2022/10/01 Cellebrite, Inc.o.Go'GERTIFICATE OF LIABILITY INSUHANCE Acc'. 22arca2
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFEBS NO RIGHTS UPON THE CERTIFICATE HOLDEB. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OB ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTBACT BETWEEN THE ISSUING INSUREB(S), AUTHORIZED
REPRESENTATIVE OR PRODUCEB, AND THE CERTIFICATE HOLOER.
COVEBAGES CERTIFICATE NUMBER REVISION NUMBER
10t01/2022
IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have AODITIONAL INSUREO provisions or be endorsed. lf
SUBROGATION lS WAIVED, subject to the terms and conditions of the policy, cortain policies may require an endorsement. A statement on this
certilicate does not conter rights to the certificate holder in lieu ol such endorsement(s).
CONTACI
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AOOFESS
PROOUCEF
Lockton Companies, LLC
3657 Briarpark Dr., Suite 700
Houslon. TX 77042 INSPERIIYC€R1S@LOCITONAFFINIIY C!U
INSUBEF{S) AFFOR9ING COYEF49q
Ace American lnsurance Co.
INSUBEO
CELLEBRITE INC.
7 CAMPUS DR STE 210
PARSIPPANY. NJ 07054'4413
PHONE
INSUREF E
INSUFER C
INSIJFEF O
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOH THE POLICY PERIOD
INDICATED, NOTWIIHSTANDING ANY REOUIREI\,4ENT. TERM OB CONDITION OF ANY CONTRACT OR OTHER DOCUI\,ENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUFIANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEBI!4S.
EXCLUSIONS AND CONOITIONS OF SUCH POLICIES, LIMITS SHOWN I.IAY HAVE BEEN BEOI]CED BY PAID CLAIMS,rNsii-TYPE OF INSUNANCE AOO! SUBF
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DESCF|PT|ON OF OPE FAITONS / LOCATTONS / VEHICLES (ACOFO 101. Addnion.r F.m..r! Sch.dul., mry b..tich.d i, mor. spa.. E r.qulr.d)
WAIVEF OF SUAROGATION lN FAVOB OF C y ol Men iee and rlsollice.s WHEN BEOUIFED BY WBITTEN CONTFACT.
CERTIFICATE HOLDEB CANCELLATION
SHOULD ANY OF THE ABOVE OESCNIBED POLICIES BE CANCELLEO BEFOFE
THE EXPIRATION OATE THEFEOF, NOTICE WILL BE OEIIVEFEOIN ACCOFOANCE WITH THE POLICY PFOVISIONS.
CITY OF MENIFEE ANO ITS OFFICERS.
EMPLOYEES, AGENTS, AND AUTHORIZED VOLUNTEERS
29844 HAUN ROAO
MENIFEE. CA 92586
AUTHORIZEO AEPRESENTATIVE
O 1988-20'16 ACORO COBPOHATION. All rights reserved.
The ACORD name and logo are regislered marks ol ACORDACOBD 2s (2016/03)
888 828 8365
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Workers' Compensation and Employers' Liability Policy
Named lnsured
CELLEBRIIE INC
7 CAMPUS DR STE 210
PARSIPPANY NJ 07054.4413
Endomement Numbtr
Symbol: RWC Number: C51498057
Policy Period
10to1 t2022 f o 10101 12023
Effective Date of Endorsement
10to112022
lssued 8y (Name of lnsurance Company)
ACE AMERICAN INSURANCE COMPANY
lnsert the policy number The remainder of the information is to be completed only when thrs endorsement is issued subsequent to the preparation of the policy
This endorsement changes the policy to whrch il is attached and is effectNe on the date rssued unless olherwise stated
CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because California is shown in ltem 3.A. of
the lnformation Page.
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule, but this waiver applies only with
respect to bodily in.jury arising out of the operations described in the Schedule, where you are required by a written
conlract to obtain this waiver from us.
You must maintain payroll records accurately segregating the remuneration of your employees whrle engaged in
the work described in the Schedule.
Schedule
X Specific Waiver
Name of person or organization
City of Menifee and its officers,
29844 Haun Road
Menifee , CA 92586
()
2. Operations
3. Premium:
The premium charge for this endorsement shall be 1.0 percent of the California premium developed on
payroll in connection with work performed for the above person(s) or organization(s) arising out of the
operations described.
4. Minimum Premium: $0
Q*nM..<
wc 90 03 75 (05/18)
Authorized Agenl
Blanket Waiver
Any person or organization for whom the Named lnsured has agreed by written contract to furnish this
waiver.
Workers' Compensation and Employers' Liability Policy
Named lnsured
CELLEBRITE INC,
7 CAMPUS DR STE 210
PARSIPPANY, NJ 07054.4413
Endorsement Number
Policy Number
Symbol RWC Number C51498057
Policy Period
10to1 12022 10 10101 12022
Etfective Date of Endorsement
1010112022
lssued By (Name of lnsurance Company)
ACE AMERICAN INSURANCE COIVPANY
lnsert the pohcy number The remainder of the informalion rs to be completed only when this endorsement rs issued subsequent to the preparatron of lhe policy
NOTICE TO OTHERS ENDORSEMENT. SPECIFIC PARTIES
A. lf we cancel this Policy prior to its expiration date by notice to you or the first Named insured for any reason other than
nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic or
other form of notification as we determine, to the persons or organizations listed in the schedule set out below {the
"schedule"). You or your representative must provide us with both the physical and e-mail address of such persons or
organizations, and we will utilize such e-mail address or physical address that you or your representative provided to us on
such Schedule.
B. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each person or
organization indicated in the Schedule at least 30 days prior to the cancellalion date applicable to the Policy.
C. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s)
named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any
such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or
organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or
representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy.
D. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any
incorrect information that you or your representative provide to us. lf you or your representative does not provide us with the
information necessary to complete the Schedule, we have no responsibility for taking any action under this endorsement. ln
addition, if neither you nor your representative provides us with e-mail and physical address information with respect to a
particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity
under this endorsement.
E. We may arrange with your representative to send such notice in the event of any such cancellation.
F. You will cooperate with us in providing, or in causing your representative to provide, the e-mail address and physical
address of the persons or organizations listed in the Schedule.
G- This endorsement does not apply in the event that you cancel the Policy.
SCHEDULE
Name of Certiflcate Holder Physical Address
City of l,4enifee and its officers,29844 Haun Road
Menifee , CA 92586
All other terms and conditions of this Policy remain unchanged.
This endorsement is not applicable in the states of AZ, FL, lD, l\,'lE, NC, NJ, NM, TX and Wl
Qaaai;,.<
wc 99 03 71 (01/1 1)
Authorized Representative
E-Mail Address
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