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PROOF OF INSURANCE (2021 - 2021) CLOSEDATIFI.... T F LIABILITY INSURANCE m.........�....� �a06/14/2021 'Y>............ 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: p -_ � ����T ..,..,..,..,IVED subject T: LINSURED,the olio���-.W..� have ADDITIONAL p y(ies) must a ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, sub'ect 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). PRODUC.ER., .,. ...,mm.... CONTACT NAME: John Ekno John Ekno(9755316) PHONE FAX 210 W Birch St Ste 205 (A/C, NO, EXT): 877-472-2517 (A/C, NO): 714-257-2522 E-MAIL Brea CA 92821-4504 ADDRESS: jekno@farmersagent.com ....................INSURCR(S)AFFORDING. ,,,,,,,,,,,,,,,., ,....., .,_... COVERAGE NAIC# INSURED INSURERA: Truck Insurance Exchange 21709 INSURERB: Farmers Insures once Exchange 21652 CROSSROADS SOFTWARE INC °° INSURERC Mid Century Insurance Company 21687 210 W BIRCH ST _ .......A., .. �.. INSURER D: STE 207 ..... ........ INSURER E: BREA CA 92821 .. m — INSURER F: COVERAGES CERTIFICATE NUMBER REVISION NUMBER: . THIS IS TO CERTIFY ...,,. .eeeeeee ......._..... YTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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 HERE W IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMFrs SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LICYEFF (. ,,..................... LIMITS..... .. ..................... ...... TYPEOFINSURANCE .........._........TL POLICYNUMBER INSR ADDTL SUBR POLICY EFF POLICY EXP _.�. LTR INSD WVD ..................m. ...,.. ..... ........ _„e.WA, (MM MM/DD/YYYY) .. _ I0 MERC1A1GENERALLIABILITY ...... ........ ............. ._ ..... ,,,,,, .... ,.,�.. EACH OCCURRENCE $ 2,000,000'.. _.... ..... ........ .,'R C'..AV"w1aCwtAt)'d�i OCCUR AGE TO RENTED $ P M ISES(EaOccurrence) 100,000 MED EXP (Any one person) $ 5,000 C Y N 604395845 08/27/2020 08/27/2021 PERSONAL& ADV INJURY $ _ 2,000,000 o GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000 000 POLICY ❑PROJECT ❑ LOC . PRODUCTS-COMP/OPAGG $ --- ----- — 2,000,00 0 j OTHER: „ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000. (Ea accident) ANYAUTO BODILY INJURY (Per person) $ SCHEDULED C OWNEDAUTOS NLY AUTOS N 604395845 BODILY INJURY (Per accident) $ 08/27/2020 08/27/2021 HIREDAUTOS X NON -OWNED PROPERTY DAMAGE ONLY AUTOSONLY $ (Peracodent) ..._._.... ... _......,.,..,...... UMBRELLAOCCUR, _ ,,,,,,,.. ._ _...,......... EACH OCCURRENCE $ ........... ........ ,. EXCESS LIAB CLAIMS -MADE '' _........ ..m,_...,_,m.... AGGREGATE $ .... DED I I RETENTION $ - ..,..... ,.. $ ... .................. ........ WORKERS COMPENSATION .......... ...... .,,,,,,,,,......... ... ....,............. PER , AND EMPLOYERS'LIABILITY ABILITY X STATUTE OTHER $ ANYPROPRIETOR/PARTNER/ Y E.L EACH ACCIDENT $ 1,000.00( EXECUTIVE OFFICER/MEMBER N/A N 4,09465956 C Y ...., 08/13/2021 08/13/2021 EXCLUDED?(Mandatory in NH) E.L.DISEASE EAEMPLOYEE1 00000( If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,00 ........ .. .. -- .................... ... DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 210 W BIRCH ST STE 207, BREA, CA 92821 ity of El Segundo Policy Department is listed as an Additional Insured. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO POLICE DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 3484 MAIN ST DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. _... ......._ ..,„..e...... �.... ........ ...._ �............................... ----- AUTHORIZED REPRESENTATIVE - n cr:r_1 Munn John Ekno ACORD 25 (2016/03) @1988-2015 ACORD CORPORATION. All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD x? CERTIFICATE OF LIABILITY INSURANCE i DATE (MMIDD/YYYY) 06/16/2021 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 Jq9NIACT Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA PHONE . Extl () 202 3007 w ........ — No) g y ADDRESS: $$$ 520 Madison Avenue E-MAIL contact@hiscox.com New Floor _ IC New York, NY 10022 INSURERS) AFFORDING COVERAGE NAIC INSURER A - Hiscox Insurance Companv Inc 10200 INSURED CROSS ROADS SOFTWARE 210 W BIRCH ST 207 BREA, CA 92821 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. FNS ...� TYPE OF INSURANCE 'ADDL.SUB§ WVD .... ........ .... ... POLICY NUMBER IMM/DD/YYYY),I e......._... ..... I POI fMM/DD/YYYYI .......,...,.,,,,.,.. LIMITS COMMERCIAL GENERALLiABILITY' EACH OCCURRENCE $ GLAIMS-MAOE �� OCC4,}H r $ C PREM SESDAMAGE E�ENTED occurrence)_ _ ,,, MED EXP An one person) $ ,,,, PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO - _ POLICY JECT LOC I PRODUCTS - COMP/OP AGG $ OTHER: $ _..._.._ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON-OWNED BODILY INJURY Y (Per accident) PROPERTY DAMAGE . $ $ AUTOS ONLY AUTOS ONLYaccident) Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIABHCLAIMS-MADE AGGREGATE $ DIED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N .... STATUTE I„E,RH ........ '.. ANYPROPRIETOR/PARTNER/EXECUTIVE E L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑,N/A ...� _..,.. ........ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under ---•.........-°°- °°°•- DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Professional Liability Y UDC-4733564-EO-21 02/10/2021 02/10/2022 Each Claim: $ 1,000,000 Aggregate: $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) El Segundo Police Department is named as an Additional Insured subject to the policy terms and conditions. CERTIFICATE HOLDER CANCELLATION El Segundo Police Department 3454 Main Street El Segundo, CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY NUMBER: 604395845 FARMERS INSURANCE ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COVERAGE FORM APARTMENTOWNERS LIABILITY COVERAGE FORM CONDOMINIUM LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. The following is added to Paragraph C. Who Is An Insured of the applicable Coverage Form: 17238 1 st Edition Any person(s) or organization(s) shown in the Schedule is also an additional insured, 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 in the performance of your ongoing operations or in connection with your premises owned by or rented to you. However: a. The insurance afforded to such additional insured only applies to the extent permitted bylaw; and b. If coverage provided to the additional insured is required by a contractor 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 is added to Paragraph D. Liability And Medical Expenses Limits Of Insurance of the applicable Coverage Form: 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 contractor agreement; or 2. Available under the applicable Limits Of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits Of Insurance shown in the Declarations. 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. J7238-ED1 02-19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 937238 J7238101 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 30 (Ed. 6-20) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA 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 named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain thisagreementfrom us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsernentshall be%oftheCaliforniaworkerscompensationpremiumotherwisedue on such remuneration, subject to a minimum change of; 50' , Schedule Person or Organization Job Description COMPUTER SERVICES 210 W BIRCH STSTE 207 BREA, CA 92821 CITYOF ELSEGUNDO POLICE DEPARTMENT 3484 MAI N ST ELSEGUNDO, CA 90245 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 08/13/21 Policy No. A0946-59-56 Endorsement No. I nsured CROSSROADS SOFTWARE, INC (DBA) CROSSROADS SOFTWARE 210 W BIRCH STSTE 207 Insurance Company MID-CENTURY INSURANCE COMPANY BREA CA 928214504 Countersigned By WC990630 (Ed. 6-20) Includes copyright material of the Workers Compensation Insurance Rating Bureau of California. All rights reserved.