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PROOF OF INSURANCE (2021 - 2021) CLOSED (2)OP ID: MN DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY I ISU AI 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 '"t''''E r Alliance Mgt. & Insurance Sery PHONE Michelle A Nowell FAX 365 Via Vera Cruz #7 A/p � Erm .760-471-7116 r.p / 760-471-9378 CA AgenVEIroker Lic# 0737966 A.DD SB.. mnowell am(scor .corm San Marcos, CA 92078 PRODUCEk �" Michelle A. Nowell _trU I�R IO4, WYATT 2 INSURED Watt Investigative Services INSURERAACcep tanceasualtyIns. Com g Garon Wyatt ........_.. ......... ...........034 3 100 12t Street iNsuRERe _1 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. TYPE OF INSURANCE POLICY NUMBER MOLIC/YEFF POLICYE ` 1LNSRR L POLICY EFF PWoOrYYXX LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X CP00962336 07/31/2020 07/31/2021 P a°� 100 $�.. _ CLAIMS -MADE X OCCUR . ED EXPS(Any one per on) �lF � person) M..........................._-........ ,_$.................................�.�.�.�.�.�_5,00( .. .. � ,00 X Errors & Omission PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $........-- 5,000,00 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ , , ..... ...X..� ... PFIO-' _........................................................................................... a.$.......................- .............._ POLICY Ll LOC AUTOMOBILE LIABILITY _....., COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person'....:...$ ......................................................................... ALL OWNED AUTOS ___ .................. _....................................... BODILY INJURY Per accident .m...................... ............. ............ $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (PER ACCIDENT) $ NON -OWNED AUTOS � �—............... —. I--- $ .-, ,,,� UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ COMPENSATIONWORKERS AND EMPLOYRSLIABILITY Y / N ... ----.. G)k .Y.. I i........ ...--__....--......-........................................ ANY O�ICER/M EXCLUDED? ECUTIVE N / A .................................................................. E:L'...D.SEASECEA IMBB H' andatory EMPLOYEE $. IF yes, describe under ............................ DESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101' Additl'ortal Remarks Schedule, 9 more space is required) City of EI Se undo, their Officials,officers,agents and em loyees are Inarned as additionainsured with respect to the work performedPb,y the named Insured. Investi ations, 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 POLICY Amended Declaration effective AMENDED DECLARATION Jun 11, 2021 Supersedes any previous declaration bearing. the same policy numberfor this policy period. . d CAROrN D WYATT WAWANESA INSURANCE PO BOX 82867 SAN DIEGO CA 92138-9492 TELEPHONE: 800-640-2920 Policy Number Account Number Policy Period 12:01 A.M. standard time at the address of 12762210 4070411-1 1 From Apr 17, 2021 to Oct 17, 2021 the Named Insured as stated herein Named Insured's Phone Number: Named Insured's Email Address. Your amended 6 month premium is $1,246.92. Refer to the breakdown of premiums below. The change in premium for the remainder of the policy period is-$14.13. Description of Owned Vehicle(s) Vehicle Year Make Model Vehicle Identification Number 1 2009 Toyota t .- — ....... 2 2014 BMW 3 2017 Chevrolet Premium Subtotal for Vehicles Premium per Vehicle($) $484.43 $375.21 .,..... $387.28 $1,246.92 Insurance is provided only with respect to the coverages for which a Premium is stated, subject to all conditions of the policy. Coverage and Limits of Liability Premiums per Vehicle ($) See Policy for Coverage Details 1 2 3 Bodily Injury Liability $250,000 per person/$500,000 each occurrence 183.87 105.61 108.50 Property Damage Liability $100,000 each occurrence 119.75 72.45 77.26 Medical Payments $5,000 each person 12.42 9.06 8.93 Comprehensive $500 deductible 10.67 20.49 29.86 Collision $500 deductible 130.97 145.57 139.34 Uninsured/Underinsured Motorists Protection $30,000 per person/$60,000 each occurrence 25.14 20.42 21.78 Jun 10, 2021 14:49 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 g ppP Y P g � Y void. Amply with thus rovisiora or t e a reement will automatically become v Date y licant Agreement for: Garon Wyatt - Agreement Dated: 4/17/2020 Joseph Lillio� tiwdd WUMMYh`Iw�w YMgb lrr'NY^+^'� JtllrneMe Reviewed by: CM4w PtldlYgW pT fS.,%f fA AFI'q�