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2023/05/12 Chambers Group, Inc.9/9/2023 Driscoll & Driscoll Insurance Agency, Inc. 41235 11th St West, Suite B Palmdale CA 93551 (661)266-9390 (661)266-9391 Certs@DriscollandDriscoll.com Chambers Group, Inc 3151 Airway Avenue Suite F208 Costa Mesa CA 92626 Nautilus Insurance Company Key Risk Insurance Company Insurance Company of the West CL235922697 A X X X X Y ECP2026303-15 5/12/2023 5/12/2024 1,000,000 100,000 10,000 1,000,000 2,000,000 2,000,000 B X BAP2037737-11 5/12/2023 5/12/2024 1,000,000 A X X FFX2026322-15 5/12/2023 5/12/2024 10,000,000 10,000,000 C N WVE 5055233 03 5/12/2023 5/12/2024 X 1,000,000 1,000,000 1,000,000 A Contr Pollution Liability ECP2026303-15 5/12/2023 5/12/2024 Per Occ / Agg 1 M / 2 M A Professional Liability ECP2026303-15 5/12/2023 5/12/2024 Claims Made 1,000,000 Blanket Waiver applies to the General Liability Policy per form # ECP 1260 01 21. Blanket Primary & Non-Contributory wording applies to the General Liability Policy per form # ECP 1246 01 21. Blanket Additional Insured applies to the General Liability Policy per form # ECP 1246 01 21 & ECP 1248 01 21; when required by written contract; in favor of: City and its officers, employees, agents, and authorized volunteers City of Menifee 29844 Haun Road Menifee, CA 92586 Ross Driscoll, Sr/DM The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person)$ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PER STATUTE OTH- ER E.L.EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes,describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S)AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INS025 (201401) DocuSign Envelope ID: 96856D54-5749-471C-BF35-D397A557DB49 DocuSign Envelope ID: 96856D54-5749-471C-BF35-D397A557DB49 DocuSign Envelope ID: 96856D54-5749-471C-BF35-D397A557DB49 DocuSign Envelope ID: 96856D54-5749-471C-BF35-D397A557DB49 DocuSign Envelope ID: 96856D54-5749-471C-BF35-D397A557DB49 DocuSign Envelope ID: 96856D54-5749-471C-BF35-D397A557DB49