PROOF OF INSURANCE (2022 - 2022) CLOSEDDATE(MMIDD/YYYY)
A"R CERTIFICATE OF LIABILITY INSURANCE 02/22/2022
64�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 NAME. Ken Noden, CPCU
......... ........ ......... ..........
... .........
Wigmore Insurance Agency Inc. PHDNE (714) 979-6543 FAX 7i4rs49-2e43
A/C Nt E 1 ArX Nc
880 W. 19th St. E•MAIU AoDREss, commercial@wigmoreins.com
^^
License #0811959 INSURER(S AFFORDING COVERAGE _ NAIC #
............
Costa Mesa CA 92627 INSURERA:Philadelphia Indemnit Ins. Com an 18056
.............- ..... ..............
INSURED INSURER B:Hartford Ins. Company of Midwest 37476
Alliance Resource Consulting, LLC, INSURER C:
1 Centerpointe Drive INSURER D :
Suite 440 INSURER E:
La Palma CA 90 623 INSURER F :
COVERAGES CERTIFICATE NUMBER:21/22 ALL LINES 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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
___.......................
%NSR AM 0.f
TYPE OF INSURANCE
POLICY NUMBER MMIOI LTR OIYYYY MM DD/YYYY
LIMITS
X COMMERCIAL GENERAL LIABILITY
''. EACH OCCURRENCE
S
1,000,000
.......00CUR
A CLAIMS-IVIAGF. ''... Xn
_ ....... E
AMA E 0 REN ()=' D
PR4-IVIISES..;,a ar, ctia.rrence}
S
100,000 .
YHPK2334371. 1.0/1.5/2021 1.0/1.5/1022
IVIED EXP (Any one person)
S......
5,000
.........................................
.PERSONAL &ADV INJURY
S
1,000,000
......
GEN'I..AGGRE.GATE IJIVITAPPI_IES PER:
GENE.RALAGGREGATE
S
2,000,000
X D PRO E
POLICYIOC
ti _
PRODUCTS - C.OMP(ORAGG
S
2,000,000
OTHER,
S
AUTOMOBILE LIABILITY
7OMN D IN LEUMiI
Ea ar'ele'
S
1. , 000 , 000
ANYAUTO
BODILY INJURY (Per person)
S
A......................................................................................
ALL OWNED SCHEDULED
AUTOS AUTOS
PHPK2334371
:1.0/�.1.5/2021.
1.0/1.5/2022
BODILY INJURY (Per accident)
,....m�._......,............._.m...................................
S
NON -OWNED
X X
PROPERT"Y C)AMAGE
HIRF_D AIJTOSAUTOS
..22., MCidenk. ..............................
.......................................
UMBRELLA LIAB C)C:CUR
EACH OCCURRENCE
S
AGGREGATE
S
EXCESS LIAB CL.AIMS -dMADE
$
GED RETENTION S
WORKERS COMPENSATION
PER 01`H-
X...
AND EMPLOYERS' LIABILITY YIN
STAT{JTE F.R
ANY PROPRIF.70RIPARTNERIEXECUTIVE
E. L. EACH ACCIDENT
S
:1., 000, 000
OFFICER/MEIVI BER EXCLUDED?
NIA
E.L. DISEASE. EA EMPLOYEE
S
1,000,000
B
(Mandatory in NH) II��NN
72.inE:CAA6BTQ
08/11/2021
08/1.I.f2022
ibe
If yes, descunder
OESCRIPTIrON OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
S......
11000,000
A
Professional Liability
PHPK23.3437:1.
:1.0/15/2021.
1.0/15/2022
Owurrence Urn
$1.,000,000
Agy�,,g.i Lirni1
$2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED WITH WAIVER OF SUBROGATION PER GENERAL LIABILITY
DELUXE ENDORSEMENT PI-MANU-1(01/00). BLANKET WAIVER OF SUBROGATION (WORKERS COMPENSATION) PER WAIVERS OF
OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA FORM WC040306.
CERTIFICATE HOLDER CANCELLATION
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
'�i1i:I.oCt}y lrf,i_ccnt,x:E;/K7.�I.Ci ""
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)
Policy # PHPK2334371
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY
GENERAL LIABILITY DELUXE ENDORSEMENT: TEMPORARY STAFFING
hass cn dor som[ n t�. irirtrdN ! i c--, si3 ra ri ce jo r ov -� der. ijridc"-r °Jho f o 1. 1. ow i.riq ::
CC)i1qM11RC' IA I, GfNERJU, kJAB, It, I 7Y COVERAGN PAR,T
is und(�aSfood ,wind aqr(',cx� t,hat. t.b.o, fol)wairiq cxLeris"cins drily apply in th('-
ovo I,: 1Lha I : no of,h(r r srxc if J c covor'gr� f or I, I I e i�nd-'i ("a, Led -Loss exposil "'o 'L
pravi.ded under. tJ'i i s rpo] �,cy . L I: such sipcci,f Mc:. co'v0r'a(10 FA.r)].) I ('s, Lho Ler'Ni""'
c�crnd ,t, I ons aiid I i 'n it. s of f ha I, cm2e r rjq(,irc, I-hc so I o Find nxc us t vo cove rcage
c.�pj,,, I il,ca b J o uirdcr' fh --Is I'm 1, i cy , I I nJ os's rat .hc nn sc, d on I I' i cz[do rs ernr-oit,
T h (c 1() -1 1 o w i' n(3 Ls a s u, i i ini a r. y, f: t h e 1, rut i t s crf 1 ri s u r a I i c o ,i ri d a d(J i, ,,, J oi, i a.a.
c cj v e r a g c I -,a r a v 1. C ie d b,,r P h J S o d 0 T 3 orn r a ir I . J� o r ofiip] o o clr L a i -1 S uj I opn c f, f f, c
Co\mrarfe ' S' c:(rmsu 1'1f fi.e po 1 i,cy cmi L ract: wording .
Covm,.aqe App-I Lcab-I o [J,m-LA:
of ].nsurairco
Page #
Darri,)qc Lo
t o You
r1 0 0 1 0 () 0
2
Exj,,��ect,cd oi lnt,cxidcoi
lnjiry , "', Darnaqc,
I nc I ucted
2
ti Linf, I,od Rem.a-l. J,oasc
Aq r eemon t C,'ori Lr, H c t, ua 1 1, l, a b 1,:Lt,
$"aO' 000
2
N o n Ownod Wa Lo r c r a f L
far. Sl9„' Lh a 1:1 1-8 F c f..
5
D'A Tri a q (:", Lo 1'r o 10 r t. y y(ol Own
Renf� or Occupy
$301 000
3
Mc oi L ca -1, t1a y i n on is
�20, 000
41
Mo d i,c,,i I Paymen Ls Borx"i r t-"i rig Per
l,od 3 Years
3
At'h I'ei, i"C", Act, � ") i
Al'noricRA,
3
i>iipple,,rien-ary 11ajimmLs
11,r,i i, I. 1:4ond.i1
$ 2 a0
Supp-I (',.jncrit tarry 11o)nrt(',n-,,,,
o f, Era rn i Tiq s
rla0,0 jocr day
4
Hmj,-a{oyoe Jridiuffni flicat a,on
D(Ff.mso C"overage
$21'l, 000
4
Who -I"'; Ara Insljrol
I rm Ludcd
4
Add f,t i onl ,aI -1I rise red Now'J y
Acqu I rf,,d or orrned orgarri za L I ori
Add rt foirra] rc'd.
Broadened yCr..3111 C r1 fnsurcA
A (J d j, t, J o Ia1., [ ri s u t d 11, 1 n k t,
Adci i t� f,ona I E nsu rcd s Whoi
All other terms and conditions of this Policy remain unchanged.
Page 1 of 13
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
Fkequ3 rc�d by Con�-racL
Ira t'J os i rtJrLc -Evont, of Occurrericcl
C) J f ( n � -,, e , C -1 a 1 1 n or: S i a L C �
J'2' a nsf ("r. of R-igji.t's of,
Rccovc��r,y Aga iins,. Oicrs Po Uz,,
(71r::1r I !(m
[�Hbera I fad on
c I aNded
I on a I Fa i I ii ro to
D 3 -,, c o c I 3 a z a r. ds,
I n c I u d e r
Rad-I I y :1, n j r y [nc Lj�des
M(n L a I Anc{C.af s h
I ricl idoci 0
lor sona I rand Ad \1 r, L i s r[ (I L ri u -r Y
inc I "� des' A b u s e o C P r occ, S S
i sc r 'In J I I at -1, o a
6
L In r. ns u ra n c c 1:111, Lrn'ar'v
CI a I, f r, 'a L �' (-"j I'l
6
S ta f f'i "Iq S E-:! r v j, c' o s' Ex c -11 i o I'l s
I i:-:i r i t i aura
S L a ff "arts; S ("r v J (-' ''s D( C' fn i L J (") 1-1
C I a r i f (^a t i n fa
A. Daiqoq(- Lo Prorni scs Rent cd to Ynji
[ f d,mi.aqe Joy f.] re Uo ,jimirri-i '-'os 'arcnt cd Lo Y("Ju J -,, n'otot:ho� w] so c:xcl-udod
J' r orn 'tlri, s C o v c -r. a g c, 1? c,a r t
I , Ujv, Dania (y�'o L, r (.InJ Sc s, P'c "'a t (pd To )Carr I I I'm L tG:.t.I on o f t. h'o
Doc: -1, a -r. a t a o ri s i-s ajvnoarrc�rd i:o r-hc qrcal cr o " �
a . $1, 000, 000; or
be Th (, arn r) u i i t: sfaown i n t h e Do C I r' r a t a ran' "'� 's L a rn a q t: -r< m ] S o "s
R c I I L c d t o You u I rn i' .
Th i s 1 s t h e rT i o S t � w o w , 1, 1, In f o n a 1, ri I a q c p -r oxt , uii t y c a t i ?, o d h y t.lae a m c,
c' v n w v t j (". -r, 'such darnaqcI, (' m'l 1, 's :from f 1 ic, 1. L cj In L n J n q , (-,.xpl o,,, i,an,
c, r lc:aaks f rom aiit.urnat L.c f 3 ("; )r rot .cscf tve systcnas ar a I x Y C ondo, i � . a f 1, a n "I c r (-, 0 f
2 11,to word f -I re Ls chaingod to f � ro, I i'ght:n Lr1q, eyp-1 os 10c 1' s'looko, or
I oakago Froin auUom,.� t,c f t.ro 1 vc,tysl:orrls wh(ro i' t a p IC) ( a 1, s -i "I
Ms . "fair, -1, a s L -a a -r. aa (A r',.a i'r h cif '_3 E C"I'l ON I COVY R A C; ES , COVERAGE A BODE'I,Y
All other terms and conditions of this Policy remain unchanged.
Page 2 of 13
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
[NIJURY AND PRO N'B"ITY DAMAGIE -JJAj0,!,1'CY, Sub�-mct,i(,n 2.
b. SECT101"I III I,WTS OJ, Tlar,aqraph 6 , ; and
c. Sl,�CTION V DNI,11N�:TIONS, Paragrapir 9,,a,; �Iid
3 Thin words I.nrramco are changod, to ansuraiicc; for
lAqhUn-ir.'g, ('Xio-losion, smokc, or f-rom frro prot(-sct,Jvc,,
s "T ON - 7 '0MMNRC'JAf, GEI'17�PAI, [,IP,BLTJ Tar wh��re i t rippoars i r SEC I C
CONDITI 0IT;, on, 4 Ot her u, Excrss [Jis'uraiv::e,
I,. Expoc t ed car` Gnat rmdod -In jur,,,7 - 11n,"j1porty Damage
SEC"11, MIN I. COVP'J`IGIIS, C,'OVI,1RAGN A RODII,Y MJURY AND PU�,OPNP,'UY DAMAGP�
—JABMPTY, 2, 1�aragrajoh a,, Nxpoctod Or InI eri,dod L"Ijwy ids:,
oolctc,<i -1:1 orit:i rct y arid by tJic, Fol Lowjnct.�
Elxjpr:ctcad Or, -1 Ira !u-y Y,
"Rode i ly LnIury" or "proporLy dtaruAgc" (-',,Xjy(,cl,mi or froul t,he
sv�,Indjpoi nd of: the j rsur(�d , This c�axcl us-i cm d(ws nat, ai,-)p-1 y t,o, "hod, I y hn j ury"
or "prr)PCr LY (JWAH(;W' -r('mI-1 t, hng I rom Uno ruso of a rasoi,Lahle force t:o arcjl oct.
p e r s (,,j I I r,; o r p r� n p (rr. L y .
C . 1, h-n 4� T,(�d Rcn La I kea[;e A(,,drec�Inertt Cont r a c t ua 1 1, i, r,a ha i -1 1 �- Y
S]4�CTTUK
I
A BOD[I Y I lf,MUPY
AND PROPERTY DAMAGE
J, [ AB F['Y ,
2 Excl.ijsAOTAS,
jlaragrc,Lph b. Conl
L"', a!rurldcd by
a d d r t, h r I
f o 1 1, o w 1, rang :
11,<,l o d 0 1 c t, l 1, r I a I � I cr d J rt I I r ( Id C ("I I I art t h o i-n o f c -1, a r T w u ra r t r c, a
i, I d orrin i fy L h i, i a rin cf irr"'cure d f r) r t b. Q�a J r, I aralri, I L I . y a s I iT.i (I n a c o Ir t r A-,) c t c) r
q r cn e r I L r, c g ra r d L ,,i I, h r I c a a f a T,:I r c an , (" 's rrrr ha"a I I r I I f: (, F t 1, 1 L I-
c-1
,, cov c., r a( jc cxLofls] on on1,-',7 Ir rerlLn 1 1 o,a c and Ls
C 0 V 0 Jr, "t r I Y :FEE 'I t . c r I s, 1, i, at,, 1 1. , i . L y i ic.,arrr,aarc r A cif: t I I- a c a c: 1, it ri t
D . N o r I () w a I c '¢ d W r a r ,>c r a f t .
All other terms and conditions of this Policy remain unchanged.
Page 3 of 13
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
:3'NCT D)NI COVE RACI-,' , A RCID I I I �, 1 I'JJRY P111,11) I
1,1A?�,f[JTY, WmsWn& q. AWWL, AuW Or WaNMCMfn PwwqMph (2) is
arnond(".d to road, as fol'Aows:
(2 1 A wr,� I c rcra f ',' you dr) r-ML OWC, t:hu t r �!:
(a) J'CSs thorl 'iFi foc?L Loral; and
(b) Nol lx,,nq us(,A', to carry porsono w proporty for a ch�-,)rqc;
provisiori appJi.os to "Irly njersorl' wh'o wLth yout consont, Isr',
or i s resnns RA o 4 r tMe uso of a watornwaft— I'lh S i I [ S UM r� a -I Cr, i, S rrcr S S 0 V (-,, r
a n y o " 1-1 ( '' T, v a 1, 1 d a r 1 (1, ( ; o -1 1, e c t 1 Ir J (1, 1 1 r a i i c a v a i I a, h I c a r liiiau r w Jr i. c e r
pi-hrT,iary, cxcc�ss or cont�Jnqr,,nt.
Darvage t'o Flrcnpurty You Own, Rent, or 0co-,u:py
S*C'T[0111 I COW�BAG��ts' cwnl Iw',N A T-,'C)D-[!,Y lbU(JR."( P&JI) PJMP-,,RTY IMMJv',f^:'�
ITAJ�,[JITY, 2. FxMskml '. DwMqe To Proporty, PFraqaph, (L) rS i,rl
ont.iroly rod rcplac-od WD"h tho foll'owirlq:
(T) Pi,olcwrLy you own, rcriat or ocriul,:,y, aria ludi,nq j.zrry corst-s or
x],,.,cnscs incurted hy yoW oy a" Met pn"an, orqan!.gait orw whUy, for
relonir, replaceiriont, cihancronout, rcstaynt-ion or of slrch'
popwAy fan any rowmn, imAudAg rwovention of injury to a Fairson or
dwuqo to anntlmr4 pwponmy, unWss M damage in p"ImMy A cauwA by
your �,1, i on f., up I:n a $3 0 , 0 0 0 1 i'ER L c -I J or " L 's do f 1 rzod as a, J'w r sorl un d or
y,oi2r di,xcct. carn and suporvr.si.an.
J,', Payniena .s
1, ""f COVENAG"E C IVIRDJECAI, PAYMEI>IT�S is not.. (Xcludod fyom t'll-is,
Covorrage Part, the MedicaJ Expoi�iso kiuilt is chaivTod ajbject- Lo aIA nr Lhc
t:cnr.ni.s of SEX,"T]ON Al WMJTS (W DMMAMNICE w the cyroacer ok�
a. $20,000; or
h TI i cM c, d i, c', a -1 Nxioonso 1, i irra f, ,, I' L a w r I rn Lhca Doc] '�rat ir)ns of, LM s
All other turns and conditions of this Policy remain unchanged,
Page 4 of 13
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
cov('-rlqc pari:'
2„ Undc r I - COVERAGES, COVERAGE C' ME1JICA1, IIAYMNI�,VUS, `)-,A,)er,h:�,nn 1—
[insurincl Aqrc,eimmnt, Par,icjraph a , Ftmn -is arnocidod Lo
(1,,a ) Th rF.ar,rrr rr s ,.ar c, L in cu _r rod and r. orm r i: o u .r w n ° li r. oc.,
y(�rs, of Lhccla!-.e oF the accddent; !,md
G, 10:hjci'J(" AcLivil aes
S1,,C'['fC)N I COVEIIACES, COVERAG'E C M,�D[CAI PAYMENTS, M. Fxc',Jusi.ons,
llrlraqrap�[ e Ac"'Liv-11-Aes de_IcLod in its, ero.Jrc.-ty and rejoJ,Ficod
w i t'h t ho f r) I Low riq -
(�. ALJA_1.oLtcs
T'o a joorsoji injui'(.d wija_JcLak.Jng part Ln rOtJoi_ics'
SD:C"TION I COWIRAGL:S, 3UP111,FMINNTARY PAY MIE NTS A AND 13, 1.
I loarid i,,d, a: rcair.onded ns:foal lows,��
h ila(1A,rn3L for' Lho cosL of I bonds changed f r OM $ 2 �_a 0 t o $ 2 ) () 0 ; a "'a d
J . IN o I i rn r, t frn Joss ctt earn-ings i_s chanqcd frcmi at day Lo $1DOO
at day.
1. Ernployco Ilrrci,�,,rrti.-ip,fi,r,,,,�itaoii, Dferim-:a Cove_raqc.�
SECT[ON F - COVE1aAGI,�'3, `,,M 11111 [J,!Dq1U,1TA1AY ]111YMENITS A Mfl) B is
a me n i d t:.o J ri c',, -1 a i d o t , h. e I () I 1 0 w i r I cT -
We w_i I i pay, on your bcl-[rOf, ear,-fen-,c ccmt:s -incor.3-cA by an 11,1 p'iyre J n rt,
a c-r-i ,rni nril procendi rig.
Thc most, w"" will pay fc+r any oyeo" wli'o i 9 di rectJ y a,Irjva.l voc'i i in r.
All other terms and conditions of this Policy remain unchanged.
Page 5 of 13
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
Cr 1 mJ z I a -1, p ,ococdi iiq r r, r 2 5 , 000 rcq,l r d J (-,ss c) f h c,,, mi in loo r s of "omp L oycos
o l- " s u i t s lo ro i i q h ta r ro ? r .; oiii 5 cl r o r (,; a ri earl, 1 o x i s ,r,) a k, " n q c I t Lms cl r
CT C rrcp " mi l i� ,,, .
J . W h o a s Aii Lfisurcd
SECT] (N 1 1, -, WHO LS, AN crnmlded as fol
1. New I y Acqu a, r od (.) r [,'ormr-d Orqaji i zat: C,ori
ear or n ("'w I y acqu P. r, ea a r. Fo r Tned car (,y Saar i rust S o ir� s i 3 11
o I h,erw i se exc] lidod f rum th Ccivo r ago P iar L, Pa ragraph. 3 , r,l a al9ccided t,a
r ea d :
a C o v (f a q e 1.11 ider t h. i o p , o v is i o ri I s a F " o r l-R r d i j r l i: i, 1, the o f, i d o fd::l'acs
p o 1 1 c Y jo (l o d ;
2 . G�;exch ofI 1,lc� fol -1 ow i iiy -J s a I so "-.m i um. rord ;
a . Brm�ldrim,.�d NaTii(oi I iasu a od Azly o r qail i zat 'i,otl ;llld oubs, i dAary ", hcreo f:
wh ch. You cojo. 1-o N, nrand act ivel Y Riariaqo oia t la(- cl r r r�c,,dJ vo d,.a try of t,h i s, Cove rage
'rant t iowe v l,,, r, co vo r a q o d (" C, li floL app �1 Y Lo rain or q a rc i.zaal. i darn ci, -r li r v riot
oalaed Di Lhc� D(-cl arat.] oxis as Named I rlmrrnd, f they ,,lre al,5o Lrisurod wol(rr
,I ri () L ki o I s i n, 1, 1 F r r p 0 -1 J c,, y , Prank, r or 3 t: s, I c r rn, i. 'i a L 1, C) i I err 1-1, ox h a ll r, 1, J () r, I o f s
I i ral t s of 111 S I ra rr c e .
b 1 a; n k e , Add 1 L 1, -1. xi 5 u r col ' s Wh.e i,i Req i i i T, (ad ll y Car: i. r a (,, L Ari y
prT ixm 0 r rg,-,ol .l Z, J 0 , fj C, r Ci C1, j r C rp j1jY al w r r I c o r I i, r cL (,x o c', od p r i ( ar,
d o Lhcoccurroxice cif a 1, as s Such, pcasori, Or, 0rC4,Ar1]zaLJoj-1 L,S atr
imsured for "lood] iy N n ] li r y llpr.operi,y damage"" or. "persoi:wi,l arid adv(,rl.Lsiinq
NTljury,, lout rm I Y for , H a]u i -1, 1 ty arl,sl,nq oul, of tho r1eq-13goric"o of t,he rainlcd
i r, l,', I I r E'd , Th 0 t DTJ S Cif: i Tlsll r a f A c (a1pp 1, r,crlb I e (Xr tlaose::r add �, L 9,rl ,lla l-(=d I ,�
Frro Lho les,,rer of rho policy linai.A.s or t,hoso lililir,s opoc-if](A in. a corli-rac,t.
or cigroerwllt, Th o 's, (" Lhint,s are iflclildE,d wDh-M rmd �io� ri adrHtAoTi Lo i,he
J'HIJLs of, LrIsurafice showil Jfa tho
p,,j,j a t i I _Ierrs car d , s -1 -1 I'll r, t l , () -1 In ,. u n, ea ri co do xioL 1 f=easo oi l r -13 in i t: s of,
irisurc.iricrl, a.s doscr-iberj irSECTr014 I I L - LEMJ'-I'S 01,1 1 NSURANCE �
All other terms and conditions of this Policy remain unchanged.
Page 6 of 13
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
(� [ n t (, r n s, Y c, i i i,,' L i� i I . e r i n w h c, p c r f o r fri i ri q d'j t I E e r "1 L o d t' C) klrrrrr
ccmduc t o f- yo j. r J,, si s a n r .,-, ,,
d , C'on t�, r a ct, o r , Any t x i d 3 v di I "i I or ol qan za I i o a I mr-le r WI-J. L Lon cors L T, a C:-' ol,
w r i t"Lo n ag r cornol L t w N t, h you who p-r ov i do s s I, a f F] ncq sca]--v i co's " on ym I r bodl a I f
a n ci ;at y () i i r d J r o c L i r) r a r a r r) aj, r c 1, "f o i: i, t, . 's .
1. Du t � es i, r L E'von t- o f Occ i i r r, r-,nce , Of f (-) nm , ('I ,i Lm of '� S u 1 t,
1. S,;CT I ON 1, V COMME RIC, I A I I G' E N ERA I , 1, T A H I I , 1TY C0 N 1) t T 1 () IN S , 1. a , L h e
T' cqi'l 'iT omen t Lh a L ym I must, See t-o it, we are not, I r as d a s smon as
r a (" L i c a b -1 f: sI " o c c, i i r r o r i c (-, " o r Fa ri o f 11 r i,,, app-1 i.cs an I y whcri 1.1-ie
o c c, u r r e n c n r of f u r a � ; a , a known tIo -
a , You , j r yaua are Clam i, I I d J V. �' d i I d I ;
ha.. 11" ju,i r t,nor, , i f you rare a t.,ar t'nc r s1l, i'p; or
c— An' "oxecnft Lve of,f icon'"" rjr .rjsw a f A ce manage r you sage a
po-r a 1:�J on
2. SECTJON 1V COMMERCI.Al, GENEPAk J,TABI LTY COND-IT-ONS, 2 Ira t, Ii,e
rmju-i roinerit: you fnusL so(: t'o i't' a'Jnat wo r ocr� Pvc, 11 a I, J, ce of ra C N a, i'm ea:a,
11
, u � -1 L 11 as s r) a ri c:i s p r a c t:. I c w a.or bo con,,, iAered breac:l'rerl. unl css, t ho
b r (,,a ch c) c, c u r s raftc, K s u c h a Em a i, s, u J L " i, s known Lo �
a . You.., N f you i re an J nd v i chaa-1 ;
b . 11, 1,) a " t f I o r , i, f Vol j c'a 1 re to pa rt, rl ; r s h 'i p ; o r
c . Ara " o xo(;u 0: 1") (, o r f, 1 c;e r 11 o r j ra u rance ma na ge r , if you it Fr
co-rpob 'i.orl,
L. Tramsl'er of Riqht:s of L)rycov(ary Ar.,laanst, Otlicr-To Us
I ON IV - COMMEBMAL (-;INERAJ, COND I 'I'll ONS , P a r a g r, ;!�r-,'ah 8.
Pransfei- Or' Riqh,Ls Of, Recovc�ay Agai,xisL OLhor�, To Us includo"s thn fo-1 lowing
All other terms and conditions of this Policy remain unchanged.
Page 7 of 13
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
T I[( r o f or c , LhN , n s, 11 r. ed (,,,a a w a [ v(,, Lha n s j r r, r ' ;-,, -r: q I i ts o F rc.covr Y, y p r L r, -r t, ()
-,o occu r -r cince o I a J o,�as , P vi,dod t, N I o wa i vo r. i..a madrs -1 n a w r Y c I, n conra( L
S11�;C1j11CM11f I v COMI,141,RC[Al: � [,JAII,[1,ITY COND [T] ONS [ s &moridmi t,o Jncludo
1Im fol-low]ng addi'Lional condD ion:
l , 'i, lo (r .. -1 -1 z a t i r a n
If c J7 1 c I'l t o p , ( j v J d r.m o r o r : r) v r, a q �:w J l , h o l
d d J, t :( j i, i, r t 1, jo r o i n i i a I n, c rl r CT C-;w o w J I I raiI om Fj M c a I ] I/ f ) r r) v i d e t :. h r, a d d i 1, i c) r L a I
co I aq ("� to as 1, 1, e 11 d 0 r S c R o I, I t la.es I rlcryaT S a S r, i.lar, d, a Y t lsCa', (',v I f; L r j r I i as C', f f t E v
N. Un-InLo�nlAonaL J'ai Vuro ['o )anclosc, Hazaraks,
S T U'll [\/ COMDERC'JA[� GI,M;PAL 1JJ1,]1IM'UY CONDIT101',IS i.,-, am(�,T.adr d LO Jn( 1 U d rr.
t� IIe: ro I I ow [a: q add i L i on"Cl t. i orl .
un-hri(wcnI kin,)l Fay-Ium Uo Iscloso H,,�zards
1s a.qrocd Lhat, ba.,,cd on our rrIA.ancr. on. your js, t,o
ex in(,y -ia r cis , �. f you sb,rjjN Lci u n 1 n t c n �, 1, orl'a I I Y farN tr, d [s, c 1, o 1 -1 s, I I c: J, I
h a z a d s p r i, r) r L o Lh c,hcq s %n i A I q o f tj'jc.� po 1. Lcy poi, � od r) I tAi a,s Cove raq(P?.cr t: ,
wo SIr�J I nw- dcmy cm/r. ragr,,, U11der. LAI i S (',0\M r,ar3e t, locc"niso of, S u c a f a I I I I r,
0. Blvd 1 y iin j u r y Mc,,,nta I Anqu-! sh
SE1'C,T ION V DEJ111°,, 1'11' LONS, 11a-r aq raph "I. � arnondcd ',,r) r(, ad :
" B 0 (1 -1 1, Y N r I I � r r Y
a . mr',,eIns bod-1 -1 Y 1 njury, sJcRnos,,-; or deaso sustaTied by a. parson, rand
_Lric, I Ados �Fv-,�nUa I a n C; s i i, I L s i j V L 1, 1! r r- I f � o i n an y r) f t : I i (, . , o ; a j i d
b , 1,,xcr;.pt f car- rnc,. n L, j d r,i '1 g(atS I r , i rAC hldOS dor ,OJ] -, r u-1 L r,n,g f r om ! Jr C*
All other terms and conditions of this Policy remain unchanged.
Page 8 of 13
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
f o re (To (':It em a. rrbwm) at- 'airy t Du(:.
1'. P c" rsonni I and A dvcnr t. r s -I ag 1, rI j u2 Y A hna��o a f 1:1 rocess , D i sc r r mina t. i on
t f ("(DVERAGE 11, LIFPtSOINA I, P&JI) AINERI-I SING I JNJURY f, I A B 1, [,1 'j"Y C'OVJITAC,E i S I I Co�
ol.hcrw so oxc', I udo d f, r oni Lh 1-s (,',OVercago llar, Lhc,dof r n fL-I,ori of. ""Laeu. cjna -I an
advor.l sdnq M l ui ys airtrridoci -,, Follcaws
��
1. SEC',I'TON V DEI� INI I [U"M" ].A., Irom is rovisod to ro,.td�
b Ma I I c -I' m I s u I, -I on. mr, a b u'io of p roc',s ;
2. SECTJ ON V DEF"I pli J III] ONS, Parag I, aph I /J . i s almondor"i 1,C) finc I �oe Lhe
f o 1 -1 Ow r' r1rT „
I,Im,soria I and advni-t � s � nq ; n � ur'Y"' "� "'m moari �3 (j] scr hm � 1:1at'i On h'ised on
rac"c" Col () r , ze I ] q i on, sox, aqe or i oria 1, or C(4 i in, oxcopt: whon
'�e . Done J ri Lori I -I on Y joy or. a t di rect, i on of, c) r w i ',-h I,hc,
Irr I o w I odqo (jr ("o I I scnt' o f: -.
( I ) Any i.riz;i,r-od; or
(2 ) Arty ("'xcc I It a V(',' (-) f f -1 cor , d r(�cf a r, , s r,,oc k ho -I der , p,�a-r I ro r a r nmmbc r
of tJle fnsur(oi; or
V). y or Jnd i,roc' ,3 y t:'(",, I at,ed f o f,lm cinj,,aJ oyinonL, formor- or
prospoct a vo unpl Oymen, Lei iTi i nw, i or! of emij-,,LoyrncrjL, or appIA catA ori for
c'mjpl'oymcnt- of any rpor,.;cn car pci,.,coin s by an Jrtsurcd; o3-.
c , Di r ccl Ly o r y ro tat,ed La Lhc.., sal o, i-eraf al , Lr,-,�asc� or
dhloase or P.ospcc.Lvc., �;alc, r c i: i t, a I , L c r a 3 o 02 s u I I c a s ("o f a r 1 y r o o r T)
dlaol I.Ling o2` by or at, t1re dAre(-�Aon of any insi,rnd; Or'
n s u ra nco for such disc r fmi na i on i s r.-aoh i L) fA od by o E ho-{ CJ _irr
v -1 1 r z W , F) I ' 11, ) 1, J c jo o L i c y , I o q s 1 a L aria c o u t, d c " c i i o T. i, case
c,oiva-fn] s L ral ivcru 1 J rAq .
[lac abovrr doos neat Asap,].. tea f Lrms o-r. I t� i os r.mpomd brca u se of
All other terms and conditions of this Policy remain unchanged.
Page 9 of 13
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
d J sc r i u i si a l..
Q , 'I; ( , c t, �, (", rr 1, V C' ()!I nrio r c 'f a -1 r i o r. a 1 1, 1 a b 1, 1 1 t, Y C"'o .oi l, t 'i, o n S J, s aute"'I ded 1) Y t 1-1e
a dd i t, I o I'l o r Lhe Eo I J ow i 11(4 ;
'Ulac f o -1 -1 o w J I I q 1 a J-1 q u, a (,{ c r i S d dd Od t 0 1 t, 0ITI 4, 0 l A C r I ns i j r a ri c o :
J i i s u r a rA c c) 1 j r) dE ' r, t h i s cl I d o r r c"rylof I l, i s, p r : Tu a, r V t, o ca r I d TI o T) c o 1a t , r L'nu t, o ry w i I J.-I, a Y
of 1rc, r i n �i � r c (ina I nil n 3 ned k:ay Lh e 1oe son o r o r g a n a z ,,i, on (Addi t icyn,�a1,
t I rs I I o d ) caxco,,)L for loss rosul,tn i COITI LhC of t hatf-xrrson
or orqand lalJon ,
IIN �",, condiI::._kcarr tall,lraIIcsa even i f ol hx�r val, Ld and co L lect, r t)l,(' i nsu:-arlce, Ls
avaA Jablr, t,o f he Add.1 LiaTT,)-L IM;UrCd t0r d. IOSS or "occiarrenco" w(cov(�r for.
th i s Add Sona I L n,,� u r od, .
R . S t a f f a, r r. g S, r , r v i (", e s Ex c J, u ,r i o" I's
The f o I i raw , i riq oxc LuLr i,(ms, ax.e uddcd (o ICJ IN I C 0Vf 11,A( , N S , COVERAGE A
iNJURY AND PROPERTY DAVAGE:
Act.Aons or Aca i,vl t I s Of IID�O Worker
"Bodi lLV �.rl �iary" w "I,,,,,roper��y damaqo" aris � ng f:rorq t h(^ am r.ons or .act ivLl I.es
of zany " PEO wo r ke r " .
Prof nss i orr,� I Srrv9.c(,s Nxc, Lus Lon
"Bodi Ly r.n ury"' or "pr oporty dam.aqra" du(= t o Lho rendcr Lnq o f, or fai Lure t.a
rendor any pro f erss i oxia I ser v 1 ce , TI-L oxcl us ,on does nol. app L-Y t () your
-1 sA)'i,I, f, Ly ('car "lood i -1 y -1 n u r y" or "Ipr'aper t y daivFMqW' •srris 4,j,ig out, oL your
llc�rrljp-1 oynn providr xv3 ("'r ra 1 1 i nq Lo pr(o), a de prof.ers i.om:f heal I la care
sorvices Lo anoLhor or your but, no is r,m ii:i,,iured foc
hi s.!, o-r. 1-ior. provLdlng or ra-i t.() provi'de rrrof(�assLofaal ho,,:Nth. carca
sorviccs.
N r o rl, g f, u -1 A c' f:. ,r
1-1, C,) d L J Y a rrnry" or, "property (Limage", ar i,s] nq f roin a wrc)nqf ul act, -1 n the,
All other terms and conditions of this Policy remain unchanged.
Page 10 of 13
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
i- ondrar Lng o- f, c) y -1 r i r. o ;,o r c, .-i d o r , r c r v ( r r , I o car for y o i a r c, 13 c, i, P- .
rear t, h o jo u j- jo o s c s (,) !: f J-1, i, "', nx c: 11 � � ,, i, on wr o i (jf is -. a c ',- sl-i.ra I I m(yan a,,'iy acl ucAl or
a a (a:. , error„ o r om L ,as i o r i , ars, s t� a t� ( tiTi c n , o r. iii i, S Lcdd a, r',(3 S t,c,at (rITV` t, 'i, 1-1
courscr of pruv:.d.mq "staf f] Eicj sei-0cesll t,o yea ar (-J loy you o., by any
f (-,) i, wh.o,�o .. c fyou Fj ,, -1 o (I a I I y spons Ll-Lo .
SEC'PfON I COVEItAGS, COVERAGE B [1X1,'30NAk AND [IIIJURY 1,7ABI PUY
CC) V'I'Iliq\("E i racier rI dod a s fo 1, Lows, '-
I. ',Ixcl k- doc-,, not apply.
2 . Exc I i wis H. h., (-, . I f. . , q . , Ir.." If y 1, . , a ri.d. p . da na t, ap ,p I y to a n y
I "; u 1, nd Who d J d aC) L pC T, S 0 rl d 1, 1 )7 rI CrJU 3 0 S Co i 1-1 C" r r c'ma i ri p a '; s -1, vcf t' r- 1, v i' 1�1.y
po r or, ,a -1 know -I odq' of, such co"Auct' 0 a r, o b 1, i (; a I- i o 1, a I o p'.1 Y s I'l. a 11. 4a q I , '. o I'a c o
r, hc, f:j, I I ro< t, L of, the as sots car t r es joan j b-I a rs u r od I.-i a s k)oon ox u
aj id. nnce t� he Ded u c t i,la 1 o a s shown i.n the Doc a a a t,� i c') ,i s eat tl,rc prj 1 i cy fits bron
S rI L s f -� a a d ,
I The fc) -I Low, i 11 q ('Xcllas aLoris Fir e 'Adcd as rag-r., a ph. 2 , Exc I us Lon,,t
Act,i ann 02 Act--i v itA t S Of L:INO
" [ I o i, ,o r j a -1 a ri d a d v r t i, n q : i-aj u r. y " a r i s on, tlae a c o n,, c a c avit ic,s of:
a I Y " [I E 0 w a r 1('„ r , 1, .
FIT-'ofoss-lona'L Sx'rv-lcc.'s I�Ixcllasi'on
I'lle-r-sona I aaid advc, r fr3 'inq in ur, Y" (I (A(',' t-o the roi�ldcI, i racy of or f a i I ur. e t:.()
rc I, Aea:- c'my .'a ro f JI nrl'a I so r v Lce ,
Wi,onqful Act,��
"Porsonal and adv(ti,sixi,g i,nazy" arLsJLnq Iroin as wroriqffr31 act -1,n t'ho
renderinq or. a: o rc rider s'c'r'vJcos Lc' or for yolar- cl
i! or tl'io pu-rpoms of LhIs oxc]u"-"Ion' wroriq(11 "act s h a 1, 1, mc � a '"I Gary a (" t u a -1 o r
a 1 logod act, c, r r o r , cj r r) rn. i a'i cd T. i , irt i , , t � a t c , mo n i � , err ri L i s -1 e a (J J i: i q s a t", oii Lc, n t i, i, i.
tho courso, of "st-aff ing sorvicos" Lo your c-Liorits loy you or by ariy
All other terms and conditions of this Policy remain unchanged.
Page 11 of 13
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY
p r, r s o n F r)-r r,VhOSC aJCt-S y a �,, " � r (rr -. r , q,a 1, 1 y r c '3 pon s o ,
Se Staf f i ng Sr., rvi.ces De f r.ri Ltions
1Sl^�CFION V - DFF'INIT-f.ONS, Par.aq{rapb. 5. 1, s -r. e v i s, e d tea r. e a d �,
'111o�mp'loyee" inc].Wes but is not AMU to a Ne"ed wodwr" ami as "MUEAq
service Employee". "EmpLoyee"' not- iriclude a "temporary wcrrker" or. a
"1?F,'0 worker" .
I. The FoNawing dMinitions are Wkid Im SEMCM V MF PN AWNS :
a. "PEO service" mean.s, staffiriq relcated se-r.vi.ces as a Professionai 1?uip-loyeja
0annIzation (HE) ymj provide Lo your cLi.rents ard. to "PF;0 wor.k.ers" in
connec,tiorl With rem]p-I-0yJ7ICMt Of S U Ch WO 1T.-, S ,
b. "PEJ0 waorkel,-" means a perswi you Inase W your client Mer a wqtten "PEO
agreement or contract.
c. "Tafnng Services" rwans ser.oicprovided by as staff.Ing cornpany to
U-jeJr. cl..-Lents including but not: LuI-ited to,
(J) Pul r] I 'I'licnt of any OF QhQ nani-in-isl,rW:h/c, functJons vqeik�h woja-..d o•lnerwi.so
bu nomany fuUMIed by an emoaym's hmmn roswrm, Q=Mn;
(M Staffimg related servi.ces joravi.de,,'I by an Administratioe
Services orqanizatl-oia (A.S,0);
(3) "PF;0 serv]..ce";
(4 5-,:af, ffi 1� I q ro I a P�c d sr, r \/ i ces P�',ovidr:,� 1 1, a your c J J on I ro r q� n(,, r oc, r j 1 L rio n L
SAUCKon and pl,tceRIC"nF, ol a porscin, for onijrlcrymorit. wI,[:h a ci.irnO ,
(5) IMporary, cont&gef.ft care ccm.tj:act.. jolacei,rent
(6) Vendror MarLagemerit Sery-..cre (VWU, mews the QcW.Itgat_ iwo 1"rAnse and
mwngwant of "sLaffinq servi.ces" for ciients including tlae placenlent arld,
of orders f.or "sta.ffing sE.rV-..C(,I M.Rr-)I(.)YEN:,S";
All other terms and conditions of this Policy remain unchanged.
Page 12 of 13
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
(7 ) Sc a, irs,ces, Tner f orricid 0 in tochat, f of ym,u c I i On L ],:�Y a: " 9�1 a f fi ng Sor vi ce
oimployrc" who J.s not. a (JA roct: or permanenL placoinc � n t. n
8 ) Scar v -i cos rxT f-.oT-. mod Eo-r a c 1. Len L (aoriijpany Lcsupp Ly Iba. L c L ien L company
i Clh a "staffing '3erwirwe oinjpl oyoca " .
(3, " S a I f J nq scry Co clupl oyoe "rm:!a n s as jpc.,j,.,soin. wtm i s, fu r n fi shed by you Lo
your (", I ioll f: Lo pe r f o r 1,7.1 t ho d u ties, t:o wh J ("JI You ha vn aq rood.
All other terms and conditions of this Policy remain unchanged.
Page 13 of 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
Policy Number: 72 WEC AA6BTQ Endorsement Number:
Effective Date: 08/11/21 Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: Alliance Resource Consulting LLC
1 CENTERPOINTE DR STE 440
LA PALMA CA 90623
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 this agreement from 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 endorsement shall be 2 % of the California workers' compensation premium otherwise due
on such remuneration.
SCHEDULE
Person or Organization
Job Description
Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from
us
Countersigned by
Form WC 04 03 06 (1) Printed in U.S.A.
Process Date: 07/01/21
Authorized Representative
Policy Expiration Date: 08/11/22