PROOF OF INSURANCE (2020 - 2021) CLOSEDOP ID: MN
CERTIFICATEDATE IMM/DD/YYYY)
�,,,,..
IOF LIABILITY INSURANCE 07/28/2020
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
Alliance Mgt. & Insurance Sery
365 Via Vera Cruz #7
CA AI, Li'c'# 0737966
San Marcos„ CA. 92078
Michelle A. Nowell
INSURED Wyatt Investigative Services
Garon Wyatt
30100 12th Street
Nuevo, CA 92567
CT
NA'hne Michelle A Nowell
PHONE 760-4717116
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._ ..... ? .......
E•MAIL....................................._.
TREs,u�WYATT-r?nlscor com
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A
PRODUCER
INSURERIS-I AFFORDING COVERAGE
INSURER A: ...Acceptance.asuIty Ins Comp.........ma......
INSURER B:
I INSURER C:
INSURER D:
INSURER E:
INSURER F:
�AX
LWq meal: 760-471-9378
.11111111111111 NAIC #,""...............,
10349
COVERAGES CERTIFICATE NUMBER:
REVISION (NUMBER:
EXCESS LIAB CLAIMS -MADE
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.
WORKERS COMPENSATION
WC STATU- 'T
L.T.QR.Y LIMI.T$..R....
.. rN, 3 Wn POLICY NUMBER INPMIDD EFF
TYPE OF INSURANCE AbUic..$u..............................._.............
049
I'MWDDt EXP
LIMITS
ANY ECUTIVE
GENERAL LIABILITY
EACH
$
1,000,000
A
IX COMMERCIAL GENERAL LIABILITY X CP00962336 07/31/2020 07/31/2021
sS�wR r ersae9
$ . ......................."RENCE
100,000
City f EI SeqIundo, their officials,officers,ag nts and em are named
as al ditionafinsured with respect to the wort, peormedpb'y the named
CLAIMS -MADE [XI OCCUR
MED EXP (Any one person)$
5,000
__................. .......................
X Errors & Omission
PERSONAL &ADV INJURY $
1,000,000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
GENERAL AGGREGATE
$
5,000,000
City of EI Segundo
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP A..
$
1,000,000
AUTHORIZED REPRESENTATIVE
X U�
..............................................................................................................
$
C 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09)
POLICY LOC _�
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
$
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
(Ea accident)
_ ................... "(Per person) I $
"
BODILY INJURY
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
(PER ACCIDENT)
UMBRELLA LIAB
�Ip OCCUR
EACH OCCURRENCE $
EXCESS LIAB CLAIMS -MADE
AGGREGATE $
�_...... DEDUCTIBLE
$
RETENTION $
$
WORKERS COMPENSATION
WC STATU- 'T
L.T.QR.Y LIMI.T$..R....
AND EMPLOYERS' LIABILITY YIN
f
.................1-
ANY ECUTIVE
EXCLUDED? N
(Mas
/ A
CIEA
dR ry i Hae
E L DISEASE EMPLOYEE(
"$
E, L DISEASE - POLICY LIMIT U $
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101 Additional Remark's Schedule, If more space Is required)
loyees
City f EI SeqIundo, their officials,officers,ag nts and em are named
as al ditionafinsured with respect to the wort, peormedpb'y the named
insured.
Investigations, CA --
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 EI Segundo
350 Main Street
EI Segundo, CA 90245
AUTHORIZED REPRESENTATIVE
a
C 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09)
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: CP00962336
COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT
CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s)
Automatic Status Included Where Required by Written
Contract. All Where Required by Written Contract.
Section 11 - Who Is An Insured is amended to in-
clude as an additional insured the person(s)
or organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury",
""property damage"' or '"personal and
advertising injury" caused, in whole or in
part, by your acts or omissions or the acts or
omissions of those acting on your behalf:
A. In the performance of your ongoing
operations; or
B. In connection with your premises owned by
or rented to you.
CG 202607 04 0 ISO Properties, Inc., 2004 Page 1 of 1 1:1
Policy Number Account Number
12762210 4070411-1
Named Insured's Phone Number:
Policy Period 12:01 A.M. standard time at the address of the
From Apr 17, 2020 to Oct 17, 2020 Named Insured as stated herein
Named Insured's Email Address:VLAUAWAHM
Your 6 month premium for three (3) vehicle(s) is $1,317.06. Refer to the breakdown of premiums below.
Description of Owned Vehicle(s)
Vehicle
Year
Make
See Policy for Coverage Details
ModelVehicle
Identification Number
Premium per Vehicle ($)
1
2009
Toyota
COROLLA BASE/S/LE/XLEI
I
601.85
2
12014
( BMW
13281 I
369.66
3
12017
+ Chevrolet
I
1500 CREW
345.55
$5,000 each person (
12.17
CAB LT I
7.53
Collision
Premium Subtotal for Vehicles
1317.06
Insurance is provided only with respect to the coverage's for which a Premium is stated, subject to all conditions
of the policy.
Coverage and Limits of Liability
Premiums per Vehicle ($)
See Policy for Coverage Details
1 I
2
3
Bodily Injury Liability
$250,000 per person/$500,000 each occurrence
264.06 I
96.74
98.21
Property Damage Liability
$100,000 each occurrence I
140.32
58.31
60.40
Medical Payments
$5,000 each person (
12.17
7.53 I
7.53
Collision
$500 deductible I
145.23
160.82 I
125.96
Comprehensive
$500 deductible (
12.89
22.36 (
28.56
Uninsured/Underinsured Motorists Protection
$30,000 per person/$60,000 each occurrence I
25.57
22.29 I
23.28
IUninsured Motorists Collision Deductible
Waiver I
1.61 I
1.61 I
1.61
Total Premium per Vehicle ($)
601.85 I
369.66 I
345.55
All Premiums listed are for the full 6 month term.
Mar 17, 2020 00:35 CT "Wawanesa Insurance" is a trademark of Wawanesa General Insurance Company
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 EI Segundo.
Policy No.
(_J 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 EI Segundo is executed. My workers' compensation insurance
carrier and policy number are:
Carrier
Name of Agent
Policy Number Expiration Date
Phone #
KI certify that, in the performance of the work set forth in the agreement with the City of EI Segundo, I will not
oy 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 9 pPp y g will automatically become void.
Si nureof A comply thos rovwsAo�n o: t e a' reement Date_''t � 1 � 7,c3
Agreement for: Garon Wyatt - Agreement
Dated: 4/17/2020
RJoseph Lillio
Reviewed by:
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