2021/08/28 Dudek (7),a,c:c>r.iy.CERTIFICATE OF LIABILITY !NSURANCE DATE (MM/OD/YYYY)
o8t18t2021
IMPORTANT: lf the certificate holder i3 an ADDITIONAL INSIJRED, lhe policy(ies) must have AODITIONAL INSURED provisions or be endoBsd. lf
SUBRoGATION lS WAlvED, subject to the terms and conditions oI tho policy, certain policies may require an endorsement. A statement on thiscortificato does not confer rights to the certificate holder in lieu ofsuch endorsement(s).
PRODUCER Lockton companies
444 W. 47th Street, Suite 900
Kansas City MO 64112-1906
(816) 960-9ooo
PHONE
IL
INSU RER(S) AFFORDING COVERACE
TNSURERA: Zurich American lnsurance Company 16535
lNsUREo DUDEK,1477058 605 THIRD STREET
ENCINITAS CA 92024
tNsuRER B: Continental Casualty Company 20443
rNsuRER c: American Guarantee and Liab lns Co 26247
INSURER D
INSURER E:
8t28t2022
ERAGES CERTIFICATE NUMBER REVISIoNNUMBER: XXXXXXX
ee me
o 1988-201 5
CERTIFICATE CANCELLAT N
IHIS IS To CERTIFY THAT THE PoLICIES oFINffi
PERIOD INDICATED, NOTWITHSTANDING ANY REOUIREI\iIENT, TERIT,l OR CONDITION OF ANY CONTRACT OR OTHER DOCUII4ENT WTH RESPECT TO
WHICH THIS CERTIFICATE I,IAY BE ISSUED OR IUAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIIIiIITS SHOWN I\.,IAY HAVE BEEN REDUCED BY PAID CLAII\,1S
ED TO THE INSURED NAMED ABOVE FOR THE POLICY
ALL THE TERIIIS
ADDLtNso SUBF LIMITS
EACH OCC1JRRENCE $ 1.000.000
$ '100.000
MED EXP rAnv one oersonl $ 10.000
PERSONAL & ADV INJI]RY $ 1,000,000
GEN E RAL AGGREGATE $ 2,000,000
PROOUCTS - COMP/OP AGG $ 2,000.000
COMI$ERCIAL GENERAL TIABILITY
GEN'L AGGREGATE LIM TAPPLIES PER
X
X X
X
JECT
CLAlMS.lr,lADE
LOC
OTHER:
Y Y
G1O014631'1 08t28t202 aat2at202i
$
COMB]NEDS]NGLE LIMIT $ 1,000,000
BOOILY INJURY (PerpeBon)$ XXXXXXX
BOOILY INJURY (Per accdent)$ XXXXXXX
$ XXXXXXX
AUTOMOBILE fIABILITY
o!!NEO
HIRED
SCHEDULED
NON OWNEO
AUTOS ONLY
X
Y Y
8AP0146329 08t2u2421 48t28t2022
$ xxxxxxx
X EACH OCCURRENCE $ 5,000,000
EXCESS LIAB
x
LA i,IS I,IADE $ 5,000,000
c
RETENTION $
N Y AUC0146407 o8t28t2421 48t28t2422
$
X
$ 1,000,000
E L OLSEASE. EA EMPLOYEE $ 1,000,000
WORKERS COMPENSATION
ANO EIIIPLOYERS' LIABILITY
ANY PROPRETOfu PARINER/EXECUII!€
OFF]CERfr EMBER E.XCLUOED?
DESCRIPIION OF OPERATIONS bEI@
N Y
wc0146330 08t28t2421 a8t2a2a22
$ 1.000.000
B PROFESSIONAL
LIABILITY
INCLUDES POLLUTION N
EEH591932835 INCL POLL oat2at2a21 48t28t2422 PER CLAIM $1 OOO,OOO
AGGREGATE $2,OOO,OOO
DESCRIPTIoN OF OPEFiATIONS / LOCA'IONS /VEHICLES (ACORD 101, Addltlonal Remarts Schedlr., may b..ttach.d lrmoE3pace i! roqulred)
PROJECT: NEWPORT ROAD WDEN NG (ANTELOPE AND MENIFEE) C P #01-13 CIry OF MENIFEE AND IIS OFFICERS, OFF CIALS, EMPLOYEES, AND AUTHORIZED VoLUNTEERS ARE
AODITIONAL INSURED ON GENERAL ANO AUTO LIABIL ry COVERAGE, ON A PRIMARY, NON.CONTRIBUTORY BASIS,IF REQU RED BY WRITTEN CONTRACI WAVER OF SUBROGATION
IN FAVOR OF TH E ADDITIONAL INSUREO APPLIES ON GEN ERAL AUTO, AN D U MBR ELLA LIABI LIry COVERAGE. F REO U]R EO BY WR|l TEN CONTRACT AN D WHERE ALLOI,\/ED BY LAW
COVERACE IS SUBJECTTOTHETERMSANDCONDLTIONS OF THE POLICY.
SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORE
THE EXPIRATIOI'I DATE THEREOF, NOTICE wlLL BE DELIVERED tN
ACCORDAIICE livlTH THE POLICY PROVISIONS.
16753211
CITY OF MENIFEE
297,14 HAUN ROAD
MENIFEE CA 92586
4"4e-4 *1
acoRo 25 (2016/03)
The ACORD name and logo are registered marks of ACORD
RD CORPORATION. All rights reserved
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.
oEo
N
AUTHORIZED REFRESENTATIVE
/l/'
Attachment Code : D564542 Master lD: 1477058, Certificate lD: 1675321 1
Lockton Companies
444 W . 47lh Street, Suite 900
Kansas City, MO 64112
If you received this certificate through ancertificate is viewable, we have your email
DU0EK.: 1477058
L67 532LL
C ITY OF I'lENIFEE
29714 HAUN ROAD,
I,IENIFEE, CA 92585
Dear Valued Cli ent:
In our continuing effort to provide timety certificate delivery, Lockton
Companies is utilizing paperless delivery of Certificates of Insurance.
To ensure electronic delivery for future renewals of thjs certificate, we
need your email address. Please contact us via the email below and referenceCertificate ID: !.5753211. You must reference this Certificate ID number inordedor us tO complete thi s process.
U Certificate ID: t67532L1I Ema i 1: kctsu@lockton. com
U Subject Line: TSU E-Delivery
Ilo(xlorl
internet link where the current
and no further action is needed
Please note
available.
that after February 2022, printed certjficates wj11 no longer be
If you no longer need this certificate, please contact us at the email
address above, reference the Holder ID number and use this subject tine"Certi fi cate Remov a l "
ilofE: fhe above enail is a collector enail regarding electronic delivery ofcerti ficates on ly,inouiries to this Please do l,l0T send certificat reouests or other i nsu rance
inbox as res nses Hill be delayed or nissed.
Thank you for your cooperation and willingness in reduc'ing our envi ronmental
footpri nt.
Lockton Compan i es
Techn i ca1 Services Unit
Email/ Marling Update - Liability Cedificates