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2020/04/01 Innovative Document Solutions CL202632726 DocuSign Envelope ID: FF32EOA1-0731-4BD4-B342-C3D3A6287355 A!'��® DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 11/10/2020 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 NAME: Tina Acevedo Bulen & Associates Insurance Services PAH/c NAX No Ext: (951)674-0675 FA/c No: (951)679-2375 40750 Symphony hon Park Ln. E'MAIL ADDRESS: tinaa@bulen.com Suite 101 INSURERS AFFORDING COVERAGE NAIC# Murrieta CA 92562 INSURER A:Nationwide Mutual Insurance Co 23787 INSURED INSURER B:Preferred Employers Ins. Co. 10900 Innovative Document Solutions INSURER C: 26855 Jefferson Ave Ste F INSURER D: Suite F INSURER E: Murrieta CA 92562-8966 INSURER F: COVERAGES CERTIFICATE NUMBER:CL202632726 REVISION NUMBER: 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. INSRPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE OCCUR DAMAGE TO RENTED 300,000 PREMISES Ea occurrence $ X Y ACP7851746108 1/24/2020 1/24/2021 MED EXP(Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO JECT ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Additional Insured $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A X ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ACP7851746108 1/24/2020 1/24/2021 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident Uninsured motorist property damag $ 3,500 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION x PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A B (Mandatory in NH) WKN196463-9 4/1/2020 4/1/2021 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,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, its officers, agents and employees named as additionally insured and the City of Menifee listed as the named as Certificate Holder in regards to Workers Compensation *30-day notice of cancellation, except for 10-day notice of cancellation for nonpayment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Menifee THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Finance Department ACCORDANCE WITH THE POLICY PROVISIONS. 29844 Haun Road Menifee, CA 92586 AUTHORIZED REPRESENTATIVE N Doverspike/NICOLE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)