PROOF OF INSURANCE (2020 - 2020) CLOSEDJOEMPOL-01 MMELTD ,d►��RO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) I 3/512020 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 endorsement(s), PRODUCER 1M ACT yAdO' p Pa newest Insurance -TAG PHONE Y FAX Nrys;i855j 215-5018 14900 SW Barrows Rd, Ste 202 , No, EaI'I: (8fi6) 276-3775 Beaverton, OR 97007 s- IiNSURERPSp. yb,'FP'ORVN'G COVERAGE NAIC d yrs I'NSU'RER A, Scottsdale Insurance Compariv 41297 INSURED I INSURER B: Joemar Polygraph & Investigative Services Inc V INSURER c: 12939 Banyon INSURER D: Rancho Cucamonga, CA 91739 INSURERE: V INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NU' MBER: 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, -AID CLAIMS, I'NSR POLICY EXP LIMITS JTR TYPE OF INSURANCE ° UWVO �! _.. PMMCDDPYYYY] 1,000,000 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED AODLSUBR POLICY NUMBER POLICY O W71DuYY.YYI � CE S EXCLUSIONS AND CONDITIONS OF ' A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE T'O RE'NT'ED 100„000 CLAIMS -MADE � OCCUR X X RDS0030279 7/29/2019 7/29/2020 �04MAGE � cE I acctilrrorYr:.w y MED EXP' fAIw om oossonl $ 5„OOOd I!q PERSONAI.8 ADV INJURY 'S 1,000,000Q IGEN'L.AOGREG T LIMIT APPLIES PER: NGENERALAGGREG�ATE I$ 2,000,0001 X POLICY PRO- ❑LOC V IPRODUGTS�COMPI'OPAGO S 2,000,0'00' JECT TH RI s L.OMBYNEf7; SI�IVOLEUM6T' AUTOMOBILE LIABILITY f/o0111 $ . ANY AUTO II BODILY 04JURY'YPew'oarxonl S OWNED DONLY SCHEDULED 4 iSODII'Y' INJURY I(Porocc,danYl SAUTOS I P�OPCE' TY (DAMAGE N ,�. HI%D ONLY A' Tf'75 O7s'11.4' AUTOS T asr acxidenYl &' I UMBRELLA LIABH OCCUR EXCESS LIAB CLAIMS -MADE DED V RETENTION $ - WORKERS COMP'ENSAT'ION AMD EMPLOYERS' LIABILITY Y I N ANY PROP RMTOR IPARTNE1'<dCrg ECUTIME ❑ p��FICER):!.1F)'IMiP�' EXCLUDED? (MandaRory n ) of yyea. dam nbewad'er I'DSCRIPTION OF OPERATIONS Ixetw A Errors & Omissions A Errors & Omissions NIA X X RBS0030279 X X R,BS0030279 N EACH OCCURRENCE S J YI bGG� R�EEGATE S IVV $ I Y J..QTH. ryry.�..._J..:wx. �.M�.V/i .. Y E't EACH ACCIDENT E L DIWEASE' -EA EMPLOYEES E L .!1"ASF - POLICY LIMIT S 7129/2019 712912020 each claim 1,000,000 7/2912019 7129/2020 aggregate 2,000,0001 DESCRIPTION OF OPERATIONS.( LOCATIONS I VEHICLES (ACORO 901, Ado lonal Remarks Schedule, maybe attached if more space is required) Certificate holder Is additional Insured per (attached GLS487 CERTIFICATE HOL'D'ER - ._ - City of EI Segundo 348 Main St EI Segundo, CA 90245 I ACORD 25 (2016103) CAN'C'ELLATION 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. The ACORD name and logo are registered marks of ACORD ENDORSEMENT SCO77SDALE INSURANCE COMPANYO NO. ATTACHED TO AND ENDORSEMENT EFFECTIVE DATE FORMING A PART OF NAMED INSURED AGENT NO. POLICY NUMBER(12:D1 A.M. STANDARD I RBS -0030279 7/29/2019 Joemar Polygraph & Investigative Services Inc 46722 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED—OWNERS, LESSEES OR CONTRACTORS— AUTOMATIC STATUS WHEN REOUIRED IN CONSTRUCTION AGREEMENT WITH YOU INCLUDING PRIMARY OR PRIMARY AND NON-CONTRIBUTORY AND LIMITED WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: ZA COMMERCIAL GENERAL LIABILITY COVERAGE PART ERRORS AND OMISSIONS COVERAGE PART A. SECTION 11—WHO IS AN INSURED is amended to include as an additional insured any person or organization for whom you are performing operations and you and such person or organization have executed a written contract or agreement prior to the time of an "occurrence" giving rise to a claim that such person or organization be added as an additional insured on your policy. Such person or organi- zation is an additional insured only with respect to liability for "bodily injury," "property damage," "error or omission" or "personal and advertising injury" caused, in whole or in part, by: 1. Your negligent acts or ornissions; or 2. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury," "property damage," "error or omission" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or sur- veying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a pal of the same project. Includes copyrighted material of ISO Properties, Inc., with its permission. Copyright, ISO Properties, Inc., 2004 GLS -487 (6-15) Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to SEC- TION lit—LIMITS OF INSURANCE: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. D. Under SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS; subparagraphs a. Pri- mary Insurance and b. Excess Insurance of paragraph 4. Other Insurance are amended as follows: If you have agreed in a written contract and executed such a contract or agreement prior to the time of an "occurrence" giving rise to a claim, that this policy will be afforded on a primary or primary and non- contributory basis and without right of contribution from any insurance in force for the liability in the performance of your ongoing operations for the additional insured(s), then this insurance will be af- forded on a primary or primary and non-contributory basis, and we will not seek contribution from any other such insurance. E. Under SECTION IV ---COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to paragraph 8. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have against an additional insured if you have agreed in a written contract, and executed such a contract or agreement prior to the time of an "occurrence" giving rise to a claim, but only with respect to liability for "bodily injury," "property damage," "error or omission" or "personal and advertising injury" caused by: 11. The named insured's negligent acts or omissions; or 2. The negligent acts or omissions of those acting on the named insured's behalf; in the performance of the named insured's ongoing operations for the additional insured. All other Terms and Conditions of this Policy remain unchanged. AUTHORIZED REPRESENTATIVE DATE Includes copyrighted material of ISO Properties, Inc,, with its permission. Copyright, ISO Properties, Inc., 2004 GLS -487 (6-15) Page 2 of 2 Renewal auto policy declarations Your policy effective date is February 11, 2020 Total Amount Due for the Policy Period Please review your insured vehicles and verify their VINs are correct. Vehicles covered UK ) 1997 Chevy 'Trk Blazer 2010 Mercedes -B E350 2016 Ram Trucks 1500 2Wd California Fraud Assessment Fee I Total* QA11.8itate, You're in good hands„ ' .: Pagel of 6: Information as of December 20, 2019 Summary Premium Named Insured(s) $462,28 Joe & One Delia 68150 856.19 2.64 $2,002.61 Policy number 1024 6016071 * Your bill will be mailed separateV Before making a payment, please ref er to your latest bill, which includes payment options and installment fee information. If you d not pay in full, you will be charged an installment feels?. See the Important payment and coverage Information section for details about installment fees. Discounts (included in your total premium) Good Driver (20%) $482.28 Distinguished Driver Anti -theft $7.$7 (Total discounts.. Discounts per vehitle (1997 Chevy Trk Blazer Good Driver (20°;16) $97.85 2010„Mercedes!O MSO Anti -theft $3.63 Distinguished $108.17 D river L2016 Ram Trucks 150,,0 29Wd Anti -theft $4.34 Distinguished $138.31 Driver Listed drivers on your policy Ona Delia Joe Delta Excluded drivers from your policy None $334.12 Distinguished $87,64 Driver Good Driver (200h) $17038 Good Driver (;20%) '$214.05 $824.3 Your policy provided by o Allstate Northbrook Indemnity Company Policy period rrnMRFe"bru ry 11, 2020 through ogust 11, 20at 12:01 a.m. standard — Your Allstate agency is N Yry �rro ' lig �'4 Some or all of the information on your Policy Declarations is used In the rating of your policy or it could affect your $18149) eligibility for certain coverages. Please notify us immediately if you believe that any information on your Policy $282.18J Declarations Is Incorrect. We will make corrections once you have notified us, and any resulting rate adjustments, will be made only for` the current policy $356:701 period or for future ,policy periods. Please also notify us immediately If you believe any coverages are not listed or are inaccurately fisted. 82077 Is CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,. DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: (_) I have and will maintain a certificate of consent of self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code § 3700 for the performance of the work set forth the agreement with the City of El Segundo. a= C_) 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 Name of Agent Policy Number Expiration Date. Phone # W) I certify that, in the performance of the work set forth in the agreement with the City of El Segundo, I will not GAPloy 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 t a workers' compensation provisions of Labor Code § 3700 1 must immediately comply with tho p ovision the agreement will automatically become void. Signature of Applicant Date 1;J 7,0W l �1W �01Agreement for: y, R)�JW,J)�Ihvvsi t1t v"'. p4Le,�,, ti V\z- U Dated: Reviewed lbyc;4k