.
VI. FELLOW I MPLOYE,E COVERAGE
VII. ADDITIONAL TRANSPORTATION EXPENSE
VIII. HIRED AUTO PHYSICAL DAMAGE :COVERAGE
IX. ACCIDENTAL AIRBAG DEPLOYMENT COVERAGE
X. LOAN/LEASE GAP COVERAGE
XI. GLASS 'REPAIR - DEDUCTIBLE WAIVER
XII. TWO OR MORE DEDUCTIBLES
XIII. AMENDED DUTIES IN EVENT OF -ACCIDENT, CLAIM, SUIT OR LOSS
XIV, WAIVER OF SUBROGATION
XV. UNINTENTIONAL ERROR, OMISSION, OR FAILURE TO DISCLOSE HAZARDS
X.V-L EMPLOYEE HIRED AUTO PHYSICAL DAMAGE
XVII. PRIMARY AND NONCONTRIBUTORY IF REQUIRED BY CONTRACT
XVIII. HIRED AUTO COVERAGE TERRITORY
XIX. BODILY INJURY REDEFINED TO INCLUDE RESULTANT MENTAL ANGUISH
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MCABS100817-CA Includes copyrighted materlal of Insurance Services Office, Inc., with Its Permisslon Page-1 of 6
VI, FELLOW EMPLOYEE COVERAGE:
SECTION II — LIAB I LITY COVL RAG E, g. Exclusions, 5. Fellow Employee
This exclusion does not alaply If you have workers' compensation Insurance In -force covering all of
your "employees". Coverage Is excess. over any other collectible: Insurance.
Vn. ADDITIONAL TRANSPORTATION EXPEhfSE
SECTION ill -PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions, a. Transportation
Expenses, Is replaced with the following;
We will pay up to $50 per day to a maximum of $1000 for temporary transportation
expense incurred by you because of the total theft of a covered "auto" of the private
passenger type, We will pay only for those covered "autos" for whi-ch you carry either
Comprehensive or Specified Causes of Loss Coverage, We will pay for temporary
transportation expenses Incurred during the period .beginning, 48 hours after the theft and
ending, regardless of the policy's explratlon, when -the covered "auto" is returned to use o.r
we pay for its. "loss". If your business shown In the Declarations Is other than an -auto
dealership, we will also pay'up to $1,000 for reasonable end necessary costs Incurred by
yo.0 to return a stolen covered auto from the place where It is recovered to its usual
garaging: iocat€on.
VIII. HIRED AUTO PHYSICAL DAMAGE COVERAGE
SECTION III — PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions, the following is
added:
C. If Liability Coverage is provided In this policy on a Symbol 1 or a Symbol 8. basis and
Comprehensive, Specified Causes of Loss; or Collision coverages are provided under
this coverage form for any "auto" you oven, then the Physical Damage Coverages
provided are extended to "autos" you hire, subject to -the following limit-
(1) The most we will pay for "loss" to any hired "auto" Is $50,000 or Actual
Cash Value or -cost of Repair, whichever Is. less
(2) $5.00 deductible will apply°to any loss under this coverage extension,
except that no deductible shall apply to "loss" caused by fire or lightning
Subject to the above limit and deductible we will provide coverage equal to the
broadest coverage applicable to any covered "auto" you own of similar size and
type. This. coverage extension is excess coverage over any other collectible
Insurance.
IX. ACCIDENTAL AIRBAG DEPLOYMENT COVERAGE
�PGCTIQN Ill - PHYSICAL DAMAGE COVERAGE, B. Exclusions, 3.a., is amended to add the following;
This exclusion does not apply to the accidental discharge of an airbag.
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MCA85100817-GA Includes copyrlghted'Materfal of Insurance Services Office; Inc., wlth Its Permisslon Page of 6
XIV. WAIVER OF 5U9ROGATJO.N
SECTION IV - BUSMSS AUTO CONDITIONS, A, Loss Conditions, S. Transfer of Rights Of Recovery
ApIrlst Others. To Us, section Is replaced by the following;
S. Transf?r Of Rights Of Recovery Against Others To Us
We w.aive any right of recovery we May -have agalnst any person or organ)zatl:on to
the extent required of you by a written contract executed prior to any "accident" or
"loss"., provided that the "accident" or "loss" arises out of the operations
contehiplated by such cohtfct. The'wa.lver applies only to the person or
organization designated In .such contract.
XV. UNINTENTIONAL ERROR,: OMISSION, OR FAILURE TO DISCLOSE HAZARDS
SECTION IV - BUSINESS AUTO CONDITIONS, B. General Conditions, Z. -Concealment,
Misrepresentation, or Fraud, the following -Is added;
Any unl'ntentional omisslon of or error in I.nformatlon given by you, or unintentional failure
to disclose all exposures or hazards existing,.as of the effective date or at any time during
the :pollcy period shall not Invalidate or'adversely affect the coverage for such exposure or
hazard or prejudice your rights under this Insurance, However, you must report the
undisclosed exposure or hazard to us as soon as reasonably possible after Its discovery.
This provision does not affect our right to collect additional premium .or exercise our right
of cancellation' or non -renewal.
XVI. EMPLOYEE HIRED AUTO PHYSICAL DAMAGE
SECTION IV — BUSINESS AUTO CONDITIONS, D. General Conditions, S. Other Insurance, b, For Hired
Auto Physical Damage Coverage, Is replaced by the following;
b. For Hired Auto Physical Damage. Coverage, the following are deemed to be covered
"autos" you own:
1. Any covered ".auto" you lease, hire, rent or borrow; and
2... Any covered "auto"' hired or rented by -your "employee" under a contract In
that Individual "employee's" name, with your permission, while performing
I' duties related to -the conduct of your business.
However, any "auto" that is leased, hired, rented or borrowed with a driver Is not a covered
auto ,
.XVII., PRIMARY AND WONCONTRIBUTORY IF REQUIRED BY CONTRACT
SECTION IV — 9USINESS AUTO CONDITIONS, D. GenerPI Condltlo.ns, S., Other Insurance, the
following Is added .and supersedes any provision to. the contrary'
e. This Insurance Is primary to and will not seek: contribution from any other Insurance
avallable to an additional Insured under .your policy provided that:
(1) The additional Insured Is a Named Insured under such other Insurance; and
(2) You have agreed In writing In a contract or -agreement that this Insurance
would be primary and would not seek contribution from any other
Insurance available to the additional insured.
Copyright 2017 Mercury Insurance Services, LLC. All rights reserved.
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