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2021/12/01 Admail Express, Inc.oiQo"tt/29 /202r THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENO, EXTEND ORALTER THE COVERAGE AFFOROED 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: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) m ust be endor36d. lI SUBROGATION lS WAlVEo, sublect to the terms and conditions of the policy, certain policies may require an endorsemont. A statoment on this certificate does not confer rlghts to the certificate holder in lieu of such endorsement(s). Barlocker Insurance Ag6ncj/, license i10580438 371 L'lain St'leet Sa.Linas CA Inc. 93 901 (831) 540-4583 rNsuRER(S) AFFOROING COVEftAGE TNSURERA: Ohio Security Insulance Company 24042 INSURED Admail Exlrress, Inc Brian Schott 31640 Hayman St!€€t Iattrard TNSURERB : Sj.ri.us nnerj,ca Insulance Conpany 34116 CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE NUMBER:cL21112908932COVERAGES REVISION NUMBER CIES OF INSURANCE LISTEO BELOWHAVE AEEN ISSUEOTOlHE INSURED NAMEDABOVE FORTHE POLICY PERIOO INDICATED, NOTWTHSIANOINGANY REOUIREMENT. TERM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSIJED OR MAY PERTAIN, THE INSURANCE AFFORDED BY IHE POLICIES DESCRIEEO HEREIN IS SUAJECT TOALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOW\I MAY HAVE EEEN REDUCEO AY PAIO CLAIMS. THIS IS TO CERTIFYTHATTHE POLI 1,000,0003 1,000,0005 MEO EXP (Any o^. p.B.n)15,000s PERSONAL & AOV NJURY 1 ,000,000 GENERALAGGREGATE 2,000,000 PROOUCIS. COMP/OPAGG COMMERC]AL GENERAL LIABILITY GEN'LAGCREGAIE LIMITAPPLIES PER x x COMSINEOSINGLE LIMIT r,000/000 BODILY INJURY (P.r p.en) EODILY INJURY (P.r..od.nr) x AUTOMOBILE L]AAIL TY SCH€DULEO i OED x 1,000,000 1,000,000B WORXERS COMPENSATIOIT ANDE PLOYERS'IIABILITY ANY PROPRIETOR/PARTNEFTEX€CIJTIVE OFFICEfu MEMBER EXCLUDEO? R]PTION OF OPERATIONS bddoEsc E L DISEASE EA EMPLOYEE E L OISEASE, POLLCY L]MIT 1,000,000 OESCRIPTION OF OPERAIIONS , fOCAnoNS / VEHICLES (ACORO 101, Addltion.l R.m.rt. Sch.du r., m.y b. .tt ch.d It ho- .p... i. .qulod)Ci.ty of Manif€e and its officers, employ€s!, ag€nt! and autholiz6d volunt€ers ar€ narnod adclitionaL REL City of Menj.fee Comnunity informatj.on nailj.ngs II II CERTIFICATE HOLDER CANCELLATION City of Monifee 29844 Haun Rd. Men:ifee, CA 92586 SHOULD ANY OF THE ABOVE OESCRIEED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCOROANCE WITH THE POLICY PROVISIONS, Tina Bar r ocker/os HUER 3?"'fi-/""&" O 1988-2014 ACORO CORPORATION. All rlghts rqsorved Tho ACORO namg and logo aro .sgl3terod marks ot ACOROACORD 25 (20r4101) lNS025 (2orao1) oscar-huerta01..vi tt . con cA 94544 T- x ] "*,rr".*o. I o."r^ lr ,,ooo,ooo Ir r Ir Policy N umber: 82558206527 BUSINESSOWNERS BP 79 96 09 t6 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS LIABILITYEXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following BUSINESSOWNERS COVERAGE FORI\,4 Below is a summarization of the coverages provided by this endorsement. No coverages are given by this summary. Actual coverage descriptions are within this endorsement. SECTION SUBJECT Supplementary Payments Bail Bonds Loss Of Earnings Broadened Coverage For Damage To Premises Rented To You lncidental Medical Malpractice lnjury Mobile Equipment Blanket Additional lnsured (Owners, Contractors Or Lessors) Newly Formed Or Acquired Organizations Aggregate Limits Duties ln The Event Of Occurrence, Offense, Claim Or Suit Liability And Medical Expenses Deflnitions Bodily lnjury lnsured Contract Personal And Advertising lnjury Sectlon ll - Llablllty is amended as follows: A. Supplamentary Payments Section A.l. Buslness Liability is modified as follows: 1. The $250 limit shown in Paragraph A.1.f.(fXb) Covsrage Extension - Supplementary Payments for the cost of bail bonds is replaced by a $3,000 limit. 2. The $250 limit shown in Paragraph A.f.f,(1Xd) Coverage Extension - Supplomentary Paymonts for reasonable expenses and loss of earnings is replaced by a $500 limit. B. Broadened Coverage For Damage To Premisos Rented To You 1. The last paragraph of Section B.l. Excluslons - Appllcable To Buslness Liablllty Coverago is r€placed by the following: With respect to the premises which are rented to you or temporarily occupied by you with the permis- sion of the owner, Exclusions c., d., e., 9., h., k., 1., m., n. and o. do not apply to "property damage,. A. B c D E F G H t. @ 2O16 Liberty Mutual lnsurance lncludes copyrighted material of lnsurance Services Office, lnc-, with its permissionBP 79 96 09 't6 Pago I ol 4 2. Paragraph D.2. Llablllty And Medlcal Expensos Llmlts Of lnsurance is replaced by the following: The most we will pay under this endorsement for the sum of all damages because of all 'property damage" lo premises while rented to you or temporarily occupied by you with the permission of the owner is the Limit of lnsurance shown in the Declarations. 3. Paragraph D.3. Llablllty And Medlcal Exponses Llmlts Of lnsurance does not apply. C. lncidental Medical Malpractico lnjury l. Paragraph (4) under Paragraph 8.1J. Excluslons - Applicable To Busln6ss Liability Coverags - Profes- sional Servicas does not apply to "lncidental Medical Malpractice lnjury" coverage. 2. With respect to this endorsement, the following is added to Section F. Llablllty And Medical Expenses Dofinitions: a. "lncidental Medical Malpractice lnjury" means bodily iniury arising out of the rendering of or failure to render, during the policy period, the following services: (l) [Iedical, surgical, dental, x-ray or nursing service or treatment or the furnishing of food or beverages in connection therewith; or (2) The furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances. b. This coverage does not apply to: (1) Expenses incurred by the insured for firslaid to others at the time of an accident and the Duties in the Event of Occurrence, Offense, Claim or Suit Condition is amended accordingly. (2) Any insured engaged in the business or occupalion of providing any of the services described under a. above. (3) lnjury caused by any indemnitee if such indemnitee is engaged in the business or occupation of providing any of the services described under a. above. D. Moblle Equipment Section C. who ls An lnsured is amended to include any person driving "mobile equipment' with your permission. E. Blanket Additional lnsuied (Owners, ContractoB Or Lessors) L Section C. Who ls An lnsured is amended to include as an insured any person or organization whom you are required to name as an additional insured on this policy under a written contracl or written agreement. The written contract or agreemenl must be: a. Currently in effect or becoming effective during the term of this policy; and b. Executed prior to the "bodily injury", "property damage", or "personal and advertising in ury". 2. The insurance afforded to the additional insured is limited as follows: a. The person or organization is only an additional insured with respect to liability arising out of: (l) Real property, as described in a written contract or written agreement, you own, rent, lease, maintain or occupy; and (2) Caused in whole or in part by your ongoing operations performed for that insured. b. The Limit of lnsurance applicable to the additional insured are those specified in th6 written contract or written agreement or the limits available under this policy, as stated in the Declara- tions, whichever are less. These limits are inclusive of and not in addition to the Limit of lnsurance available under this policy. c. The insurance afforded to the additional insured does not apply to: (l) Liability arising out of the sole negligence ofthe additional insuredi (2) "Bodily injury", "property damage'', "personal and advertising injury", or defense coverage under the Supplementary Payments section of the policy arising out of an architect's, en- gineer's or surveyor's rendering of or failure to render any professional services including: @ 2016 Liberty MutuEl lnsuranceBP79 96 09 16 lncludes copyrighted material of lnsurance Services Office, lnc.,with its permission. Page2of 4 s (a) The preparing or approving of maps, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and speciflcations; and (b) Supervisory, inspection, architectural orengineering activities. (3) Any .occurrence" that takes place after you cease to be a tenant in the premises described in the Declarationsi or (4) Structural alterations, new construction or demolition operations performed by or for the person or organization designated in the Oeclarations. Any coverage provided hereunder shall be excess over any other valid and collectible insurance avail- able to the additional insured whether primary, excess, contingent or on any other basis unless a contraci specilically requires that this insurance be primary or you request that it apply on a primary basis. F. Nswly Formed Or Acqulrod Organlzations The following is added to Section C. Who ls An lnsured: Any business entity acquired by you or incorporated or organized by you under the laws of any individual state of the United States of America over which you maintain majority ownership interest exceeding fifty percent. Such acquired or newly formed organization will qualify as a Named lnsured if there is no similar insurance available lo that entity. However: 1. Coverage under this provision is afforded only until lhe 180th day after the entity was acquired or incoporated or organized by you or the end of the policy period, whichever is earlier; 2. Section A.1. Buslnsss Llablllty does not apply to: a. "Bodily injury" or "property damage" that occurred before the entity was acquired or incorporated or organized by you; and b. "Personal and advertising injury" arising out of an offense committed before the entity was ac- quired or incorporated or organized by you. 3. Records and descriptions of operations must be maintained by the first Named lnsured. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named lnsured in the Declarations. G. Aggregate Llmlts The following is added to Paragraph D.4. Aggrogale Llmits Liability and Medical Expenses Limits Of lnsurance: '1. The Aggregate Limits apply separately to each of the "locations" owned by or rented to you or temporarily occupied by you with the permission of the owner. 2. The Aggregate Limits also apply separately to each of your projects away from premises owned by or rented to you. For the purpose of this endorsement only, "location" means premises involving the same or connect- ing lots, or premises whose connection is interrupted only by a street, roadway, waterway or righ! of-way of a railroad. Dutios ln Ths Event Of Occurrenco, Offenso, Claim Or Suit 1. Paragraph E.2.a. Dutles ln The Event Of Occurronce, Offense, Claim Or Sult Liability And Medical Expenses General Condition applies only when the "occunence" is known to any insured listed in Paragraph C.1. Who ls An lnsured or any "employee" authorized by you to give or receive notice of an "occurrence" or claim. Paragraph E.2.b. Outlos ln The Ev€nt Of Occurrence, Offense, Claim Or Suit Liability And Medical Expenses General Condition will not be considered breached unless the breach occurs after such claim or "suit" is known to any insured listed under Paragraph C.l. Who lsAn lnsured or any "employee" authorized by you to give or receive notice of an "occurrence' or claim. 3 H @ 2016 Liberty Mutual lnsurance lncludes copyrighted material of lnsurance Services Ofilce, lnc., with its permissionBP 79 96 09 16 Page 3 of 4 Section F, Liablllty And Medlcal Expenses Deflnltlons is modified as follows 1. Paragraph F.3. is replaced by the following: 3. "Bodily lnjury" means bodily injury, sickness, disease, or incidental medical malpractice injury sustained by a person, and includes mental anguish resulting from any of these; and including death resulting from any of these at any time. Paragraph F.9. is replaced by the following 9. "lnsured contract" means: 3. Paragraph F.14.b. Personal And Advertising lniury is replaced by the following b. Malicious prosecution or abuse of process; a A contract for a lease of premises. However, that portion of the contract for a lease of prem- ises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an 'insured contract": b. A sidetrack agreement; c. Any easement or license agreement, except in connection with construction or demolition operations on or within 50 feet of a railroadi d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indem- nification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or ''property damage" to a third person or organization, provided the "bodily injury" or "property damage" is caused, in whole or in part, by you or by those acting on your behalf. However, such part of a conlract or agreement shall only be considered an "insured contract" to the extent your assumplion of the tort liability is permitted by law. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (l) That indemnifies a railroad for 'bodily injury'' or "property damage" arising out of con- struction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road-beds, tunnel, underpass or crossing; (2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opin- ions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (3) Under which the insured, if an architect, engineer or suryeyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (2) above and supervisory, inspection, architectural or engineering activities. E ! 8 s BP 79 96 09 16 Page 4 of 4 @ 2016 Liberty Mutual lnsurance lncludes copyrighted material of lnsurance Services Offlce, lnc., with its permisston.