Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
PROOF OF INSURANCE (2019 - 2020) CLOSED
20 q " " CERTIFICATE OF LIABILITY INSURANCE flATEi0611188/!22019019 Y) 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. 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 endorsementfs)- PRODUCER ONTACI NHON.IE EXtI;� 8 Al ...•._ S�irffP "'lif9 SKALA INSl1RANCE AGENCY INC PHONE AD9-583-8861 Arc, Nay �& 4214 N SIERRA WAY E-MAILNE GENESKALA.CO a EDr1M ...�_.. ...__......._.�. _..... ITm,mm•�mm-, GCOVEf�.QGE (409 GENE SKALA, AGENT LIC. 0557032 StaterFa Farm Insurance SAM BERNARDINO, CA 92407 Rls)_aFFoaorN INSURER ralTce Company 25151 I INSURED INSURER suRER : State Fane Mutual Automohile Insurance Company 25178 NANCY K BOHL INC INSURER C: ..,_w,w_,w, DBA THE COUNSELING TEAM INTFIRNATIONAL INSURER D: ......................... AND DBATHE ORGANIZATIONAL NETWORK INSURER E: IN§yRER F: ... COVERAGE$ CERTIFICATE NUMBER: R'EVIS'ION NUMBER: THIS IS TO CERTIFY THAT THF POLICIES OF INSURAI14GF LISTFD BELOW HAVE BEEN ISSIJFD TO TNF IM%JRF_D NAMED ABOVE FOR THF POLICY PERIOD INDICATED. NOTWTHSTANDING ANY REOUIREMEN I-, I -E -RM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMEN I WI I H RESPLCT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED IIEREIN IS SUBJECT TO ALL TI IE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. d.TR OINSURANCE ._..,_.,, .. w MMER IALC NERPOLICY NUMBER AL(ABILITY I 4L1 Y hi7 Yf AkAR015tw YM Jr1MRDORYYYYI LIMITS (NSR COMMERCIAL O """" AUUL.�If�'�R—...-_._ POLIGYE, s.. :114bS,r,,liihUrlY"YY"`I. g 1,000,000 eDAMAtIt I �.i'`Si�Nr,1I5„n,wx,A�,�Inc;,nacm,L„_�, $ ,,00.000 A �TNOL DAUIO PIh b ;IUIiL uww,n�UR $5,00D .... � d.-.Lllrnotra.L°F+Lub'Ps'u'I-u°- Y Y 92L614261&92YD04220 07/1212019 O7i1212020`!E�NERAL.�G"`..EGrnTEl,n__.5�.2...........................................". e.st.aua, .. GR 0 r��Ihr��°'.•I;,,, c R1(A:��,la':r • ' , I ,nll•.k�n � 0' �,-,,: I,nl°,r r ��,,,�, s .0 AUTOMOB f.ro'HIl¢ Io ma rohf"&IflAlp �:, ._ ILE LIABILITY Y 4414167F2475 06/24/2019 1212412019 „ •I,i, -•, PVjylj h, 1 11 0"P Urdl V rsr,a':nl. ,' ukl.yl-!Awry (G r�✓p,e« uriB s 1.000,000 t'ff,'IM9",Y(P"'rc.:ioMI s 1,000,000 PROK R1 exiW40F' _....__....$.....1..000.000 ,lR�L+rcarY�lorra4,' . UMBRELLA LIAR eOr,. ,l V4 Lq'- 6 'Lr O R'R11i Pf l EXCESS L.IAB ,.,r APIVI.; IVA it AG'Cir'EGATE 'WORKERS COMPENSATIONC('I"�' CitF-i_ AND EMPLOYERS° LIABILITY YIN_•_ -- ANY PRJnRIETORrPARTNE€/EY.ECUTIVE r.11 II" t 41 K Y l Ulmml-IJV n Y711 N L Lt IAWI r l_._.._ (M fide ory IY'.V MNHJ EXCLUDED?N I a I, s If yes describe andar _ DESCRIPTION OF nPF,Rs.T! (V5 MEE�L DISEASE -POLICY LINAT S DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES iACORD 101, Additional Remarks Schedule, may be attacl;ed if more space rs regmredl Business Office Policy Property Locations: 1881 Business Center Dr, San Bernardino, CA 92408 39755 Murrieta Hot Springs Rd, Ste D16D, Murrieta, CA 92563 1545 Anacapa Rd Ste 7C, Victorville, CA 92392 135 S State College Blvd Ste 200, Brea, CA 92821 444 Camino Del Rio Ste 2015,San Dieoo, CA 92108 7701 Palomar Airport Rd #300, Carlsbad, CA 92011 74075 FI Paseo Ste A9 Palm Desert, CA 92260 232 Harrison Ste D, Claremont, CA 91711 CERTIFICATE HOLDER CANCELLATION 0 0.2015 A ROCO ORA N. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo, its officers; officials, employees, agents ACCORDANCE WITH THE POLICY PROVISIONS. and volunteers 35D Main St A I ED R'EP TIVE EJ Segundo, CA 90245 0 0.2015 A ROCO ORA N. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD 92 -YD -0422-0 028378 CMP -4786 1 . s Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY. CMP -4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 -YD -0422-0 Named Insured: NANCY K KOHL INC DBA THE COUNSELING TEAM INTERNATIONAL AND DBA THE ORGANIZATIONAL NETWORK PO BOX 110427 SN BERNRDNO CA 92423-0427 Name And Address Of Additional Insured Person Or Organization: CITY OF EL SEGiUNDO ITS OFFICERS OFFICIALS EMPLOYEES AGENTS & VOLUNTEERS 350 MAIN ST EL SEGUNDO CA 90245-3895 1. SECTION II — WHO IS AN INSURED of b. If coverage provided to the additional in - SECTION II — LIABILITY is amended to in- sured is required by a contract or agree- clu'de', as an additional insured, any person or ment, the insurance provided to the organization shown In the Schedule, but only additional insured will not be broader than with respect to liability for "bodily injury", that which you are required by the contract or '"personal and advertls- or agreement to provide for such addition - ing Injury" caused, in whole or In part, by: al insured; and a. Ongoing Operations c. If the contract or agreement between you (1) Your acts or omissions, or and the additional insured is governed by (2) The acts or omissions of those acting California) Civil Code Section 2782 or 2782.05, the insurance provided to the on your behalf; additional insured is the lesser of that in the performance of your ongoing opera- tions for that additional insured; or which: (1) Is allowed for the satisfaction of a de- b. Products – Completed Operations fense or indemnity obligationby� Cali - `"Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability; or completed operations hazard". (2) You are required by contract or However, Paragraph 1, above is subject to the agreement to provide for such addi- following: tional Insured, a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement un - ted by law; til a claim or "suit" is tendered to us, @, Copyright, State Farm Murmal Automobile Insurance Company, 2013 Includes copyrighted material or Insurance Services Guice, Inc., vwdh its permission. -VD -0422-0 D28378 M 28370 CMP -1786 1 Page 2 of 2 2. Any ;a.,d to Lh,,- ,:additional in- (3) The nature and location of any injury ;cured shall only apply with respect to a claim or damage arising out of the "occur - made of a "$Llit°" bI`ougIU for danna es for rence" or offense; which you are provided coverage. b. Tender the defense and indemnity of any 3. With respect to the insurance afforded to the claim or "suit" to us and to all other insur- aclditponal insured, the following is added to ers who may have Insurance potentially SECTION II -M-- LIMITS OF INSURANCE available to the additional insured; and If coverage providod to the additional insured c. Agree to make available any other insur- is required by contract or agreement, the most ance the additional insured has for de - we will pay on belialf of the additional insured fence or damages for which we would will 'be t ae lesser of tlIaraIorint of insurelice� provide coverage under SECTION 11 — a. Required by the contract or agreement; or LIABILITY. b. Available under the applicable Limits Of 5. With respect to the insurance afforded the ad - Insurance shown in the Declarations. ditaonal insured, the following replaces SEC- TION 11 —LIABILITY of Paragraph 7. Other This endorsement shall not increase the ap- Insurance of SECTION I AND SECTION Il --- plicable Limits Of Insurance shown in the COMMON POLICY CONDITIONS: Declarations. a. This insurance is primary to and will not 4. With respect to the insurance afforded to the seek contribution from any other insurance additional insured, the following is added. to available to the. additional. insured, provided Paragraph 3. Duties In The Event Of Occur- thai the additional insured is a h arne� d in- rence, Offense, Claim Or Suit of SECTION sured under such other insurance, II — GENERAL CONDITIONS: b. regardless of .any agreement between The additional insured must: you and the additional INUI-ori, this il'1sur- ance is excess over any other insurance a. See to it that we are notified as soon as whether primary, excoss„ contingent or on practicable of an "occurrence" or an of- any other basis for which the additional in- fense which may result in a claim. To the cured has been added as an additional in - extent possible, notice should include: sured on other policies. (1) How, when and where the "occur- There will be no refund of premium in the event rence" or offense took place; this endorsement is cancelled. (2) The names and addresses of any in- jured personas and witnesses; and All other policy provisions apply. CMP -4786 1 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission 92 -YD -0422.0 028380 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP -4787 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TOUS....,,,, .. ... . , .. ., ... .. This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 -YD -0422-0 Named Insured: NANCY K BOH!L INC DBA THE COUNSELING TEAM INTERNATIONAL AND DEA THE ORGANIZATIONAL NETWORK PO BOK 10427 SN EERNRDNO CA 92423.0427 Name And Address Of Person Or Organization: CITY OF EL SEGUNDO ITS OFFICERS OFFICIALS EMPLOYEES AGENTS & VOLUNTEERS 350 MAIN ST EL 'SEGUNDO CA 90245-3895 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of.payments we make for injury or damage arising out of.- a. f:a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP -4787 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. PHILADELPHIA 1CPH INSURANCE COMPANIES 4 01Sa'CS' RTES Certificate of Liability Insurance Date Issued: 07/2912019 Underwritten by: Philadelphia Indemnity Insurance Company • One Bala Plaza, Suite 100 • Bala Cynwyd, PA 19004 - NAIC #: 18058 Administered by: CPH & Associates - 711 S. Dearborn St. Ste 205 - Chicago, IL 60605 - P 800.875.1911 - F 312.987.0902 • info@cphins.com DISCLAIMER: This certificate is issued as a matter of information only and confers no rights upon the certificate holder. The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon. Insured: Nancy K. Bohl Inc. dba The Counseling Policy Number: 025826 Team International Nancy Bohl Policy Term: 08/31/2019 to 08/31/2020 1881 Business Center Drive #11 San Bernardino, CA 92408 Covered Locations Professional Liability: Portable coverage, not location sDecific Coverage Type Per Incident Aggregate (Occurrence Form) (Per Individual claim) (Total amount per year) Professional Liability $ 1,000,000 $ 5,000,000 Supplemental Liability $ 1,000,000 $ 5,000,000 Licensing Board Defense $ 35,000 $ 35,000 Commercial General N/A N/A Liability N/A N/A Fire/Water Legal Liability Business Personal Property N/A N/A Vicarious Sexual $ 1,000,000 $ 1,000,000 Misconduct Cyber Liability (Claims Made Form) $ 25,000 $ 25,000 Retroactive Date: 08/31/2018 Comments/Special Descriptions: Certificate Holder EI Segundo Police Department 348 Main Street EI Segundo, CA 90245 ® Certificate Holder has been added as an additional insured If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). Notice of Cancellation will only be provided to the first named Insured In accordance with policy provisions, who shall act on behalf of all additional insureds with respect to giving notice of cancellation. (' P)&f Aw*,- Authorized Representative C- Philip Hodson POLICYHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 08-12-2019 EL SEGUNDO POLICE DEPARTMENT SP 348 MAIN ST EL SEGUNDO CA 90245-3813 GROUP: POLICY NUMBER: 0702761-2019 CERTIFICATE ID: 94 CERTIFICATE EXPIRES: 08-12-2020 08-12-2019/08-12-2020 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by The policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2018-11-28 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: EL SEGUNDO POLICE DEPARTMENT ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-12-2011 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2019-08-12 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: EL SEGUNDO POLICE DEPARTMENT EMPLOYER NANCY K BOHL INC SP 1881 BUS CTR DR STE 11 SAN BERNADINO CA 92408 M0410 PRINTED : 07-17-2019 (REV.7-2014) ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 702761-19 RENEWAL SP HOME OFFICE 2-47-86-99 SAN FRANCISCO PAGE 25 OF 27 ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC EFFECTIVE AUGUST 12, 2019 AT 12.01 A.M. STANDARD TIME OR THE TIME INDICATED AT AND EXPIRING AUGUST 12, 2020 AT 12.01 A.M. PACIFIC STANDARD TIME NANCY K BOHL INC 1881 BUS CTR DR STE 11 SAN BERNADINO, CA 92408 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, EL SEGUNDO POLICE DEPARTMENT WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, NANCY K BOHL INC IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. 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: AUTHORIZED REPRESENT IVE' SCIF FORM 10217 (REV.4-2018) AUGUST 2, 2019 2570 PRESIDENT AND CEO OLD DP 217