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2022/10/01 Gallagher Benefit Services, Inc.SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 WITH 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 10/6/2022 Arthur J.Gallagher Risk Management Services,Inc. 300 S.Riverside Plaza,Suite 1500 Chicago IL 60606 Direct All Inquiries to Email Chi_Certificates@ajg.com Arch Insurance Company 11150 ARTHJGA113 Arch Indemnity Insurance Company 30830GallagherBenefitServices,Inc. Koff &Associates 2835 Seventh Street Berkeley CA 94710 96166751 A X 2,000,000 X 1,000,000 10,000 2,000,000 4,000,000 X Y 41GPP4938415 10/1/2022 10/1/2023 4,000,000 A A 5,000,000 X X X 41CAB4938315 41CAB4939015 10/1/2022 10/1/2022 10/1/2023 10/1/2023 A B X N Y 41WCI4938115 44WCI0501915 10/1/2022 10/1/2022 10/1/2023 10/1/2023 1,000,000 1,000,000 1,000,000 General Liability: General Aggregate Per Location Subject to $10 Mil Policy aggregate. Certificate holder is included as an Additional Insured on the General Liability policy per form 00 GL0596 00 04 10 attached as required by written contract pursuant to and subject to the policy's terms,definitions,conditions and exclusions. RE:Project:City of Menifee Classification &Compensation Study.City and its officers,employees,agents,and authorized volunteers are Additional Insured on See Attached... City of Menifee 29844 Haun Road Menifee CA 92586 DocuSign Envelope ID: 8B58F238-5302-447A-8912-706A21F3C560 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: ARTHJGA113 1 1 Arthur J.Gallagher Risk Management Services,Inc.Gallagher Benefit Services,Inc. Koff &Associates 2835 Seventh Street Berkeley CA 94710 25 CERTIFICATE OF LIABILITY INSURANCE the General Liability policy per form 00 GL0596 00 04 10 When required by written contract.The insurance provided in the General Liability policy is primary and any other insurance shall be excess only,and not contributing.Waiver of subrogation applies in favor of Additional Insured per Workers Compensation form# WC000313,when required by written contract. DocuSign Envelope ID: 8B58F238-5302-447A-8912-706A21F3C560 41GPP4938415 10/01/2022 DocuSign Envelope ID: 8B58F238-5302-447A-8912-706A21F3C560 44WCI0501915 44WCI050191510/01/2022 DocuSign Envelope ID: 8B58F238-5302-447A-8912-706A21F3C560 41WCI4938115 41WCI493811510/01/2022 DocuSign Envelope ID: 8B58F238-5302-447A-8912-706A21F3C560 41GPP4938415 DocuSign Envelope ID: 8B58F238-5302-447A-8912-706A21F3C560