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PROOF OF INSURANCE (2021) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD(YYYY) 12/10/2020 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(les) 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 P�aWAC@ I.'.°: I'tT 111, I'„Rl,prr nS>rr --- -- Stewart Insurance Service, Inc 1.10NI�,la'ty'{'@ ti'iFAx�L.xx (AIC,NxI 4515 E Anaheim Street IiMAII As, i5f's)c 3tt tI •Q'r'pI; )UH 'VII' %A,';,vtd',,'WM1,`EllrtlHlww. P:,h.Y R'I'tl INSURF RJSt AFFORDING C'.OVVRA(;,it', NA@C N Long Beach CA 90804 INSURER A : NAl..1T IL UIS IN"Sd'.IRANC;E COPw IPANY 173 "70 INSURED INSURER'ED Elite Command Training LLC INSURER C 26741 Portola Pky, Suite 1 E 4833 INSURER D (INSURER t Foothill Ranch CA 921310 INsuPR) rA r COVERAGES CERTIFICATE NUMBER: REVISION' NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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 10 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR :ADDL SUBR Iaox,lCy I -P I, Put III,Y R M, I„TR TYPE OF INSURANCE '.._ .... ktd.ii.�.._.�.I�'PVCY� I"OLr{:Y dWIJ Pr7C3F: F'? ...._., ..-..'LM11AN1G167%YMY'Nq fPr9MdS7DRY'Y Y'X' LPMITS COMMERCIAL GENERAL LIABILITY 1,000 ,000 1, CLAIMS-MADE%'II lq ,'' III G. ll', 50,600 U1 0 1 P I Clo"y 5,000 A Y Y NN1121141 05/0212020 uYI1/'Qlr.,,:/ ID..."f !'I b,!.'I. I', uw's,u+n:,r tl4)11,0100 ,III I ; RI: a,;,IR,. R'n;l,l I,,v UR axr tl, �, l I � ", +';da;+l7u'¢;'.':.� I': r"'�",xV'r.a xti.�'.) .'r, INCLUDED AUTOMOBILE LIABILITY ............................._....—„ ___, ..w,.,.,.,.,.,.............W. 111 Np,uc;llwrb�r)x ��IINI'!'44,p;;"i"ii@"q tt .,I"d.Y tl'1I'r 1 t1,Pl'.d11111'r VI^,I VPI P:[ u'i,1 I'•' I,drin! pd,, ru; 11111 VIIN I'I 1111 i ll' 1,1:, 111 1 I1,?1 IS II IIII'Jil' lig, r"d (�i 'V ^i iYtlhpl �._. ........................ S UMBRELLA LIAR ...................� _..,....... �, �., ., ,1., II'.'.: ' r'ru Ih II , ''4!I II'�i,ll I'e1 i,"I'..... EXCESS LIAB I' .4110�rS NOIR I�;.IJItil'C iE'I"I'I I(:VPq +, WORKERS COMPENSATION AND EMPLOYERS' UASILI'CY YtN ANY PROr'rUFTOId(r'ARTNEFd/CYCCU rIVC E] NIA A OFFIrERWEMDER EXCLUDCD'r IMand alwy in NH) 1ll�' I nL I ! ", I' NIPI.LI1'r'1 I 'w, r.., oYllr. rm t�$(1'�I�O'w?,JON�1VI�11 '18''11 1 I'i,'11lr,rrI.III ;uI ,. J,ESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) PRIVATE TRAINING CLASSES FOR EMERGENCY MANAGEMENT FORR CORPORATIONS THE OWNER OF THE COMPANY IS THE ONLY COVERED INSTRUCTOR.• COVERAGEPRIVATE C* ADDITIONAL WAIVER OF SUBROGATION PRIMARY ! iCONTRIBUTORYR APPLIESPOLICY ADDITIONAL INSURED: SEE BELOW CERTIFICATE 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 ACCORDANCE WITH THE POLICY PROVISIONS. 50 Main St. AUTHORIZED REPRESENTATIVE EI Segundo, CA 9024 111 1 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID; LOC #: AC"R of ADDITIONAL REMARKS SCHEDULE Pace AGENCY NAMED INSURED Stewart Insurance Service, Inc. Mite Command 'r -raining LLC POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: - - ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: „Certificate of Liability Insurance 777 777777! 777:'77-7771 30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions. Subject to all terms and conditions included in the policy. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: NN1121141 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Where required by written contract LocationLs) Of Covered Operations All operations of named insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include 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: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to 'bodily injury" or "property damage" occurring after: 1. All work, including materials„ parts or equipment fumished 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 location of the covered operations has been completed; or 2. 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 then another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement applicable Limits of Declarations. shall not increase the Insurance shown in the Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 0413 POLICY NUMBER: NN1121141 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Opera - Or Organization (s): tions Where required by written contract All operations of the Named Insureds. Informationsir ed,to complete this Schedule. if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tion(s) shown in the Schedule, but only with respect to liability for "bodily injury" or, "property damage"" caused, in whole or fn part, by "your work" at the location desig- mited and described in the schedule of this endorse- ment performed for that additional insured and included in the "products -completed operations hazard". CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑ 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: U 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_ (__) 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 Policy Number Expiration Date Name of Agent Phone # z I certify that, in the performance of the work set forth in the agreement with the City of EI 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 pr visions or the agreement will 21 itomatically become void. Signature of Applicant 1 Date (Z Agreement for: r-1% I Dated: Reviewed by: