2020/08/01 Debi McCluskey Companies, Inc. (4) DocuSign Envelope ID: E8BCOF28-CB38-432B-8D6A-9OB61853A62D
A l L> DATE(MM/DD/YYYY)
�� CERTIFICATE OF LIABILITY 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 BOLDER.
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 PHONE FAX
10769 WOODSIDE AVE,STE 103 (A/C,NO,EXT):858-569-1000 (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
DBA DMC INSURERC:
1499 POMONA RD STE C INSURERD:
CORONA,CA 92882 INSURERE:
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
REQUIREMENT 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 TYPE OF INSURANCE ADDTL SUBR POLICY NUMBER POLICYEFF POLICY EXP LIMITS
LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY)
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE OCCUR DAMAGETORENTE❑
PREMISES(Ea Occurrence) $ 1,000,000
MED EXP(Any ore person) $ 10,000
A Y 72SBWB86458 08/01/2020 08/01/2021 PERSONAL&ADVINJURY $ 1,000,000
GEN'L AGGREGATF HMITAPPLiES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY PROJECT ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Fa accident)
X ANYAUTO BODILY INJURY(Per person) $
OWNEDAUTOS SCHEDULED
A ONLY AUTOS BODILYINJURY(Peraccident)$
72UEGHC2851 08/01/2020 08/01/2021
HIREDAUTOS X NON-OWNED PROPERTY DAMAGE
X ONLY AUTOS ONLY (Peraccidert) $
X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000
A EXCESSLIA8 CLAIMS-MADE 72SBWBB6458 08/01/2020 08/01/2021 AGGREGATE $ 1,000,000
DEQ 1 1 RETENTION$10,000 $
WORKERS COMPENSATION PER
AND EMPLOYERS'LIABILITY STATUTE OTHER $
ANY PROPRIETOR/PARTNER/ YIN E.LFACHACCIDENT $ 1,000,000
N/A
EXECUTIVE OFFICER/MEMBER 72WEGAD3KHU 04/06/2020 04/06/2021
B EXCLUDED?(Mandatory in NH) Y E.L.DISEASE-EA EMPLOYEE 1,000,000
Ifyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-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) @1988-2015 ACORD CORPORATION.All is Reserved
31-1769 11-15 The ACORD name and logo are registered marks of ACORD