2022/04/01 Habitat for Humanity Inland ValleyCERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
03/01/2022
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 INSURERS(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
Lockton Affinity, LLC
P.O. Box 873401
Kansas City, MO 64187-3401
CONTACT
NAME:
PHONE
(A/C No.Ext): 888-553-9002 FAX
(A/C, No):
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC
INSURER-A: ACE American Insurance Co.22667
INSURED
Habitat for Humanity Inland Valley
27475 Ynez Rd #390
Temecula, CA 92591-4612
INSURER-B: ACE Property and Casualty 20699
INSURER-C: Westchester Fire Ins. Co.10030
INSURER-D:
INSURER-E:
INSURER-F:
COVERAGES CERTIFICATE NUMBER: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.
INSR
LTR TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)LIMITS
A GENERAL LIABILITY GL1064456-22 04/01/2022 04/01/2023 EACH OCCURRENCE $1,000,000
XCOMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES (Ea occurrence)$1,000,000
CLAIMS
MADE X OCCUR MED EXP (Any one person)$0
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN’L AGGREGATE LIMIT APPLIES PER:PRODUCTS – COMP/OP AGG $2,000,000
XPOLICY $
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)$
ANY AUTO BODILY INJURY (Per Person)$
ALL OWNED
AUTOS
SCHEDULED
AUTOS BODILY INJURY (Per accident)$
HIRED
AUTOS
NON-OWNED
AUTOS
PROPERTY DAMAGE
(Per accident)$
B X UMBRELLA LIAB X OCCUR UM1064456-22 04/01/2022 04/01/2023 EACH OCCURRENCE $1,000,000
EXCESS LIAB CLAIMS MADE AGGREGATE $1,000,000
DED X RETENTION $10,000
WORKERS COMPENSATION
AND EMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
Y/N
WC STATU-
TORY LIMITS
OTH-
ER
OFFICER/MEMBER EXCLUDED?E.L. EACH ACCIDENT $
(MANDATORY IN NH)
If yes, describe under E.L. DISEASE – EA EMPLOYEE $
DESCRIPTION OF OPERATIONS below E.L. DISEASE – POLICY LIMIT $
A Builder's Risk
-Special Form
BR1064456-22 04/01/2022 04/01/2023 Limit
Deductible
$10,000,000
$Per Schedule
Insurer A: Property Incl. Crime, Policy # PC1064456-22, 04/01/2022 - 04/01/2023, Limits Per Schedule on File with Lockton Affinity, LLC
Insurer A: Directors & Officers Liability, Policy # DO1064456-22, 04/01/2022 - 04/01/2023, Limit: $1,000,000
Insurer A: Excess Directors & Officers Liability, Policy # DOX11064456-22, 04/01/2022 - 04/01/2023, Limit: $1,000,000
Insurer C: Volunteer Accident Medical Expense, Policy # MED1064456-22, 04/01/2022 - 04/01/2023, Limit: $250,000
Insurer C: Volunteer Disability, Policy # DIS1064456-22, 04/01/2022 - 04/01/2023, Temporary Total Disability Limit: 60% Salary
CERTIFICATE HOLDER CANCELLATION
Proof of Coverage SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS
AUTHORIZED REPRESENTATIVE
ACORD 25 (2010/05)The ACORD name and logo are registered marks of ACORD
1064456
DocuSign Envelope ID: 2390B461-7412-43B2-890A-D5D9A31FD458DocuSign Envelope ID: 126B47E1-EB7E-4DD5-A6AF-EF8A73A666A3