PROOF OF INSURANCE (2019 - 2020) CLOSED°129AC CERTIFICATE OF LIABILITY INSURANCE 0%2/201�1
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).
PRODUCER
Brian Hunt Insurance Agency PNGT . 47 [a .Nd
Brian Hunt, Lic# OE02545 JAlc o -E Q 5621804-91 rpt -9756
E-MAlt,
5693 Woodruff Ave .x%u RIW.q;y=.__qn@ptiaiiHuntinsurance.com .......................
Lakewood, CA 90713 INSURERISIAFFORDING COVERAGE NAIG#
INSURER A, State Farm General Insurance Oampany 25151
......... ALLISON, ROBBY DBA ALLISO_. _. �-.
INSURED N TRAINING
tNsuRERB:
PERSPECTIVES & SERVICES
INSURERGa
4067 HARDWICK ST STE 495
INSURER D;
LAKEWOOD CA 90712
INSURERS ,pm_
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 M
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION
OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS P
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.
sl
INSR TYPE OF INSURANCE ADt1L LI
POCY NUMBER
LA
POLICY EFF POLICY EXP
IMMIDDIYYXYI CMMYDDJ'WY1'Y)
LIMR9
GENERAL LU\B �I7Y
D
11
1011212019 10!1212020
EACH OCCURRENCE
$ 1,000,000
�gW09'/0"ACNTED
$ 0
? 92 -EL -8253.8
CLAIMS -MADE OCCUR
.PREMISESrEs occurraroal
MEDSXP Anyone arson)
$ ,00m0[PERONAL
$ADV INJURY
._...W�3...0..0.m,00
$ 1,000,000
GENERAL AGGREGATE
$ 2,000'000m
®GEN'LAGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMPlOPAGG
$ 2,000,000
PRO -
POLICY T LOC
�,fr. I V
�.—....W.,.................
Business O'r'o P �Y
_
I $ 1,800
Au
AUTOMOBILE LIABILITY I, 1
� Lu lu_._......
1$
ANY AUTO 4�pL�BODILY
INJURY(Par person)
$
ALL OWNED
1 SCHEDULED
BODIL ( a dent
AUTO5
AUTOS
HON -OWNED
_
Y AMACrEPer
PRO -
$_..............�.................... .......m
I HIRED AUTOS
AUTOS
ffe'r n rkt
UMBRELLA LIAB
OCCURnEl
EACH OCCURRENCE
$
_..y
EXCESS LIAB I
l CLAIMS -MADE
AGGREGATE
$
DED RETENTION$
p�
li
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
YIN
ANY PROPRIETDRIPARTNEPJEXECUTIVE
OFFICEJMEMBER EXCLUDED? ❑ N f A
(Mandatory to NH)
'It yea, da%nbe under
nr sr WEe!CdILIaF-r�P a4ATshA-
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 1111, Additional Remarks Schedule, if more space is required)
I WC STATU- OTH-
TORY LIMITS � 4 ER_.
E.L. EACH ACCIDENT $
E.L. DISEASE -EA EMPLOYEE $
E.L. DISEASE -POLICY LIMIT _
$
CERTIFICATE HOLDER CANCELLATION
Additional Insured: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS.
300 Main St.
EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE
Q 1988-2010 ACORD PORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012
CMP — 46161
DESIGNATED PERSON
ORGANIZATION
This endorsement modifies insurance
provided under the following;
PRODUCTS AND COMPLETED
OPERATIONS LIABILITY COVERAGE
FORM
Policy No: 92 -EL -8253-8 G
Named Insured:
ALLISON, ROBBY
DBA ALLISON TRAINING
PERSPECTIVES & SERVICES
4067 HARDWICK ST STE 495
LAKEWOOD CA 90712-2350
Name and address of Additional Insured
Person or Organization:
I . WHO IS AN INii
SURED is amended
to include, as an additional insured,
any person or organization shown in
the Schedule above, but only with
respect to liability for "bodily injury"
or "property damage" caused
..
deor in part, by "your work'
performed for that additional insured
and included in the "products -
completed operations hazard".
However, Paragraph 1. above is subject to
the following:
a. The insurance afforded to the additional
insured only applies to the extent permitted
by law;
b. If coverage provided to the additional
insured is required by a contract or
agreement, the insurance provided to the
additional insured will not be broader than
that which you are required by the contract
or agreement to provide for such additional
insured; and
c. If the contract or agreement between you
and the additional insured is governed by
California Civil Code Section 2782 or
2782.05, the insurance provided to the
additional insured is the lesser of that which:
(111 Is allowed for the satisfaction of
a defense or indemnity obligation
by California Civil Code Section
2782 or 2782.05 for your sole
liability; or
(2) You are required by contract or
agreement to provide for such
additional insured.
We have no duty to defend or indemnify the
additional insured under this endorsement
until a claim or "suit" is tendered to us.
2. Any insurance provided to the
additional insured shall only apply
with respect to a claim made or a
"suit" brought for, damages for which
you are provided coverage.
3. With respect to the insurance
afforded to the additional insured,
the following is added to
SECTION 11-- LIMITS OF
INSURANCE:
If coverage provided to the additional
insured is required by contract or
agreement, the most we will pay on behaif
of the additional insured will be the lesser of
the amount of insurance:
a. Required by the contract or
agreement; or
b. Available under the applicable Limits
Of Insurance shown in the
Declarations.
Page 1 of 2
CMP — 4616.1
This endorsement shall not increase the
applicable Limits Of insurance shown in the
Declarations.
4. With respect to the insurance
afforded to the additional insured,
the following is added to Paragraph
3. Duties In The Event Of
Occurrence, Offense, Claim Or
Suit of SECTION II
— GENERAL CONDITIONS:
The additional insured must:
a. See to it that we are notified as soon as
practicable of an "occurrence" or an offense
which may result in a claim. To the extent
possible, notice should include:
(1) How, when and where the
"occurrence" or offense took place;
(2) The names and addresses of any
injured persons and witnesses; and
(3) The nature and location of any
injury or damage arising out of the
"occurrence" or offense;
b. Tender the defense and indemnity of any
claim or "suit' to us and to all other insurers
who may have insurance potentially vailable
to the additional insured; and
c. Agree to make available any other
insurance the additional insured has
for defense or damages for which
we would provide coverage under
SECTION II — LIABILITY.
5. With respect to the insurance afforded
the additional insured, the following
replaces SECTION It — LIABILITY of
Paragraph 7. Other Insurance of SECTION
I AND SECTION II --
COMMON POLICY CONDITIONS:
a. This insurance is primary to and will not
seek contribution from any other insurance
available to the additional insured, provided
that the additional insured is a named
insured under such other insurance.
b. Regardless of any agreement between
you and the additional insured, this
insurance is excess over any other
insurance whether primary, excess,
contingent or on any other basis for which
the additional insured has been added as
an additional insured on other policies.
All other policy provisions apply,
Page 2 of 2
GEICO GEICO GENERAL INSURANCE COMPANY
Washington DC VERIFICATION OF COVERAGE
(SEE BELOW UNDER CAUTIONARY NOTE)
To whom it may concern:
This letter is to verify that we have issued coverage under the above policy number for the dates indicated in the
effective and expiration date fields for the vehicle listed. This should serve as proof that the below mentioned vehicle
meets or exceeds the financial responsibility requirement for your state.
This verification of coverage does not amend, extend or alter the coverage afforded by this policy.
Vehicle Year: 2004
Make: FORD
Model: EXPXLS/SPT
VIN:
COVERAGES
Bodily Injury Liability
Each Person/Each Occurrence
State Minimum $15,000/$30,000
Property Damage Liability
State Minimum $5,000
Uninsured & Underinsured Motorists
Each Person/Each Occurrence
Uninsured Motorists Property Damage
Lienholder
Additional Insured
LIMITS
$25,000/$50,000
$25,000
$25,000/$50,000
$3,500
Interested Party
DEDUCTIBLES
Additional Information:
Issued 10/21/2019
If you have any additional questions, please call 1-800-841-3000.
CAUTIONARY NOTE: THE CURRENT COVERAGES, LIMITS, AND DEDUCTIBLES MAY DIFFER FROM THE COVERAGES, LIMITS AND DEDUCTIBLES IN EFFECT AT
OTHER TIMES DURING THE POLICY PERIOD. THIS VERIFICATION OF COVERAGE REFLECTS THE COVERAGES, LIMITS, AND DEDUCTIBLES AS OF THE ISSUED
DATE OF THIS DOCUMENT WHICH IS SHOWN UNDER "ADDITIONAL INFORMATION" OR IF AN ISSUED DATE IS NOT SHOWN. THE DATE OF THIS FACSIMILE.
U-33 10-07
I have and will matntain a certificate of consent of seffinsure f, ( workers' compensation, issued by the Director
of f(idustrial Relations as provided, for by Labor Code § 3700 for the performance of the work set forth the agreement
with the City of El Segundo.
Policy No.
I have and will maintain workers' compensation insurance as required by Labor Code § 3700 for the performance
of the work for which the agreement with the City of El Segundo is executed. My workers' compensation insurance
carrier and policy number are:
Carrier Policy Number Expiration Date
Name of Agent Phone #
D!� I certify that, in the performance of the work set forth in the agreement with the City of El Segundo, I will not
employ any person in any manner so as to become subject to the workers' compensation laws of California, and
agree that, if I should become subject to the workers' compensation provisions of Labor Code § 3700 1 must
immediately comply with those orovjs�ons or the agreement will automatically become void
Signature of Applicant Dat
e
.......... ...........
I
Agreement for: A-Lio c --,r-4 -� '-) C-,
Date&
Reviewed by;
I P,<,- Xs-,�,4;-14 � Z