2021/07/01 RivCo HR
P.O. Box 1210, Riverside, CA 92502 (951) 955‐3540 (951) 955‐4027 riskmanagement@rivco.org
BRENDA DIEDERICHS,
Asst. County Executive Officer/
Human Resources Director
CERTIFICATE OF INSURANCE OR SELF-INSURANCE
Date: October 21, 2021 Lari Camarra
cc: Johnny, Perez, Admin Serv. Supervisor, Environmental Health
THIS IS TO CERTIFY THAT THE SELF-INSURED COVERAGE LISTED BELOW IS CURRENTLY IN EFFECT 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 COVERAGE AFFORDED BY THIS CERTIFICATE DESCRIBED HEREIN IS SUBJECT TO ALL THE
TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH CERTIFICATE.
COVERAGE PROVIDED IS SUBJECT TO THE TERMS AND CONDITIONS OF THE EXCESS POLICY.
Type of Coverage Company and
Policy Number
Policy Period Limits of Liability
Bodily Injury/Property Damage
Commercial General
Liability Including
Vehicle Liability
Self-Insured 07/01/2021
to
07/01/2022
$1,000,000 Combined
Single Limit Per
Occurrence with No
Aggregate Limit
Workers’
Compensation
& Employers’
Liability
Permissibly
Self-Insured
07/01/2021
to
07/01/2022
$2,000,000 Per Occurrence
with No Aggregate Limit
The County of Riverside certifies that the above self-insured program is in effect as respect to: Remaining in
compliance per agreement between Certificate Holder and Riverside County Department of Environmental Health.
Certificate Holder Cancellation
City of Menifee
Attn: Martisa Ramirez
29844 Haun Road
Menifee, CA 92586
In the event of cancellation of the self-insurance program or
policy designated below, it is the intent of the County of
Riverside to mail 30 days’ prior notice thereof.
X
X
This certificate is not valid unless signed by an authorized representative of the County of Riverside, Risk Management Division
DocuSign Envelope ID: FD9298FF-3696-4C49-86C2-C65FBACFA9C1