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2022/05/17 Dollamur, LPALoRi}CERTIFICATE OF LIABILITY INSURANCE 5117 t2022 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 AFFOROED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE OOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, ANO THE CERTIFICATE HOLDER, IMPORTANT: lf the certificate holder is an ADOITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. lf SUBROGATION lS WAIVED, subject to the terms and conditions oI the policy, certain policies may r6quire an endorsement. A statement on this cortificate does nol confer rights to lhe csrlificale holder in lieu of such endorsement(s). PRODUC€R Hagginbotham lnsurance Agency, lnc. 500 w. 13TH Fort Worth TX 76 102 817 -336-2377 817 -882-9284 cenificales hi inbotham.nel tn s URER(s) AFFOROING COVERAGE rNsrrR€RA: TeXaS MUlUal lnSUranCe cOmpany 22945 INSUREO Dollamur LP 1734 E. El Paso Street, Suite 1'10 Fort Worth TX 76102 rNsuRER a: Fedeaal lnsurance company 24281 tNsURER c: The continental lnsurance company 35289 rNsURER O: EVanslon lnSUIance cOmpany 35378 rNsuRER E: HSB SpecialW lnsurance Company 14438 COVERAGES CERTIFICATE NUMBER:'1 50557784 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AAOVE FOR THE POLICY PERIOO INDICATEO. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED AY THE POLICIES DESCRIBED HEREIN IS SUAJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCEO BY PAID CLAIMS, c x COMMERCIAL G!NERAL LIAB LITY CLAIMS.MADE GEN'L AGGREGATE LIltvlIT APPLIES PER: X 5F"1 I.o" X X 7014967855 5t17n422 5117 t2423 EACH OCCIJRRENCE s I 000 000 PREMISES (Ea MUtrence)51000.000 M€D ExP (Any on6 person)s 15.000 PERSONAL & ADV INJIJRY 51.000.000 GENERAL AGGREGATE s2 000.000 PROOUCTS . COMP/OP AGG $2.000.000 c AUTOMOBILE LIAAILITY x OWNEOAIJ'OS ONIY HIREO SCHEOULEOAUIOS NON.OWNEOxX 7014938839 5t17t2422 5117t2023 COMBINEO SINGL€ LIMIT s 1.000 000 BOOILY TNJURY (P6rp€Bon) sBoOILY INJURY (P6r a@rdenl) s D EXCESS LIAS X CIAIMS.MAOE MKLV3EUL1O2356 5t1712022 5t17 QA23 EACH OCCURRENCE 5 5 000 000 x AGGREGATE s 5 000 000 DED RETENTION $s WORXERS COMPENSATION ANO E PLOYERS' LIABILITY ANYPROPRIETOF/PARTNER/EXECUTIVE OFFICERlMEMBEREXCLUOED? DESCRIPTION OF OPERATTONS below 0002447787 5117 t2022 5t17t2023 x I 8FIr,r. I OTH. E L EACI] ACCIDENT 51 000.000 E L OISEASE. EA EMPLOYEE 51000.000 E L OISEASE. POLICY LIMIT s 1000.000 B E 42254404 01-cY-0005512131-00 1 000 000 1 000 oo0 10 000 OESCRIPTIOIiI OF OPERATIONS / LOCATIONS / VEHIC LES (ACORO lOl,Additionel R.m.rt. Sch.dul., m.y b..tt ch.d ii mor..p.c.l. r.qul.d) The General Liability and Automobile Liability policies include a blankel automatic addilional insured endorsemenl lhat provides additional insured status and General Liability, Automobile Liability and Workers' Compensation policies includes a blankel waiver of subrogation endorsement to the cerlillcate holder only when there is a wrillen conkacl betlveen lhe named insured and lhe cerlificale holder thal requires such slalus. The General Liability and Automobile Liability policies have a blanket Primary & Non Conkibutory endorsement lhat affords lhat coverage lo cerlilicate holde.s only where lhere is a witten contracl between lhe Named lnsured and the cerlifcate holder that requkes such stalus Umbrella is Follow Form. City of lrenifee is included as Additional lnsured in accordance wilh lhe policy provisions oflhe General Liabilily policy. CERTIFICATE HOLDER CANCELLATION City of Menifee Attnr Finance Department Accounts Payable 29844 Haun Road Menifee CA 92586 SHOULO ANY OF THE AAOVE OESCRIBED POLICIES BE CANCELLEO BEFORE THE EXPIRATIOII DATE THEREOF, NOTICE wlLL BE OELIVERED lN ACCORDANCE WITH THE POLICY PROVISIONS, O 1988.2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORDACORD 2s (2016/03) l s|7t2022 I 5117t2023 1st17t2022 15117t2023 CERTIFICATE OF LIABILITY INSURANCE 511712022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRIIATIVELY OR NEGATIVELY AMEND, EXTENO OR ALTER THE COVERAGE AFFORDEO 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. IMPORTANT: ll the certificate hold€r is an ADDITIONAL INSUREO, the policy(ies) must have ADOITIONAL INSUREO provisions or be endorsed. lf SUBROGATION lS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A slalement on this certificate does not confer rights to (he certificate holder in lieu oI such endorsemenl(s). PROOUCER Higginbotham lnsurance Agency, lnc. 500 w. 13TH Fort Worth TX 76102 817 -336-2377 817 -882-9284 certillcate h am.nel INSU RER(S) AFF ORDING COVERAGE TNSUFERA: Texas l\rutual lnsurance Company 22945 Dollamur LP 1734 E. E|Paso Street, Suite 110 Fort Worth TX 76102 tNsuRER B : Federal lnsufance companY 20281 rNsuRER c: The continenlal lnsurance company 35289 rNsuRER D: EVanslon lnsurance company 35378 Ir,tsuRER E: HSB Specialty lnsurance company 14438 COVERAGES CERTIFICATE NUMBER: 180596041 5 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOO INDICATED. NOTWTHSTANDING ANY REQUIREMENT, 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIO CLAIMS. (:x COMMERCIAL GEN ERAL LIABILITY CLAIMS.I\IADE GEN'L AGGREGATE LIMIT APPLIES PER X JECI OTHER X X 7014967855 5t1712022 EACHOCCURRENCE s1000.000 OAMAGE TO RENTED PREMISES (Ea occ!r€n.6)91,000.000 MEo ExP (Any on6 p6/son)s 15 000 PERSONAL & AOV INJURY s 1.000 000 GENERAL AGGRE GAT E $ 2.000 000 PRODUCTS . COMP/OP AGG s2 000 000 S c AUTOMOBIL€ LIABILIIY X OWNEO HIREO AUTOS ONLY SCHEDULEO NON,OWNEOXx 511712022 5t'17 t2023 COMAINEDSINGLE LIMIT s1000.000 eO0lLY INJURY (Per p66on)S SO0ILY INJURY (Pff accrd6nl)s S s 0 EICESS LIAB x OCCUR MKLV3EUL1O2356 5/17 t2022 5117/2023 s 5.000 000 X s5 000 000 DEO RETENTION S s WORKERS CO PEI{SATION AND EI'PLOERS' UASILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERA,IEMBER EXCI!OEO? OESCRIPTION OF OPERATTONS below N 0402047147 5t1712022 X STATUIE OTH.ER E L EACH ACC]OENT t1.000.000 E L DISEASE. EA €MPLOYEE $1.000.000 E L. OISEASE, POLICY LIMIT $1.000.000 B E 82254404 01-cY-0005512131-00 5t17 t2022 5h712022 511712023 5/17/2023 1.000000 1 000 000 10 000 oEscRlPllol{ OF OPERAIIONS / LOcAnOtS / VEHICLES (ACORD 101, Additlon.l F.m..i. S.h.d!lo, ma, b..tt ch.d It mo.. rp&.li r.qui6d) The Gene.al Liability and Aulomobile Liability policies include a blankel automalic additional insured endo6emenl that provides General Liability, Automobile Liability and Workers' Compensation policies includes a blanket waiver of subrogation endorseme when there is a writlen conkacl between the named insured and the certificate holder that requires such slalus. additional insured status and nt to lhe ce.tificate holder only The General Liability and Automobile Liability policies have a blankei Primary & Non Contribulory endorsement that affords thal coverage to certifcale holders only where there is a written conlract between the Named lnsured and the certificate holder lhat requires such status Umbrella is Follow Form. See Attached... CERTIFICATE HOLOER CANCELLATION City of Menifee Attn: Finance Department - Accounts Payable 29844 Haun Road Menifee CA 92586 SHOULD ANY OF THE ABOVE OESCRIAEO POLICIES BE CANCELLEO BEFORE THE EXPIRATIOi{ DATE THEREOF, NOfICE WILL BE OELIVEREO It,I ACCOROANCE WlTH fHE POLICY PROVISIOI{S, @ 1988-2015ACORD CORPORATIoN. All rights reserved The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) 5t1712023 ll^'-'"" 5t17t2423 ---\ .A(,-()r?t)" AGENCY CUSTOMER lD: DOLLLP0-0'l LOC # ADDITIONAL REMARKS SCHEDULE Page T of 1 Higginbolham lnsurance Agency Inc. NATED INSUREO Dollamur LP 1734 E. El Paso Street. Suile 110 Forl Worth TX 76102 EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SC}IEOULE TO ACORO FORM, FORM NUMBER: 25 FONM ITLC.CtR IIFICA IE OF LIABILITY INSURANCL Certificale Holder is included as Addational lnsured in accordance wlh the poliry provisions of the General Liabilily policy. . General Liabilily policy evidenced herein rs Pflmary and Non-Contribulory lo olher insurance avarlable lo Addrtronal lnsured. but only rn accordance wth lhe policy's provisions. O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORO ACORD 101 (2008/01) a,<:c>pi:" 5t17 t2022 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, IMPORTANT: lf the certificato holder is an AODITIONAL INSUREO, the policy(ies) must have ADDITIONAL INSUREO provisions or be endorsed. lf SUBROGATION lS WAIVED, subiect lo the terms and conditions of the policy, certain policies may require an endorsement. A slalement on this cer(ifi6ate does not conf€r rights to the certificate holder in lieu of such endorsement(s). PRODUCER Higginbotham lnsurance Agency, lnc. 500 w. 13TH Fort Worth TX 76102 817 -336-2377 417 -882-9284 cerlificales h nbotham.nel INSU AFFORDING COVERAGE TNSURERA: Texas Mutral lnsurance Com 22945 INSUREO Dollamur LP 1734 E. El Paso Street. Suite 110 Fort Worlh TX 76102 DOLLLPO-01 rNsuRER B: Federal lnsurance Com 20281 rNsuRER C : The cOnlrnental lnsurance com 35289 rxsuRER D : Evanston lnsurance a 35378 INsURER E HSB lnsurance Com 14438 COVERAGES CERTIFICATE NUMBER: 500431 129 REVISION NUMAER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWiTHSTANDING ANY REQUIREMENT. 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, c x COMMERCIAL GENERAL LIAA ILlTY CLAIMS.MADE GEN'L AGGREGAIE LIMITAPPLIES PER OTHER JECI LOC X X 7014967855 5117 t2022 511712023 EACHOCCURRENCE $ 1 000 000 OAMAGE TO RENTEO PREMISES (Ea @c!rcnco)$ 1,000 000 MEo ExP (Any on6 p6rso.)$ 15.000 PERSONAI & AOV INJURY 51000.000 GENERALAGGREGATE s2 000.000 PROOUCTS , COMP/OP AGG 52.000.000 t AUTOMOAILE LIABILITY X OWNEO AUTOS ONLY HIREO AUTOS ONLY SCHEOULED X X COMBINEO S]NGLE LIMIT $1.000 000 SODILY TNJURY (P6rpe60r)$ SODILY INJURY (P6r accrd6nl)$ 5 $ o EXCESS LIAB X IVKLV3EUL1O2356 5117P422 511712023 EACHOCCURRENCE s5 000.000 x AGGREGATE s 5 000.000 oE0 RETENT ONS s WORKERSCOTPENSANON A'IO ETIPIOYERS' IIABILIIY ANYPROPRIETOfu PARTNER/EXECUIIVE OFFICER/MEMgEREXCLUDEO? OESCRIPT]ON OF OPERATIONS b6IN N 0042047787 511712022 5117t2423 OTH- E L. EACH ACCIOENT $1.000.000 E L, OISEASE,EA EMPLOYEE E.L, DISEASE, POLICY LIMIT $1.000 000 $ 1.000 000 B 42254404 01-cY-0005512131-00 5t17 /2022 5117 t2022 5117t2023 511712023 1 000 000 1 000 000 10 000 DESCRIPTION OF OPERAnO S / LOCATIONS /vEHlCLEs (ACORD 1Ol. Addltlon.l R.m.rt. sch.dul., n:y b..tl,ch.d ll no.. .p.c. I. ..qui6d) The General Liability and Automobile Liability policies include a blankel automatic addilional insured endorsemenl lhat provides additional insured status and General Liability, Automobile Liability and Workers' Compensation policies includes a blankel waiver ol subrogation endorsemenl to lhe ce.tifcate holder only when there is a written contracl between the named insured and lhe certifcale holder that requires such slalus. The General Liability and Aulomobile Liability policies have a blankel Primary & Non Conlributory endorsement thal affords that coverage to certificale holders only where there is a wrillen contracl betv/een the Named lnsured and lhe cerlifcate holder that requires such status Umbrella is Follow Form. City of Menifee is included as Additional lnsured in accordance with lhe policy p.ovisions oflhe General Liability policy. CERTIFICATE HOLDER CANCELLATION City of Menifee 29844 Haun Road Menifee CA 92586 SHOULD ANY OFTHEABOVE OESCRIBED POLICIES BE CANCELLEO BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE OELIVEREO IN ACCORDANCE wlTH THE POLICY PROVISIOT{S. @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016i 03) CERTIFICATE OF LIABILITY INSURANCE tr c ll^'"*" ,",ror, lrn,or"