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PROOF OF INSURANCE (2021 - 2021) CLOSEDOP ID: MN DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY I ISURAI CE 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 366 Via Vera Cruz #7 CA Agent/Broker Lic# 0737966 San n�arcos, CA 92078 Michelle A. Nowell 'aA'l E ' ' Michelle A Nowell PHO ? _ E FAX .E�L760-471-7116rI 760�71-9378 �� ADRBS amrSCOr l:om PRo,UCER TT 2 r e1G7r1... An e- INSURED Watt Investigative Services INSURER A : U p_ 0349 Garon W att y 30100 12th Street INSURER B Nuevo, CA 92567 INSURER C INSURER D INSURER E : 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. 1LN l POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X CP00962336 07/31/2020 07/31/2021 RFM 100� _ CLAIMS -MADE X OCCUR MED EXP ( (Any m one person) A o on) 5,00 $ 5,000 X Errors & Omission PERSONAL & ADV INJURY $ 1,000,00 .....................5,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,00 ...X.� . ...... PFtCY- -.......................$.......................- .............._ POLICY LOC AUTOMOBILE LIABILITY a .,..• COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person'.......$ ......................................................................... ALL OWNED AUTOS ___ .................. _...................................... .m........... BODILY INJURY Per accident $ ........... ............. ............ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (PER ACCIDENT) $ NON -OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION C; STA OTH J AND EMPLOYERS' LIABILITY Y / N T. �� ..... �- OFFICER/MEMBER EXCLUDEDANY ? PROPRIETOR/PARTNER/EXECUTIVE N / A EAC .E L...D.SEASECEA $................................................................... andatory EMPLOYEE IF yes, describe under ............ .......................... DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATtONS I VEHICLES (Attach ACORD lilh Additional Remarks Schedule. R more space is required) City of El Se undio, their officials,officers,agents and em loyees are roamed as additions lnsured with respect to the work perfclrimedPby the named insured. Investigations, CA -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE OLUtu-Qu ©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 II - 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", T"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 ❑ PERSONAL AUTOMOBILE Offer To Renew Declaration effective e Oct 17, 2020 -^^^-- 117SIVANWe Your coverage expires Oct 17. 2020, at 12:01 A.M. Payment of the premium renews your policy for the period shown. If your payment is not received before Oct 17, 2020 this Offer to Renew will be null and void. ADDRESS SERVICiE7oWFICE - * tr ♦ . rw WAWANESA INSURANCE PO BOX 82867 SAN DIEGO CA 92138-9492 Telephone: 1-800-640-2920 Policy Number Account Number Policy Period 12:01 A.M. standard time at the address of the 12762210 From Oct 17, 2020 to Apr 17, 2021 Named Insured as stated herein Named Insured's Phone Number i Named Insured's Email Address: Your 6 month premium for three (3) vehicle(s) is $1,294.90. Refer to the breakdown of premiums below, Description of Owned Vehicle(s) Vehicle 1 I Year 2009 I Make Toyota i Model 11 Vehicle Identification Number COROLLA BASES/LE/XL Premium per Vehicle ($) 601.85 2 2014 BMW 3281 366.59 3 2017 Chevrolet SILVERADO 1500 CREW CAB LT 336.46 Premium Subtotal for Vehicles 1294.90 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 2 3 Bodily Injury Liability $250,000 per person/$500,0( Property Damage Liability $100,000 each occurrence Medical Payments $5,000 each person Comprehensive $500 deductible Collision $500 deductible each occurrence Uninsured/Undednsured Motorists Protection $30,000 per person/$60,000 each occurrence Uninsured Motorists Collision Deductible Waiver Total Premium per Vehicle ($) All Premiums listed are for the full 6 month term. 1 264.06 96.74 98.21 140.32 58.31 60.40 12.17 7.53 7.53 12.89 20.77 26.88 145.23 149.34 118.55 25.57 22.29 23.28 1.61 601.85 1.61 356.59 1.61 336.46 Sep 16, 2020 03:40 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 El Segundo. Policy No. 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 Policy Number Expiration Date Name of Agent Phone # KI certify that, in the performance of the work set forth in the agreement with the City of El 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 Y P Y P g � Y void. Signature of Applicant comply ith tl�a�s rovision or% t e re+sment will automatically become v Date Agreement for: Garon Wyatt - Agreement Dated: 4/17/2020 Joseph Lillio'"�" "�" CNN 'e*WWnM 'W0"MNM lrnyynamm. JtlgneMe Reviewed by: �""