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2023/04/29 Dr. Susan Saxe Clifford PhDWLTR005
THE HARTFORD
BUSINESS SERVICE CENTER
3600 WISEMAN BLVD
SAN ANTONIO TX 78251 March 31, 2023
City of Menifee, Its officers, agents
and employees
Office of Finance
29844 HAUN RD
MENIFEE CA 92586
Account Information:
Policy Holder Details :Dr. Susan Saxe Clifford PhD
Contact Us
Need Help?
Chat online or call us at
(866) 467-8730.
We're here Monday - Friday.
Enclosed please find a Certificate Of Insurance for the above referenced Policyholder.Please contact us if you have any
questions or concerns.
Sincerely,
Your Hartford Service Team
DocuSign Envelope ID: 602987EC-5DFB-431F-8ACB-2D7616783B97
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
03/31/2023
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:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATIONIS 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).
PRODUCER
UNITED VALLEY INSURANCE SRVC/PHS
51131589
The Hartford Business Service Center
3600 Wiseman Blvd
San Antonio, TX 78251
CONTACT
NAME:
PHONE
(A/C, No, Ext):
(866) 467-8730 FAX
(A/C, No):
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC#
INSURED
Dr. Susan Saxe Clifford PhD
16530 VENTURA BLVD STE 603
ENCINO CA 91436-5017
INSURER A : Sentinel Insurance Company Ltd.11000
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:
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.
INSR
LTR TYPE OF INSURANCE ADDL
INSR
SUBR
WVD
POLICY NUMBER POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/Y YYY)LIMITS
A
COMMERCIAL GENERAL LIABILITY
X 51 SBA BA9405 04/29/2023 04/29/2024
EACH OCCURRENCE $2,000,000
CLAIMS-MADE X OCCUR DAMAGE TO RENTED
PREMISES (Ea occurrence)$1,000,000
X General Liability MED EXP (Any one person)$10,000
PERSONAL & ADV INJURY $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $4,000,000
POLICY PRO-
JECT X LOC PRODUCTS - COMP/OP AGG $4,000,000
OTHER:
A
AUTOMOBILE LIABILITY
51 SBA BA9405 04/29/2023 04/29/2024
COMBINED SINGLE LIMIT
(Ea accident)$2,000,000
ANY AUTO BODILY INJURY (Per person)
ALL OWNED
AUTOS
SCHEDULED
AUTOS BODILY INJURY (Per accident)
X HIRED
AUTOS X NON-OWNED
AUTOS
PROPERTY DAMAGE
(Per accident)
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS-
MADE
EACH OCCURRENCE
AGGREGATE
DED RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY
PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/ A
PER
STATUTE
OTH-
ER
Y/N E.L. EACH ACCIDENT
E.L. DISEASE -EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Those usual to the Insured's Operations. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this
policy.
CERTIFICATE HOLDER CANCELLATION
City of Menifee, Its officers, agents
and employees
Office of Finance
29844 HAUN RD
MENIFEE CA 92586
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
DocuSign Envelope ID: 602987EC-5DFB-431F-8ACB-2D7616783B97