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PROOF OF INSURANCE (2023) CLOSED7 a DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/05/2022 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 endorsements „ Yer a Insurance Services, LLC 877 41 CONTACT PRODUCER VICtOrla L. Smith N.I. _.............. PHONE 571 248 319 FAX 8 5422 Yerg Parsons Lane A DID � „._... � 9Y E-MAILSS vi tn(ia erg�y n mcom ICin George VA 22485-2434 INSURED Four Star Investigations, LLC 400 N Tustin Ave #401 Santa Ana CA 92705 COVERAGES CERTIFICATE NUMBER: INSURERA: ACE Fire Underwriters Insurance Com an INAQftERB: -------- .. .._----------- IN uR m . ...... --- _------- .... ...... INSURER D ...... .............„ _._ .... -- INSURER E ......." ......_ ....... ..... . INSURER F. REVISION NUMBER: 20702 —--------- .. ......... -- ... ......... THIS IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUIREMENT, OF INSURANCE LISTED BELOW HAVE BEEN TERM OR CONDITION OF ANY ISSUED TO CONTRACT THE INSURED OR OTHER NAMED ABOVE FOR THE DOCUMENT WITH RESPECT POLICY PERIOD TO WHICH THIS INDICATED. 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. 1�6sk NCE ADDL SUBR 11 PO ICY NUMBER POLICY EFF / 1 POLICY 'MnEXP LIMITS COMMERCIALPEOFINSURANCE_ GENERAL LIABILITY A CH OCCURRENCE $ 4,000,0 •••••• I.iAMA+�aE TO RENTED $ 10�0 000 CLAIMS -MADE OCCUR „ try+.�I ,0l) _ _.. ML:D r-�tl .m one pecsa $ 5 Cid O A Y SPIG28990649004 05/13/2022 05/13/2023 PERSONAL & ASV INJURY $ 4,000,000 X ENAGGREGATELIMITAPPLIESWPER: GENERAL AGGREGATE s 4,000,000 wG'L °w POLICY ❑PRO- ❑ LOC PRODUCT S - COMP/OP AGG $ 4 000,,0 O., J JI CT $ 0 / NIL,000 OTHER: oM Ntible/Retention O S1NGr E LIMIT $ 1 000 Au TOMOBILE LIABILITY I ..LF „..pMldtia ..6 ....... „------- _-- ANY AUTO BODILY INJURY Per person) $ A OWNED SCHEDULED Y SPIG28990649004 05/13/2022 05/13/2023 BODILY INJURY (Per accident) ..._° $ AUTOS OAUTOS NLY HIRED NON -OWNED PROPERTY DAMAGE c J ' oqn ---- $ ...... "" " AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENd: IT $.. . EXCESS LIAB CLAIMS -MADE' AGGREGATE —........ $ ,.,., . DIED RETENTION $ PAR"i°(g. $ WORKERS COMPENSATION YA '..,,; ER.. AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETORIPARTNER/EXECUTIVE „ ._ E„L.. EACH ACCIDENT OFFICERiMuEMSER' EXCLUDED? ❑ N / A E,.L DISEASE - EA EMPLOYEE $ (Mandatory in NH) If fi�rres, describe under DESCRIPTION OF OPERATIONS below E I DISEASE - POLICY LIMIT $ A Professional Liability / Y FY SPIG28990649004 05/13/2022 05/13/2023 Occurrence $4,000,000 Errors and Omissions Errors and Omissions Aggregate $4,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of El Segundo is included as additional insured for general liability including completed operations if required by written contract SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo AUTHORIZED PRESENTATIVE 350 Main Street S I EI Se undo CA 90245 me Email; ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD PROFESSIONAL INVESTIGATION SERVICE CONTRACT — ADDITIONAL INSURED ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies all insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SECTION II — LUBILITY is amended as follows: The following is added to Paragraph C. Who Is An Insured: A. 3. Any person(s) or organization(s) for whom you are performing "professional investigation services" is also an additional insured, if you and such person(s) or organization(s) have agreed in writing in a contract or agreement that such person(s) or organization(s) be included as an additional insured on your policy. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage", "personal and advertising injury" or "economic loss" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; in the performance of your ongoing "professional investigation services" for the additional insured. However, the insurance afforded to such additional insured: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required to provide by the contract or agreement to provide for such additional insured. A person's or organization's status as an insured under this endorsement ends on the earlier of the date: a. When your "professional investigation services" for that insured are completed; or b. The service agreement you have entered into with the addition insured is terminated. 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: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; 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. All other terms and conditions of the policy remain unchanged. Authorized Representative BOP-4523oa (05/16) Page i of 1 SST BEST' S CREDIT RATING DISCLOSURE FORM SINCE 18 AMB #: 002109 - ACE Fire Underwriters Insurance Company 1. The Symbol, Number, or Score in the Rating Scale used to Denote the Credit Rating Categories and Notches as required by Paragraph (a)(1)(ii)(A) of Rule 17g-7 ACE Fire Underwriters Insurance Company AM Best #: 002109 NAIC #: 20702 FEIN #: 06-6032187 h Rating Rating: Affiliation Code: Financial Size Category: Outlook: Action: Effective Date: Initial Rating Date: A++ (Superior) g (Group Rating) XV ($2 Billion or Greater) Stable Affirmed December 17, 2020 June 30, 1963 Long -Term Issuer Credit Rating View Definition Long -Term: aa+ Outlook: Stable Action: Affirmed Effective Date: December 17, 2020 Initial Rating Date: August 16, 2005 ( i ) Denotes Indicative Rating u Denotes Under Review Rating pca Best's Preliminary Credit Assessment is an independent opinion on the relative general credit strengths and weaknesses of an issuer, obligor, security, or a proposed transaction or financing structure primarily based on business plans, term sheets, and AM Best's expectations relative to the execution of such business plans. AM Best does not define a PCA as a Credit Rating, however, the assessment is expressed using the existing Best's Credit Rating scales,. Best's Credit Rating, Analyst Rating Issued by: A.M. Best Rating Services, Inc. Ambest Road, Oldwick, NJ 08858 United States +1 908 439 2200 Associate Director: Gregory Dickerson +1 908 439 2200 Ext. 5161 Senior Director. Michael J. Lagomarsino, CFA, FRM Page 1 of 16 FOUR STAR INVE571GA110NS City of El Segundo Attn: Rebecca Redyk 350 Main St. El Segundo, CA 90245 SUBJECT: AFFIRMATION OF EXEMPTION FROM LABOR CODE SECTION 3700 I am aware of the provisions of Section 3700 of the Labor Code, which requires every employer to be insured against liability for workers' compensation or to undertake self-insurance in accordance with the provision of that Code. I certify that at all times during the performance of the work under the permit, license, agreement, purchase order, or contract with the City of El Segundo, I shall not employ any person in any matter that would subject me to the workers' compensation laws of the State of California. If at any time I employ any person such that I become subject to worker's compensation laws of California, I shall immediately give the City a certificate of consent to self - insure, or a certificate of worker's compensation insurance, as required by law. By my signature below I affirm under penalty of perjury that I am authorized to bind my company and I am not required to comply with Section 3700 of the Labor Code, or any workers' compensation laws of the State of California, and further, I agree to hold harmless, indemnify, and defend the City of El Segundo against any claims or damages resulting from a violation of Section 3700 of the Labor Code. Keith L. Kilmer, Owner/Manager Date: 76P /Zf Four Star Investigations, LLC Keith L. Kilmer 400 N. Tustin Ave., #401 Owner/Manager Santa Ana, CA 92705 (562) 491-5651