2020/11/01 LifeStreamCERTIFICATE OF LIABILITY INSURANCE I I n t202t 912812021
THIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER. THIS
CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVELY AMENO, EXTENO OR ALTER THE COVERAGE AFFOROEO BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES t{OT CONSTTTUTE A CONTRACT BETWEEN THE tSSUr{c [{SURER(S), AUTHORTzED
REPRESE'{TATIVE OR PRODUCER, ANO THE CERTIFICATE HOLDER.
It PORTANT: lf tho canificato holder is an ADDITIONAL INSUREO, the policy(ies) must havo AODITIONAL INSUREO provlsloda or l,o sndoBodlf suBRoGATloN ls wAlvED, subjoct to tho te.m8 and condltlon3 of tho pollcy, certaln pollclos may ,Equirc an sndorsomenl A gtatomgnt onthi8 c€rtlficate dosr not contur rlghts to the certlflcate holder tn eu of auch ondor!omont(s).
PROOUCER Locklon Companies
El l0 E Union Avenue
Suire 100
Denver CO 80237
(303) 4r 4-6000
PHONE
INSUREO LifeShe6m
384 West Orsnge Show Road
San Bemardino, CA 92408
1454980
COVERAGES CERTIFICATE NUMBER: I REVISION NUMBER: XXXX
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AEOVE FOR THE POLICY PERIODINDICATEO NOTWTHSTANDING ANY REOUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUMNCE AFFORDED BY THE POLICIES DESCRIEED HEREIN IS SUBJECT TO ALL THE TERMSEXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOVI/I.I MAY HAVE BEEN REOUCED BY PAIO CLAIMS
LIMITS[\]sRT-LrR I TYPE OF INSUFANCE laOOLlsuEiT
xfl,c7ti9819A003 r/t/2020 t 1/l t2o2t
lM occ+
90-04101,02 I v t /2421
$ xxxxxxx
X N $
s
I]N \
MEO EXP
t I t/2020
000,000$l0
TH
s XProf. Liab CIms Made
SIR: $l M each occ _
LAGGREGATE LIMIT APPLIES PER
PoLrcYEi$t ELoc
ESMts
sl 000 000
AOOILY INJURY (P6r p6Bon)$ xxxxxxx
BOOILY INJURY (P6r 6@ld6nD 5 xxxxxxx
COMMERCIAL GENERAL TIAEII IIY
$ xxxxxxx
$ xxxxxxxPRODUCTS, COMP/OP AGG
GENFRAI AGGRFGATF
AUTOMO€ILE UAAILITY
x
rxEACH OCCURRENCE
L
SCIiEDULEO
NONOWNED
AUTOSONLY
a-
CLATMS MAOE IX OCCua
OW!EDAUTOS ONLY
BrREO
AUTOS ONLY
r0,000,000
xxxxxxxxxxxx
rE6 edonll
x
A UMBRELLA LIAB |fir2o2o tvtno2tv Nl xrr.czr rsr.rse.oo:OCCUR
EXCESS LIAB
RETENTIONi
EACH @CURRINCE
AGGREGAIE -INCL, ABOVF,
$ xxxxxxx
! xxxxxxx
s xxxxxxx
WORXERS CO PENSANON
AND EiIPLOYERS' LIABILIrY
ANY PROPR ETOR/PARTNER]EXECUTIVE
OFFICER/MEMAER EXCLUOED?
DESCRIPTION OF OPERAT ONS barN
X T PER --- llsrATUrE I
E L, DISEASE . POLICY LIMIT s 1.000.000
$1,000Jo0
EL OISEASE - E r,000000EMPLOYEE5
C
I]E L EACH ACC]OENT
t 1/ 1n020
I | /t/2020
1t/t 12021
It1t2021
OESCRIPI|ON OF OPERAnONS / LOCATIONS /VEHICLES IACORO lol. Addtuml R. rlr. S.h.duh, yb..lt cn drlll@.p.oltlrqulndl
Auto Physicll Ddag. i. S.lf-lnsucd C.nificlt Holdd is m Addilio.d lnlEd I rcsFcB Gcn.El, Auto ed Excc$ Lisbi,ity. C@.89. ii ofcrEd on r Pnm,IyNo.-ConEihtory b8i3 sh.rc Eqrrcd by winc, cort aq *i$ es.rd to Blood Driv.r & chr.d Weial *615 ho3r.d by Ns.d Ls.d All cov.rEges includc Wovd ofsubros.t,onld8@9. vhich rsvoE
^dditionsl
ln!@d whcr. Equircd by *rincn rAtld.nl sd ns Fmin d by lN Prof.srion l Lirbility (ClaimsM.d. R.to 0 I /0 I /02 ) Addiuon.l bsutrd: Ciry
CERTIFICATE IIOLOER CANCELLATION SeeAttachments
17902337
City of Menifee
29844 Haun Rd
Menifee CA 92586
SHOI'LD AI{Y OF IIIE ABOVE OESCRIBEO POLICIES BE CAI{CELLEO BEFORE
THE EXPIRATION DATE THEREOF, NOTICE wlLL BE DELIVERED II{
ACCOROANCE WTH THE POLICY PROVISIOI{S.
AUTl]ORIUEO REPRESE'!TA
@,t98 ACOR
acoRD 25 (2016/03)The ACORO name and loqo are regiate.Gd marks of ACORD
coR TION. All rights reservsd
AC;oRif
PERsoNAT !ADvTNJURY r XXXXXXX
y/N N goolt o tot
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