2021/08/28 Dudek (8).q<:c>pif CERTIFICATE OF LIAB!LITY INSURANCE 08t't8t2021
THIS CERTIFICATE IS ISSUEO 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), AUTHORIZEO REPRESENTATIVE
OR PRODUCER, ANDTHE CERTIFICATE HOLDER,
IMPORTANT: lf the certificats holdor 13 an ADOITIONAL INSURED, lhe policy{ies) must havo ADOITIONAL INSURED provision3 or b6 endorsed. lf
SUBROGATiOT{ lS WAIVED, subjecl to th€ terms and conditions of ths policy, certain policie3 may require an endorsem€nt. A statem€nt on this
c€rtificat6 does not confer rights to th6 certificale holder in liou of3uch €ndorsement(s).
PFOOUCER LOCKOrICompanies
444 W. 47th Street, Suito 900
Kansas Ci9 MO 64112-1906
(816) 960-9000
INSU RE RISI AFFORDING COVERAGE
rNsrrRERA: Zudch American lnsurance Company 16535
INSURED DUDEK
1477058 605 THIRD STREET
ENCINITAS CA 92024
rr,rsuRER B, Continental Casualty Company 20443
r suRER c : American Guaranlee and Liab lns Co 26247
INSURER O
8/2812022
COVERAGES CERTIFICATE NUMBER: 1 7 3224 REVISION NUMBE
o 1988-2015 CORD CORPORATION. All rights reserved
CERTIFICATE HOLDER CANCELLATION
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
PERIOO INDICATED, NOTWITHSTANOING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO
WHICH THIS CERTIFICATE MAY 8E ISSUED OR MAY PERTAIN, TI-IE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUAJECT IO
AI L THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
TYPE OF INSUiANCE tNso
EACH OCCURRENCE $ 1.000.000
$ 100 000
MED EXP lAnv one oe6on)$ 't0.000
PERSONAL & AOV ]NJURY $ 1.000.000
GENERAL AGGREGATE $ 2.000 000
PFODUCTS . COMP/OP AGG e 2,000,000
COMIIIERClAL 6ENERAL LIABIL[Y
AGGREGATE L MIT APPL ES PER
X
X X
x
G
CLAIMS MAOE
LOC
OTHER
JECT
Y Y
G1O0146311 08t28t202 08t28t2022
5
COMBINEDSINGLE LIMIT s 1,000,000
SODILY INJURY (Perp€Bon)$ XXXXXXX
aOD LY lNJllRY (P€raccde.()$ XXXXXXX
$ xxxxxxx
AUTOMOBILE LIABILITY
OWNED
HIREO
AUTOS ONLY
SCHEOULED
NON OVVNED
AUIOS ONLY
X
Y Y
BAP0146329 0812812021 08t28t2022
$ xxxxxxx
x $ 5,000,000
EXCESS LIAB
X
IMS.MADE AGGREGAIE $ 5,000,000
C
DED RETENTION S
N Y AUC0146407 08t28t2021 aat2at2a22
$
$ 1,000,000wc01463301at28t2a21
E L DISEASE.EA EMPLOYEE
X
$'1 000 000
$ 1.000.000
WORKERS COMPENSATION
ANO EI'PLOYERS' LIABILITY
B PROFESSIONAL
LIABILITY
INCLUDES POLLUTION N N
EEH591932835 INCL POLL 08t28t2021 0at2at2022 PER CLA|[' $1 000 000
AGGREGATE $2,OOO,OOO
DESCRIPITON OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Addluon.l R.m.,t. Sch.dulo, may b. rtt ched ll moo .p.c. l. BquiEd)
RE ANNUAL ON CALL PROFESSIONAL SERVICES THE CITY OF MENIFEE ITS COUNCILMEMAERS, OFFICERS, AGENTS, AND EMPLOYEES ARE ADDITIONAL
INSURED ON GENERAL AND AU'TO LIAEILITY COVERAGE. ON A PRIMARY, NON,CONTRIBUTORY BASIS, IF REOUIRED BY WRITTEN CONTRACT, WAIVER OF
SUBROGATION IN FAVOR OF THE ADDITIONAL INSURED APPLIES ON GENERAL, AUTO, AND UMBRELLA LIABILITY COVERAGE, IF REOUIRED BY WRITIEN
CONTRACT AND WHERE ALLOWED 8Y LAW COVERAGE IS SUAJECT TO THE TERMS AND CONDITIONS OF THE POLICY
SHOULO ANY OF THE ABOVE OESCRIBED POLICIES AE CANCELLED BEFORE
THE EXPIRATIOiI OATE THEREOF, NOTICE wlLL BE DELIVERED IN
ACCORDANCE wlTH THE POLICY PROVISIONS,
167 53224
CITY OF MENIFEE
29714 HAUN ROAD
tlIENtFEE CA 92586
AUIHORIZED REPRESENTATIVE
,04/4^*7 ta1
ACORD 25 (2016/03)
The ACORD name and logo are .egistered marks of ACORD
oat28t202
rhmenl
/'l
fr
Attachment Code : D5&542 Master lD: 1477058, Certificate lD: 16753224
Lockton Companres
444 W . 47th Street. Suite 900
Kansas City, MO 64112
L
m(xroil
DUDEK.; 1477058
L6753224
CITY OF I.lENIFEE
29714 HAUN ROAD,
MENIFEE CA 92586
Dear Valued Cli ent:
In our continuing effort to provide timely cert'if icate del ivery, Lockton
Companies 'is utiliz'ing paperless defivery of Certificates of Insurance.
To ensure electronic delivery for future renewals of this certificate, we
need your email address. Please contact us via the email below and referenceCertificate iD: 15753224. You must reference this Certificate ID number in
r .lar f^r ll< t o com nl at. f hi s ro e
T'LuE
\,)
erti f i cate ID: 16753224
mail : kctsu@lockton.comubject Line: TSU E-Delivery
Pl ea se note
ava i 1ab1e.
that after February 2022, printed cert'ificates r.ri11 no longer be
Thank you for your cooperation and willingness in reducing our env'ironmentalfootpri nt.
Lockton Compan i e s
Techni cal Servi ces [rnit
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