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PROOF OF INSURANCE (2021 - 2021) CLOSED
,�.„� DATE (MMIDDIYYYY) �M""�" CERTIFICATE OF LIABILITY INSURANCE 08/27/2020 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, theolit p y(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). PRO11 D 11 UCER .... (CONTACT Alis Maynard Insurance Solutions PHONE (949) 348-7400 I FAX (949) 201-4515 (A(Cr, No. Ext): (AIC, No). License #0746539 I E-MA'IL AlisM@ins-solutions.com ADDRESS: 33302 Valle Rd, Suite 200INSURER(S) AFFORDING COVERAGE Y NAIC # San Juan Capistrano CA 92675 INSURERA : HiscoX Insurance Company Inc, 10200 INSURED I INSURER B : Emergency Management Consulting Solutions Inc INSURER C: 21520 Yorba Linda Blvd. Ste. G560INSURER D INSURER E: Yorba Linda CA 92887 U INSURER F: COVERAGES CERTIFICATE NUMBER: 20-21 REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. EFF POLICY EXP INSR TYPE OF INSURANCE IVSD Ui1 POLICY NUMBER MM ODY/YYYY) (MMDDffyyy) LTR INSD WVD ( I I LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 3,000,000 CLAIMS -MADE � OCCUR A A E TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one Person) $ 5,000 A UDC -1487197 -CGL -20 08/28/2020 08/28/2021 PERSONAL& ADV INJURY $ 3,000,000 G'EN'LAGGRE:GA'i'E LIMITAPPLIES PER: I I GENERAL AGGREGATE $ 3,000,000 PROPOLICY LOC I PRODUCTS - COMP/OP AGG $ 3,000,000 OTHER ' I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANYAUTO BODILY INJURY (Per person) $ OWNED SCHEDULED I BODILY INJURY (Per accident) $ AUTOS ONLY .. HIRED q AUTOS NON -OWNED PROPERTY PRO'PER'TY DAMAGE $ AUTOS ONLY AUTOS ONLY '�IPor $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE G AGGREGATE $ DED I � RETENTION $ p - $ WORKERS COMPENSATION PER I OTH- STATUTE ER JE AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED?�, N / A (Mandatory in NH) E L DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE • POLICY LIMIT $ Limit: $1,000,000 Ded: $500 Errors and Omissions A UDC -1487197 -EO -20 08/2812020 08/2812021 Aggregate: $1,000,000 n DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Disaster Preparedness Consulting Services @ Witherbee Auditorium at The Los Angeles Zoo Certificate Holder is included as additional insured CERTIFICA'TE', HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo Attn: Carol Lynn Urner ACCORDANCE WITH THE POLICY PROVISIONS. Senior Management Analyst AUTHORIZED REPRESENTATIVE 5333 Zoo Drive Los Angeles CA 90027,,, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 440 NIJCOX Policy Number: L1DC_-1_4.8..719.7—aGL20 Named Insured: Emergency Management Consulting Solutions Inc. Endorsement Number: 9 Endorsement Effective: August 28, 2020 Hiscox Insurance Company Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - AUTOMATIC STATUS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any per- son(s) or organization(s) for whom you are performing operations or leasing a premises when you and such person(s) or organiza- tion(s) have agreed in writing in a contract or agreement that such person(s) or organiza- tions) be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to lia- bility 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: 1. In the performance of your ongoing opera- tions; or 2. In connection with your premises owned by or rented to you. A person's or organization's status as an addi- tional insured under this endorsement ends when your operations or lease agreement for that additional insured are completed. CGL E5421 CW (02/14) Includes copyrighted material of Insurance Services Office, Inc., with its Page 1 of 1 permission. Confidential Proprietary Information a lnterinsurance Exchange of the Automobile Club Automobile Insurance Policy Coverages and Limits Renewal Declarations We are pleased to offer you a renewal for your automobile insurance policy. To renew your policy, send at least the minimum payment on or before the due date. Insurance is in effect only for the vehicles, coverages, and limits of liability shown on this declarations page and as set forth in the insurance policy and endorsements. These declarations, together with the contract and the endorsements in effect, complete your policy. If any change to your policy or to the information we have on file results in a premium decrease during the policy period, the Interinsurance Exchange reserves the right to apply any refund due to your outstanding balance. NAMED INSURED (Item 1.) AUTO POLICY NUMBER: CAA 087654017 BIRi POLICY PERIOD (PACIFIC STANDARD TIME) 92886-1948 POLICY EFFECTIVE DATE: 01.25-20 12:01 A.M. POLICY EXPIRATION DATE: 01-25-21 12:01 A.M. VEHICLES VEH. YEAR MAKE MODEL IDENTIFICATION VEHICLE GARAGE ANNUAL"" VERIFIED NO. NUMBER USE ZIP CODE MILES MILEAGE SALVAGE 7 2010 JEEP WRANGLER UNLIMITED PLEASURE 92686 10,001 - 12,500 VERIFIED NO 8 2016 FORD F150 CREW C SUPER PLEASURE 92886 12,501 -15,000 VERIFIED NO COVERAGES AND LIMITS Coverage is not in effect unless a premium or the word "included" is shown. COVERAGES LIMITS OF LIABILITY Liability o Bodily Injury $500,000 each person/ $1,000,000 each occurrence Property Damage $1,000,000 each occurrence Medical Physical Damage (Actual Cash Value unless otherwise stated, less deductible) Vehicle 7 Vehicle 8 Comprehensive ACV ACV (Less Deductible) $500 $500 Collision ACV ACV (Less Deductible) $500 $500 Car Rental Expense (Per Day) No Coverage No Coverage Uninsured Motorist Bodlly Injury- $500,000 each person/ Uninsured & Underinsured Vehicles Uninsured Deductible Waiver Uninsured Collision Total Premium $1,000,000 each accident ANNUAL PREMIUMS Vehicle 7 Vehicle 8 Vehicle 9 Vehicle 10 Vehicle N « « a « N « Y Y Y d N B 1 Y A Y M1 1 « 1 u n q « N N « r « 1 l m ya N N r a n tl N N 1 d Y « a n r I I n I I « e x a n r r u a o N « n a a Y « a Y a Y « a ry Y I i u m I -. j « r n a r q I I I ) 0 q i t i N ( k tl Y Y N Y A Y i I q i a Y Y PREMIUM DISCOUNTS No Coverage" indicates coverage not purchased. Please refer to the enclosed document entitled "Premium Discounts Applied to Your Automobile Policy." Total Annual Premium* «` If at any time you choose to pay less than the full balance outstanding, (Includes all applicable discounts.) finance charges of up to 1.5% per month of the balance outstanding will apply Less Policyholder Savings Dividend � as explained in your billing statements, which are part of these declarations. Net Premium,* OMEN he annual mileage for your expiring policy, please refer to the "Noti,ce of Annual Mlleagg',',,page contained In your„ renewal,, 'package 1 �' PROCESS DATE 12-17-19 PLEASE ATTACH TO YOUR POLICY (SEE REVERSE) 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 (#700,000), 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 pequry under ft laws of California one of the following declarationw. (_) I have and will maintain a certificate of consent of selfLinsure for workers! with of . •• (_) I have and will maintain workers' compensation insurance as required by Labor Code § 3700 for the performance of the work far 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 # (JL/) 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 I must immediately comply with those provisions or the agreement will automatically become void. // Signature of Applicar� Date 111.0 /(,e 'ak"Agreement for: Dated: 68 • 11 • cv Reviewed by . -"-I r'� �