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PROOF OF INSURANCE (2020 - 2020) CLOSED'I DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE A4.__- 10/03/2019 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 I CONTACT NAME: Rebecca Huddle Becky Huddle Insurance Agency PHONE916-789-7500 FAX (A/C, No. Ext1: (A/C, Not: 916-789-2545 729 Sunrise Ave Ste 504 ADDRESS: SS: staff.rhuddle@farmersagency.com Roseville CA 95661 I INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: MID CENTURY INSURANCE 21687 INSURED I INSURER B Lotus Communications $ 5,000 i INSURER C 737 W 31st St Unit A $ 1,000,000 GGEEN'LAGGREGATE LIMIT APPLIES PER: INSURER D: San Pedro, CA 90731 $ 2,000,000 POLICY ❑ PRO ❑LOC JECT INSURER E PRODUCTS - COMP/OP AGG 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 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYYI MERCIAL GENERAL LIABILITY LIF EACH OCCURRENCE $ 1,000,000 A �ECLAIMS-MADE ❑ PREMISESS( OCCUR 60669-02-33 10/1/2019 10/1/2020 DAMAGERENTED (Ea occurrence) $100,00 30 -DAY NOTICE OF CANCELLATION, 10 -DAY NOTICE OF NON-PAYMENT OF PREMIUM WAIVER OF SUB: workers' comp ADDITIONAL INSURED (COMPLETED OPERATIONS): The City of EI Segundo CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 MAIN STREET, ROOM 6 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245 AUTHORIZED m REPRESENTATIVE P ,I © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web Software. www.FormsBoss.com (c) Impressive Publishing 800-208-1977 MED EXP (Any one person) $ 5,000 i PERSONAL & ADV INJURY $ 1,000,000 GGEEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ PRO ❑LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY �I I IJ COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ OWNEDSCHEDULED BODILY INJURY $ AUTOS ONLY AUTOS (Per accident) _ HIRED NON -OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLALIAB OCCUR uu EACH OCCURRENCE $ 5,000,000 A ✓ EXCESS LIAB HCLAIMS-MADE 60669-09-68 10/1/2019 10/1/2020 AGGREGATE $ 5,000,000 F-1 DED RETENTION $ $ WORKERS COMPENSATION❑ PER I 1OTH- STATUTE ER AND EMPLOYERS' LIABILITY Y/N A ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F-1 A0949-23-59 N/A 10/1/2019 10/1/2020 E.L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 �( LJD F7 F—F1 1 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 30 -DAY NOTICE OF CANCELLATION, 10 -DAY NOTICE OF NON-PAYMENT OF PREMIUM WAIVER OF SUB: workers' comp ADDITIONAL INSURED (COMPLETED OPERATIONS): The City of EI Segundo CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 MAIN STREET, ROOM 6 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245 AUTHORIZED m REPRESENTATIVE P ,I © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web Software. www.FormsBoss.com (c) Impressive Publishing 800-208-1977 POLICY NUMBER: 60669-02-33 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 Lotus Communications 737 W 31st St Unit A San Pedro, CA 90731 ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR 10MVII >•1��1�] This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: The City of EI Segundo CG 20 37 07 04 POLICY NUMBER: 60669-02-33 BUSINESS OWNERS POLICY Lotus Communications 737 W 31st St Unit A San Pedro, CA 90731 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS This endorsement modifies Insurance provided under the following, BUSINESS OWNERS POLICY Name of Person Or Organization: SCHEDULE* The City of EI Segundo `Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declarations. The following is added to Paragraph C, Who is An Insured in the Business Owners Liability Coverage Form: 4. Any person or organization for whom you are performing operations is also an insured, if you and such person or organization have agreed in writing in a contract or agreement that such person or organization be included as an additional Insured on your policy. Such person or organization is an additional insured only with respect to liability arising out of your ongoing operations performed for that insured_ A person's or organization's status as an insured under this paragraph ends when your operations for that insured are completed or the contractor's agreement is terminated. DATE (MM/DD/YYYY) ACCOR " CERTIFICATE OF LIABILITY INSURANCE 11/21/2019 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 I CONTACT Luisa Alvarez NAME: Bristol Bay Insurance & Income Tax I (A/C No. EXfi: (310) 533-8098 ac, No): (310) 533-6981 20725 S Western Ave Ste. 132 I ADDRESS: luisacbristolbayinsurance.com I INSURER(S) AFFORDING COVERAGE NAIC # Torrance CA 90501-1884 INSURERA: Builders & Tradesman INSURED INSURER B: Bass Underwriters JOSE GOMEZ JR I INSURER C : DBA: Lotus Communications I INSURER D: 2084B Central Ave Ste B I INSURER E: Duarte CA 91010-2913 I 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 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) COMMERCIAL GENERAL LIABILITY = CLAIMS -MADE 1:1 OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: $ 1,000,000 POLICY [:]PRO JECT [:]LOC BODILY INJURY (Per person) OTHER. 11/11/2019 11/11/2020 BODILY INJURY (Per accident) AUTOMOBILE LIABILITY PROPERTY DAMAGE X ANY AUTO A OWNED SCHEDULED $ 5,000,000 AUTOS ONLY AUTOS X HIRED NON -OWNED AUTOS ONLY AUTOS ONLY E.L. EACH ACCIDENT UMBRELLALIAB OCCUR HCLAIMS-MADE B X EXCESS LIAB $ DED I I RETENTION $ WORKERS AND COMPENSATION EMPLOYERS' LIABILITY Y Y 2003433956 Y Y EBU16998761 YIN ANYPROPRI ETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? F—] NIA (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) BODILY INJURY (Per person) $ 1,000,000 11/11/2019 11/11/2020 BODILY INJURY (Per accident) $ 1,000,000 PROPERTY DAMAGE $ 1,000,000 (Per accident) DEDUCTIBLE $ 1,000 EACH OCCURRENCE $ 5,000,000 04/30/2019 04/30/2020 AGGREGATE $ 5,000,000 PER STATUTE EERH E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) LICENSE# 967691 CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ROOM 6 ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO CA 90245 AUTHORIZED REPRESENTATIVE ED HARAZIN ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 4"N FARMERS INSURANCE WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY Named .LOTUS COMMUNICATIONS, LLC Insured 737W31STSTUNITA SAN PEDRO CA907316726 WC 99 06 19 Agent Effective Date 10/01/18 95-39-R6A A0949-23-59 2018 Policy Number Policy of the Company Year WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- BLANKET We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization for which you perform work under a written contract that requires you to obtain this agreement from us. The additional premium for this endorsement shall be 3-0 %of the Workers' Compensation premium otherwise due for the state(s) listed below on such remuneration, subject to a mi nimum charge of .... All written contracts in the state(s) of. CA This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. Countersigned WC 99 06 19 9-07 Page 1 of 1 93-6369 J6369101