Loading...
2022/02/01 Lunar Cow Publishing Inc.04/05/2022 Wascovich - Lake Shore Insurance Agency, Inc. 9265 Olde Eight Road Northfield, OH 44067 Bob Dombrowski 330-467-4348 330-467-8664 bobd@lakeshoreinsurance.com 00059705-0 5 LUNAR COW PUBLISHING INC 344 W Turkeyfoot Lake Rd Ste B Akron, OH 44319-4085 Erie Insurance Company 26271 A Y Q97-1733767 02/01/2022 02/01/2023X X X 1,000,000 1,000,000 10,000 1,000,000 2,000,000 2,000,000 Erie Insurance 26271 B Y Q26-0171837 02/01/2022 02/01/2023 X X 1,000,000 2,000,000 CITY OF MENIFEE WILL BE ADDITIONAL INSURED. CITY OF MENIFEE 29844 HAUN ROAD Menifee, CA 92586 (BAD) Printed by BAD on 04/05/2022 at 10:04AM ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ PER OTH-STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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 certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DocuSign Envelope ID: 9EB868E4-DC6F-4BF6-8C8C-1E648074D21C GG1163 Other Interest: As Listed Below Ultrapack Plus Policy Declarations Amended Declarations Effective 04/05/2022 Attach This To Your Policy See ***Reason for Amendment Processed On:04/05/2022 (See Reverse Side)1 4 Mailing Name and Address for Insured: Erie Insurance Exchange LUNAR COW PUBLISHING INC ATTN BENJAMIN HARRIS 344 W TURKEYFOOT LAKE RD STE B AKRON OH 44319-4085 Named Insured's Full Name: LUNAR COW PUBLISHING INC Agent:Policy Period:Policy Number: GG1582 W ASCOVICH LAKE SHORE INS AGY 02/01/2022 to 02/01/2023 Q971733767 Agent Address and Phone W ASCOVICH LAKE SHORE INS AGY 9265 OLDE 8 RD NORTHFIELD OH 44067 330-467-4348 Policy begins at 12:01 A.M.standard time on the effectiv e date and ends at 12:01 A.M.standard time on the expiration date.Standard time is determined at the stated address of the named insured. The insurance applies to those premises described below.This is subject to all applicable terms of the policy and attached forms and endorsements. Premium Summary Large Premium Discount Applies Total Annual Policy Premium:$1,799.00 (This is not a bill.Your invoice will follow in a separate mailing.) x No Difference In Premium Due To This Change $0.00 Property Protection -As Per Attached Supplemental Declarations Deductible (Property Protection Only)$500 Policy-Level Coverages Liability Protection Limits of Insurance Commercial General Liability Limits of Insurance Each Occurrence Limit $1,000,000 Damage to Premises Rented to You $1,000,000 Any One Premises Medical Expense limit $10,000 Any One Person Personal &Advertising Injury Limit Excluded General Aggregate Limit $2,000,000 Products/Completed Operations Aggregate Limit $2,000,000 DocuSign Envelope ID: 9EB868E4-DC6F-4BF6-8C8C-1E648074D21C Insured Name:LUNAR COW PUBLISHING INC Policy Number:Q971733767 Policy Period:02/01/2022 to 02/01/2023 Page 2 of 4 Processed On:04/05/2022 CONTINUED ON NEXT PAGE 2 4 ***Amended Other Interest Information Added Other Interest CITY OF MENIFEE 29844 HAUN RD MENIFEE CA 92586-6539 Mailing Name 1 =CITY OF MENIFEE Added Additional Insured Additional Insured Type =State or Governmental Agency or Subdivision -Permits or Authorizations CG2012 Waiver of Subrogation =No Do you want Special Cancellation Notice?=No Optional Coverages Deductible Amount of Insurance Policy-Level Optional Coverages: Property and Inland Marine -Optional Coverages: Data Breach Response Expenses –Increased Coverage $250,000 Terrorism Included General Liability -Optional Coverages: Additional Insured-State or Political Subdivisions-Permits (CG2012) Other Optional Coverages: Enhancement Endorsement-Offices DocuSign Envelope ID: 9EB868E4-DC6F-4BF6-8C8C-1E648074D21C Insured Name:LUNAR COW PUBLISHING INC Policy Number:Q971733767 Policy Period:02/01/2022 to 02/01/2023 Page 3 of 4 Processed On:04/05/2022 (See Reverse Side)3 4 Supplemental Declarations Location 1 /Building 1 Address: 344 W TURKEYFOOT LAKE RD STE B AKRON OH 44319-4085 County:Summit Occupancy/Operations: Advertising Office Interest of Named Insured In Such Premises:Tenant/Entire Coverage Deductible Amount of Insurance Property Protection 1.Buildings NIL 2.Business Personal Property and Personal Property of Others Replacement Cost Theft Exclusion Applies:No Property Deductible BLANKET 3.Income Protection &Extra Expense Actual Loss Sustained 12 Months Blanket Coverage -Contents -All Locations $296,000 Protective Safeguard Condition:Central Station Fire Alarm System Protective Safeguard Condition:Central Station Burglar Alarm System Automatic Adjustment of Business Personal Property and Personal Property of Others Coverage –2% Property and Inland Marine -Optional Coverages: Accounts Receivable -Increased Coverage $25,000 Electronic Data –Expenses for Reproduction or Replacement and Valuable Papers and Records –Increased Coverage $250,000 Electronic Data Processing Endorsement -Blanket $500 $50,000 Sewer and Drain Backup $1,000 $25,000 Policy-Level Additional Interests Additional Insured -Subdivisions-Permits CITY OF MENIFEE 29844 HAUN RD MENIFEE CA 92586-6539 Schedule of Static Forms Form Number Edition Date Description / UPP 01/10 ULTRAPACK PLUS POLICY PK0001 05/20 ULTRAPACK PLUS COMMERCIAL PROPERTY COVERAGE PART PKAA 01/10 ACCOUNTS RECEIVABLE -INCREASED COVERAGE PKAO 01/10 ELECTRONIC DATA PROCESSING COVERAGE DocuSign Envelope ID: 9EB868E4-DC6F-4BF6-8C8C-1E648074D21C Insured Name:LUNAR COW PUBLISHING INC Policy Number:Q971733767 Policy Period:02/01/2022 to 02/01/2023 Page 4 of 4 Processed On:04/05/2022 4 4 Schedule of Static Forms -(continued) Form Number Edition Date Description PKAX 01/10 PRODUCTION OR PROCESS MACHINERY -DEDUCTIBLE PKAY 12/14 SEW ER AND DRAIN BACK-UP COVERAGE PKAN 01/12 ELECTRONIC DATA -EXPENSES FOR REPRODUCTION OR REPLACEMENT AND VALUABLE PAPERS AND RECORDS-INC CVRG PKJG 07/16 OFFICES ENHANCEMENTS ENDORSEMENT PKRF 11/10 OHIO AMENDATORY ENDORSEMENT CL0209 11/10 IMPORTANT NOTICE -LEAD LIABILITY EXCLUSION CL0212 11/10 IMPORTANT NOTICE -POLICY SERVICE FEES CL0217 11/10 IMPORTANT NOTICE -NO FLOOD COVERAGE PKGP 01/10 AMENDMENT OF MOBILE EQUIPMENT DEFINITION PK0003 05/20 ULTRAPACK PLUS EXTRA LIABILITY COVERAGES CG0001 04/13 COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG0099 11/85 CHANGES IN GENERAL LIABILITY FORMS FOR COMMERCIAL PACKAGE POLICIES CG2012 04/13 *ADDL INSURED -STATE OR GOVT AGCY OR SUBDIV OR POLITICAL SUBDIV -PERMITS OR AUTHORIZATIONS CG2138 11/85 EXCLUSION -PERSONAL AND ADVERTISING INJURY CG2147 12/07 EMPLOYMENT-RELATED PRACTICES EXCLUSION CG2167 12/04 FUNGI OR BACTERIA EXCLUSION UFB213 11/12 SUBSCRIBER'S AGREEMENT CG2170 01/15 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM CG2196 03/05 SILICA OR SILICA-RELATED DUST EXCLUSION PKGK 11/10 PUNITIVE DAMAGES PKW A 07/14 DATA BREACH RESPONSE EXPENSES -INCREASED COVERAGE CL0396 01/17 IMPORTANT NOTICE -DATA BREACH RESPONSE EXPENSES COVERAGE CG2106 05/14 EXCL-ACCESS OR DISCLOSURE OF CONFIDENT OR PERS INFO AND DATA-RELATED LIAB -W ITH LIMIT BOD INJ EXCEP CG2109 06/15 EXCLUSION -UNMANNED AIRCRAFT IL0017 11/98 COMMON POLICY CONDITIONS IL0021 09/08 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) IL0244 09/07 OHIO CHANGES -CANCELLATION AND NONRENEW AL IL0952 01/15 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM IL985F 03/21 DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT PKMJ 01/10 EXCLUSION -LEAD LIABILITY PKMD 01/10 EXCLUSION -ASBESTOS PKMQ 12/14 EXCLUSION -PROFESSIONAL LIABILITY PKRO 01/10 AMENDMENT OF POLICY -TW O OR MORE COVERAGE PARTS DocuSign Envelope ID: 9EB868E4-DC6F-4BF6-8C8C-1E648074D21C