2021/05/01 Lee & Stires, Inc.ArCoRiJ CERTIFICATE OF LIABILITY INSURANCE DAIE (f /DO/YYYY)
11130t2021
THIS CERTIFICATE IS ISSUEO AS A IIATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR I{EGATIVELY AMEND, EXTENO OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFTCATE OF TNSURAT{CE OOES NOT CONSTTTUTE A CONTRACT BETWEEN THE TSSU|NG TNSURER(S), AUTHORTZEO
REPRESENTATIVE OR PRODUCER, ANO THE CERTIFICATE HOLOER.
IMPORTANT: lf the certiflcats holdor is an AODITIONAL INSURED, tho policy(ios) must have AOOITIONAL INSURED provi3ion! or bo ondorsod.lf SUBROGATION lS WAIVEO, subject to tho torm3 and conditions ot the policy, corlain policiss may requirs an endorsoment. A ltatemont on
this certificete do€s not coniar rlghl6lo thg cerlilicato holdor in liou of such endorsement(s).
PRooucER Patriot Risk & lnsurance Services
2415 Campus Drive, Suite #200
lrvine, CA 92612
Annetle Romero
949-486,7
a m
INSU AFFORDI IIG COVER.AG E
14167
23434
36056
0K07568 TNSURERA: Guideone National lnsurance Company
INSURED rNsuRER B: Middlesex lnsurance ComLee & Stires lnc.
PO Box 2124Montclair CA 91763
IXSURER C : N lnsurance
rNst RER o : lnsurance Company of The Wesl 27W7
INSI'RER E
[rst RER f
COVERAGES
CERTIFICATE HOLDER
CERTIFICATE NUMBER:REVISION NUMBER
CANCELLATION
lll9R POLICY EXP
THIS lS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAi.{ED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWTHSTANDING ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES OESCRIBED HEREIN IS SUBJECT TO AIL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
EACH OCCIJRRENCE
OAMAGE IO RENTEO
PREMISES lE3 mu16n6J
COMiIERCIAL GEI{ERAL LIABITITY
GEN'L AGGREGATE LIMITAPPLIES PER
5gt f l.oc
56300040300 51112021 5t112022
MED EXP (Any ono p€Bo.)
PERSONAL A ADV INJ URY
GEN ERAL AGGREGATE
PRODUCIS . COMP/OP AGG
r1.000,000
s50,000
$2,000,000
$
$2,000,000
5 000
$1 000 000
COMBINEO SINGLE LIMITB
OWNEO
HIREO
SCHEDULED
NON,OWNEO
AUTOTIOBILE LIABILITY A0173630001 5t1t2021 5t1t2022
BOOILY INJURY (Por p.@n)
BOOTIY INJURY (Pq a@id6.t)
PROPE TY OAMAGE(Por addst\
$ 1,000,000
Itta
c
EXCESS LIAS
DED REIENTIONS
OCCUR LA2l EXCZOlJFYIC 51112021 51112022 !!p. !800
r5,000,009
I
D woRKERacoxPEttaafloir
AI{O EXPLOYERS' LlABILtrY
ANYPROPRIETOR/PARTI{ER/EXECUIIVE
OFFICER/MEMSEREXCTUOEO.7(x...hqy ln tlB)
lf y.., deb. undg
NFSCRIPTION OF OPFRATIoNS MI&
N
4 1 311
E,L. EACH ACCIOENT
E,L DISEASE. POLICY LIMIT
E,L. OISEASE, EA
11,000,000
31 000.000
! 1,000.000
A0173630003A lnland Marin€5t1t2021 5t1t2022 Leased/Rent€d 5100,000
Oeductible $1,000
DESCRIPTION OF OPERATIOIS / LOCATIONS / VEHICLES (AC ORO 10, , Addilion.l R.m..t. S.h.dul., m.y b. .tt ch.d It mor. .p!c. i. r.quiod)
Citv of Menifee
29714 Huan R.l
Menifee CA 92586
SHOULD ANY OF THE ABOYE DESCRIBED POLICIES AE CANCELLED AEFORETHE EXPIR.qNON DATE THEREOF, NOTICE wlLL BE OELIVERED IN
ACCORDANCE wlTH THE POLICY PROVISIOI{S.
AUTHORIZED REPRESENIATIVE
Dave Jacobson
@ 1988-2015 ACORD CORPORATION. All rlghta rosorvod.
ACORD 25 (2016103) Tho ACORD name and logo aro reglstered marks of ACORD
6522arc! | 2t/27 cLlAU.m/rM ,r/.' rc lAnnd_. pJnrro I rl.ro/r02, I Pas.. of lThis.ert-ficaEe cancels and supersed;. ALL prevroLsly isaued ce,rifrcaLes.
I
I o""u"
I
Re: Transporlation Permit
'30-day notic€ of cancdllation / 1o-days 6r non-paymont ot premium.
Lee & Stires Inc
POLICY NUUBFR 56300040300 GOTTERCTAL OEI'ERAL LIABIUTY
CO 20 l0 0,4 13
THIS ENDORSEMENT CHAI{GES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SGHEDULED PERSON OR
ORGANIZATION
Thb andorrmait modfras lnll,rrrlca paot ldcd urdar tha loltdrlng:
COiM|ERCIAL GANEML LIABIUTY @I/ERAGE PART
SCHEDULE
ilams Of Addl0orrl llEurtd Pa]ron(!]
Or Olelnts Uon(rl Locotlon(t) Of Coyortd ODcrrtlons
lnfo.rilton rsqulr€d b comDleto thlt S:dr.dub. nd C|own 8bovo, wll b. sh6xn ln lha Dcd.ouonr.
A S.cOo.! ll - luho b An lntllnd b mnd.d tohdu& a fr rddtsral l nod lh€ pe[on(r) dolgt {t 0oo(.) .tEwn h Olr Sdl.(ltb, U,l mly
u,lti rrrprct b [.mry lbr to( y hl'ry, ?ogGftydmg." or he[ond rnd rlrvrrtdng lnl4,,
c.ua€d, ln strde a ln p!rt, by:
l. Youi !d3 or omhdqtr; or
2. The acls or omllslons ot lhoaa acIng on yout
b.halt
h lhs p.]lbntlE of your ongohg oparatlom fortl. rddlumd hf,Jltd(.) .t lh. lrdon(3)
daalgnabd abor..
Hova\rar:
l. Tho h$nnca .fbrdod b rrdt .ddloodhurrd only .DpIe. b lra c,(bnt pdml[od bylixr: mrl
2. lf colrartg! F(ovldad to lhe addfrond lnrnad bllqulrql by a cmtrct or tortqnent th.hor,trE rftdcd b rdr.ddlthfial hamdwlll not b. bm.dar tisn ttd ri ch ),ou .ror.qulnd by 0u contract of .ori3irgrt bpmvldc tor aroh !(E[onal lnaurad.
B, \,t tti r{p.cl b thc hrn nca afiordod io th€.€a(Euond hrJrr(b, lh. lbMrg ad.I0o€lo,cidqrsgly
Thb lrflrr.nE do.. not apply b tody lnlury or
!rcp€dy Am.gc' ocilnlng .tbr:
1. All wo*. lrdudlng mr[dd8, frt! or
aquhmort fumhh€d h cornec0on wllh luchuo , on th€ plolact (drar th.n lorvlco,mdnbrac. or rap.l,r) b b! p.rtrm€d by or
on b.h.lt of lha .ddltsd lnllred(t) et th.bcstbfl d tfu cov.rtd op.,rtotrt h.a bcr
comcabdi or
2. Thn po.ton ot .yqlr u,orf oI d whlch th.hiry or d!,lrlgc art6 h.t bsdi put b ltslnblIlod uts by my parto.r q ollmtsdsr
olrlsr lhm rndraf aonhrlor a ubconlttdorengf,g.d h pa.Ernhg opo.ltdrt lbr tpdn@l.r . p. ortha arlre prolsct
cc 20 't0 0a t3 O Inruruc. Sewl6 Ofiao, |rc., 2012
6sr2orol | :r/r, GL/^u/m/rM 22/2r rc | | r}/rolr021 r,5s,]1 pra (psri i p!q. 2 or ,ThiB certific.t. crnccl6 ad supe,seda€ AI-L prevroualy iE8ued celtificateB,
Plgo I ot 2
C. VU0i ,E p.d b lha lnsur.ncs lllbftf.d b tr.s6ddtlond lnardr. ulc b[oul,B b 8.l.,ed b!.coon lU - Llnfia Ot ln.u]rllc.:
lf covara0a provldad b 0re addton l lnunld bra$ftld by r omtraal or agrlrlmnt, 0rr moat wg
wnl p.y on behalf ot llo lddltolrll ll[urrd b lh6
amounl ot lnturutca:
f . R€qrr€d by tlc cmtect or lgraornclt or
& Av.[rU. und.r Ur. rpCc.bb Lbnlt! ollnau rca drown ln thr Dechnlbo.:
wlilahavar b lata.
ThL lndoltanant drall ]d lnorllrc lhosppllc.U. Llmlta d l ultnco rhowr ln thsDaclrr ofil.
Prg. 2 or 2 O lnruranca Scrutrcsa Olttcs. lnc.. 2012
6122ora1 | 27/22 cL/^u/w/LA 2ll23 ic | ^M.tt. R6.ro I lr/ro/2o2r t'ss:!1 rPsr) | P.se I of ]Thls celtiftc.t. c.nc.l. ud supelaedas ALL plevloudIy r6su.d c.ttifi.aLe6.
CO 20 l0 0.1 lt