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PROOF OF INSURANCE (2022 - 2022) CLOSED.r" C DATA W, CERTIFICATE OF LIABILITY INSURANCE 10/18/2021Y) Y_........... THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS N......_.�..N _....................... .._.� O RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE 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 CONTACT NAME: John Ekno John Ekno(9755316) PHONE _ FAX 210 W Birch St Ste 205 (A/c, No, Ex�: 877-472-2517 (A/c, No>: 714-257-2522 E-MAIL Brea CA 92821-4504 ADDRESS: jekno@farmersagent.com INSURER(S) AFFORDING COVERAGE NAIL# ..... ......................... ....._ .. ... ._. ............... ----� INSURED INSURERA: Truck Insurance Exchange 21709 INSURERB: Farmers Insurance Exchange 21652 INSURER C: Mid CROSSROADS SOFTWARE INC _ ....' I'nsu............. 7 Centu......ry ra..nce Company 21687 210 W BIRCH ST INSURER D: STE 207 INSURER E: ........ BREA CA 92821 INSURER F: ...................... .................. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS ISTO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE m BEEN ISSUEDTO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHS..... TANDING ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTOALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, ......... ._........................ LIMITS SHOWN MAY HAVE BEEN REDUCED . .............................. ..... BY PAID CLAIMS. INSR ................. TYPEOFINSURANCE ADDTL SUBR POLICY NUMBER POLICYEFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) — .............. X' COMMERCIAL GENERAL LIABILITY ._...... ............. EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE XOCCUR DAMAGE PREMISES (E(ETO RENTED a Occurrence) 100,000 MED EXP (Any one person) $ 5,000 C ._...._.. Y N 604395845 08/27/2021 08/27/2022 PERSONAL &ADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER. GENERAL AGGREGATE $ 4,000,000 POLICY I PROJECT LOC AG G $ 2,000,000' PRODUCTS - COMP/OP mmm... OTHER: $ AUTOMOBILE LIABILITY ..... . (OMBIN�EED)INGLELIMIT $ 2,000,000 ANY AUTO BODILY INJURY (Per person)mmw $ C OWNEDAUTOS SCHEDULED BODILY INJURY (Per accident) $ ONLY AUTOS N 604395845 08/27/2021 08/27/2022 HIREDAUTOS X NON -OWNED PROPERTY DAMAGE $ ''.. ONLY AUTOSONLY (Peraccident) .... ......... - ........ ....... UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X PER JOTHER $ AND EMPLOYERS' LIABILITY STATUTE ANY PROPRIETOR/PARTNER/ Y/N E,L EACH ACCIDENT $ 1,000,00 C EXECUTIVE OFFICER/MEMBER Y N/A 09465956 08/13/2021 08/13/2022 ....EE ' E.L.DISEASE - EA EMPLOYEE 1�000�QQ EXCLUDED? (Mandatory in NH) _ ................. If yes, describe under DESCRIPTION OF E.L DISEASE -POLICY LIMIT I$ 1,000,00 OPERATIONSbelow DESCRIPTION W OFOPERATIONS/ LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 10 W BIRCH ST STE 207, BREA, CA 92821 City of El Segundo Police Department is listed as an Additional Insured. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO POLICE DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECANCELLED WBEFORE THE EXPIRATION 3484 MAIN ST DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY .......PROVISIONS. AUTHORIZED REPRESENTATIVE �_.... ELZEGUNDO_.. .. 90245. John Ekno ACORD 25 (2016/03) @1988-2015 ACORD CORPORATION. All Rights Reserved 31-1769 11-15 TheACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, POLICY NUMBER: 604395845 0 ;1 �Al 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 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 forsuch 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 underthe 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-ED 1 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 paymentsfrom 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 obtai n this agreement from us.) You must maintain payroll records accurately seg regating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shallbe%oftheCaliforniaworkerscompensationpremiumotherwisedue on such remuneration, subject to a minimum charge of $250, Schedule Person or Organization job Description COMPUTER SERVICES 210 W BIRCH STSTE 207 BREA, CA 92821 CITYOF ELSEGUNDO POLICE DEPARTMENT 3484 MAI N ST EL SEGUNDO, 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 Insured CROSSROADS SOFTWARE, INC (DBA)CROSSROADS SOFTWARE 210 W BIRCH STSTE 207 BREA CA928214504 Policy No. A0946-59-56 Endorsement No. Insurance Company MI D-CENTURY INSURANCE COMPANY Countersigned By WC 99 06 30 (Ed. 6-20) Includes copyright material of the Workers Compensation Insurance Rating Bureau of California. All rights reserved.