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PROOF OF INSURANCE (2021) CLOSEDOP ID: MN ,a►coRO CERTIFICATE OF LIABILITY INSURANCE �'' DATE(M9120 04/0/200 20 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 355 Via Vera Cruz #7 CONTACT NAME: Michelle Nowell PHONE FAX A/c No Ext : 760-471-7116 (A/C, No): 760-471-9378 CA Agent/Broker Lic# 0737966 San Marcos, CA 92078 Michelle A. Nowell E-MAIL i amscor ll ADDRESS: mnowell@amiscorp.com PRODUCER WYENN-1 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Wyenn & Associates INSURER A: Acceptance Casualty Ins Comp 10349 Joel Wyenn 815 S Central Ave #20 INSURER B Glendale, CA 91204 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. INSR LTR TYPE OF INSURANCE DDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X Errors & Omission X CP00960505 03/06/2020 03/06/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 100 000 $ e MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JECTPRO LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (PER ACCIDENT) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) El Segundo Police Department,officials, officers, agents and employees are named as additional insured with respect to the work performed by the named insured. aodonnell@elseagundo.org Investigation, CSC -- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo Police Department ACCORDANCE WITH THE POLICY PROVISIONS. Assistant to the Captains AUTHORIZED REPRESENTATIVE Amanda O'Donnell 345 Main Street EI Segundo, CA 90245 OL fattLw © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CP00960505 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", "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 © ISO Properties, Inc., 2004 Page 1 of 1 11 Thank you for choosing Allstate WAllstate.. You're in good hands. Proof of Insurance Card Page I of z For your convenience, two insurance cards have been included for each vehicle. State law requires that one of these cards be kept in each vehicle. Please place them in your vehicles by the effective date. Allstate. VO -It in good hands. Please use the printed Insurance Cords below, I,�� Allstate. Voore La goad hands. MOMS PD�e" "0598. Da1hs. TX =&WOOw� ThaMMIdoafaG9tS62 az This poky meets Da mgrdremenls of the awkaWeCalifomia Onandal responswity bnv(s). M)UCYNUiM YEAR/MALE/YDM 0443E951 m6 ftmm eudn EFTiLM DATE VEME ID MABER Oi/IQ/t! 5wo E7MTN)NDATE ............................... Allstate. mdrEingoodnards. i Please use the printed Insurance Cords below. Camolubprodof Allstate — -- AfkfateNorthlxookladm� cure oc g PO a�ms 5605pp9 =-11 Tx� NNC# 36155 �NoodQt� TtaxWd QaAtf A9W-Z42i This mewls the requbenwOtolsheapO bloCalifomiaslimKial r law(s). POULVNIAIBER VEAR/ MAKE/MODEL 9344MOM 2OT6t4a4i6Mba EEEKRVE DATE VENIM IDNUMBER OI 818 S E7fMRATION DATE Th)s cmd must becor»edin Nw vahitle at aAtmres as evldenaaajinuua xa This codmW becannedin the mhh*pt all timesas evidence of fn ammr. 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 self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by ode § 3700 forthe performance of the work set forth the agreement with the City of El Segundo. Policy No. U I have and will maintain workers' cone of the work for which the agreement with carrier and policy number are: Carrier Name of Agent certify that, in the pr mplo any person in any agree that, if I should be immediately comply with tt Signature of Applicant _ required by Labor Code § 3700 forthe performance is executed. My workers' compensation insurance Policy Number Expiration Date Phone # of the work set forth in the agreement with the City of El Segundo, I will not s as to become subject to the workers' compensation laws of California, and :ct to the worke"mpensation provisions of Labor Code § 3700 1 must ions or the hnent will automatically become void. ] Date Agreement for: �c.j' 4 w "a Dated: Reviewed by: �bW k