ACORD® DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
06/26/2024
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 have ADDITIONAL INSURED provisions or be endorsed f SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement, A statement or this certificate does not confer rights to the certificate holder in lieu of such endorsements).
PRODUCER CONTACT JOHN FORBING NAME:
StateFarm JOHN FORBING PHONE (909) 620-5869
PAC. No. Ext: (909) 623-8571 (A/C, No):
E-MAIL [email protected]
ADDRESS:
154 W. SAN JOSE AVE INSURERS) AFFORDING COVERAGE NAIC # CLAREMONT CA 91711 INSURER A : State Farm General Insurance Company 25151 INSURED INSURER B :
LDM ASSOCIATES, INC. INSURER C:
10722 ARROW ROUTE INSURER D:
SUITE 822 INSURER E:
RANCHO CUCAMONGA CA 91730 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO VDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI
INSR TYPE OF INSURANCE LIMITS
LTR INSD WVD POLICY NUMBER
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _s 1,000,000 X OCCUR DAMAGE TO RENTED $ 300,000
CLAIMS-MADE PREMISES (Ea occurrence)
MED EXP (Any one person) $ 5,000
Y 92-J9-L481-1 07/01/2024 07/01/2025 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PACT LOC PRODUCTS - COMPIOP AGG 3, 2.000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
X ANY AUTO 07/01/2024 07/01/2025 BODILY INJURY (Per person) $ 1,000,000 689 3742-E13-75
OWNED SCHEDULED BODILY INJURY (Per accident) $ 1,000,000
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $ 1,000,000
AUTOS ONLY AUTOS ONLY Per accident)
MEDICAL $ 25,000
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE
RETENTIONS
AND ELOPES LAST
Y / N
N/ A ELL. EACH ACCIDENT
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE S
scribe und
SCRIPTION OF OPERATIONS belo EL. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER IS ADDITIONAL INSURED.
The City of Lancaster, its elected officials, officers, employees and volunteers are included as additional covered parties, but only insofar as the operations under this contract are concerned.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
CITY OF LANCASTER
AUTHORIZED REPRESENTATIVE
44933 FERN AVENUE
LANCASTER lala
CA 93534 Stu Q
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.13 04-22-2020
NAME OF INSURED: LDM ASSOCIATES INC
POLICY NUMBER: 92-J9-L481-1
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY
ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization: City of Lancaster, including elected or appointed officials, directors, officers, agents, employees, volunteers or contractors. (if no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your use of premises owned or leased by the additional insured.
The insurance provided by this policy shall be primary as respects any claims related to any activities, anywhere and any insurance, pooled coverage, or self-insurance maintained by the City, its elected or appointed officials, directors, officers, agents, employees, volunteers, or contractors shall not contribute to it.
Uh othe
Authorized Signature
ACORD® DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
6/24/2024
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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
NAME eupel
The Buckner Company of Colorado FAC, NO:
6400 S. FIDDLERS GREEN CIRCLE, SUITE 950 (AIC. Ne, Ext: 13037563418 Greenwood Village CO 80111 ADDRESS: [email protected]
INSURERS) AFFORDING COVERAGE NAIC #
License#: 480397 INSURER A : Hanover Insurance Company 22292 INSURED LDMASSO-01
INSURER B:
LDM Associates, Inc.
10722 Arrow Route, Suite 822 INSURER C :
Rancho Cucamonga CA 91730 INSURER D:
INSURER E :
COVERAGES CERTIFICATE NUMBER: 664444674 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
ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERN XCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM INSR
LTR POLICY NUMBER
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE
RO
POLICY ECT LOC PRODUCTS - COMP/OP AGG
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMI s
Ea accident
ANY AUTO BODILY INJURY (Per person)
OWNED SCHEDULED BODILY INJURY (Per accident) S
AUTOS ONLY AUTOS
HIRED NON-OWNED ROPERTY DAMAC
AUTOS ONLY AUTOS ONLY Per acciden
S
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED RETENTIONS
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBEREXCLUDED? N/ A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE S
E.L. DISEASE - POLICY LIMIT S
A Professional Liability LH4 J006134 03 7/1/2024 7/1/2025 320000000 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
City of Lancaster
44933 Fern Avenue
Lancaster CA 93534 AUTHORIZED REPRESENTATIVE
A Bichi
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD LDMASSO-01 ITOLOSA
ACORD DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 6/27/2024
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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
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 ol his certificate does not confer rights to the certificate holder in lieu of such endorsements).
PRODUCER
Acrisure Southwest Partners Insurance Services, LLC HON /C. No, Ext FAC, No):
4000 Westerly Place
Suite 110 ADDREss: [email protected]
Newport Beach, CA 92660
INSURERS) AFFORDING COVERAGE NAIC #
INSURER A : State Compensation Insurance Fund of California 35076 INSURED INSURER B :
LDM Associates, Inc INSURER C:
10722 Arrow Rte, Ste 822 INSURER D:
Rancho Cucamonga, CA 91730
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
TYPE OF INSURANCE POLICY NUMBER LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
MED EXP (Any one person)
PERSONAL & ADV INJURY
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE
POLICY LOC
PRODUCTS COMPOP AGO S
OTHER:
COMBINED SINGLE LIMI
AUTOMOBILE LIABILITY (Ea accident
ANY AUTO BODILY INJURY (Per person)
BODILY INJURY (Per accident) S
PROPERTY DAMAGI
Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED RETENTIONS
A UND EMPLOYERS LIABILIN X PATUTE I
Y / N X 9361203-24 7/1/2024 7/1/2025 E.L. EACH ACCIDENT 1,000,000 Y N/ A 1,000,000
ELL. DISEASE - EA EMPLOYEE S
LESSON OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1,000,000 DESCRIPROOF OF COVERAGEATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Waiver of subrogation applies.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Lancaster ACCORDANCE WTH THE POLICY PROVISIONS. E WILL BE DELIVERED IN EXPIRATION DATE 44933 Fern Ave
Lancaster, CA 93534
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ENDORSEMENT AGREEMENT
STATE WAIVER OF SUBROGATION
BLANKET BASIS 9361203-24
FUND NEW
SP
HOME OFFICE
SAN FRANCISCO EFFECTIVE JULY 1, 2024 AT 12.01 A.M. PAGE 1 OF 1 AND EXPIRING JULY 1, 2025 AT 12.01 A.M.
LDM ASSOCIATES, INC
10722 ARROW RTE, STE 822
RANCHO CUCAMONGA, CA 91730
WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE
LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL
NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR
ORGANIZATION NAMED IN THE SCHEDULE.
THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU
PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US.
THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE
2.008 OF THE TOTAL POLICY PREMIUM.
SCHEDULE
PERSON OR ORGANIZATION JOB DESCRIPTION
ANY PERSON OR ORGANIZATION BLANKET WAIVER OF
FOR WHOM THE NAMED INSURED SUBROGATION
HAS AGREED BY WRITTEN
CONTRACT TO FURNISH THIS
WAIVER
NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND
ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE
HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT.
COUNTERSIGNED AND ISSUED AT SAN FRANCISCO:
JUNE 12, 2024
2572 AUTHORIZED REPRESENTA PRESIDENT AND CEO
SCIF FORM 10217 (REV.4-2018) OLD DP 217