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CERTIFICATE OF LIABILITY INSURANCE 0
THIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER. THIS
CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTENO OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURAT.ICE OOES NOT CONSTITUTE A CONTRACT SETWEEN THE ISSUING INSURER(S), AUTHORIZEO
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLOER.
IMPORTANT: lf th€ certlflcato holder ls an ADDITIONAL INSURED, tho policy(l6s) musl have ADDITIONAL INSURED provisions or bo ondorsed.
to the terms and conditlons of tho potlcy, certaln pollcies may requlre an endo.sement A statement onlf SUBROGATION ls wAlVEo, subject
the certificate holde. in lleu of such endo6ement(s)-this certificate does not confer rights to
PHOI.lE
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626-577-6656
agema upp e-me
Lisa Hageman
626-795-9921
Penn-Star lnsurance CompanyINSURERA:
PROOUCERSupple-M€rrlll & Driscoll lnc.
lnsurance AgonE and BrokoE
P O. Box 2408
Pasadena, CA 91102
Supple-Mer.ill & Orlscoll lnc.
626-795.9921
35076R I . State Compensation lns. FundtNs
rNsuRERc: Mt. Hawley ln3urance Co,
r{suREi D . California Automobile lns. Co.
15792r,rsuRER E. Underwriters at Lloyds
INSUREOCommorclal Transportatlon Ssrvicoa lnc.
Dino P6ruolno
702 S. Treinor Avenuo
San Olmas, CA 91773
ERTAIICATE
HAVE
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EXP LIMITSSUPOUCY NUiIBERINSRTYPE OF INSIJRAiICE
1,000,000NCEx
100,000D
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2,000,000
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AUTOMOBILE LIABILITYD
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2,000,000OCCUR
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ANO EMPLOYERS' UABILITY
ANY PROPRIEIORJPARTNER/EXECUTIVEOFFICERfi EMAER EXCLUOEO?
EA CLAIM
AGG
1,000,000
1,000,000
09t01120221251186EPROFES
DESCRIPnO|I OF OPERATTONS I LOCAnONS / VEHTCLES (ACORD I Ol, Addlllon.l R.m.rk. Sch.dul., m.y b. .t!.ch.d li more .p.c. l. 6qulEd)
Proof of insurance.
CITYOME
City Of Menifee
Ms. Wendy Welch
29714 Huan Rd.
Menifee, CA 92586
SHOULO ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLEO BEFORE
THE EXPIRATION DATE THEREOF, NOTICE wlLL BE DELIVEREO IN
ACCORDANCE wlTH THE POLICY PROVISIONS,
AIITHOR12EO REPRESENIATIVEbr;{ t. ,/hrrr//
O 1988.2015 ACORD CORPORATION. All rights resewed.ACORD 25 (2016/03)
The ACORD name and logo are regiBtered marks of ACORD
INSIIFEPISI AFFORDING COVERAGE
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