PROOF OF INSURANCE (2022) CLOSEDA+I :"CAR CERTIFICATE OF LIABILITY INSURANCE
F'DATE(MMIDDIYYYY)
04/11I2022
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
CMTACT Fred Dean
NAME'_
Premier One Ins Srvcs
PHONE (949) 727-2025 949) 727-9219
A No Exft 'd, No):
100 Pacifica Ste 480
MAII. . fred.dean@premierone.com
ADDRESS
INSURER(S) AFFORDING COVERAGE NAIC q
INSURERA: Beazley Insurance Company
37540
Irvine CA 92618
INSURED
INSURER B ;
INSURERC:
(Water, Inc..
12 Goodyear #130
INSURER D
INSURER E
Irvine CA 92618
INSURERF:
COVERAGES CERTIFICATE NUMBER: CL2110710318 REVISION NUMBER:
THIS
IS TO CERTIFY THATTHE 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,.
INSR
A
SD
POLICY EFF
POLIC Y. P
_.
LTR
'.. TYPE OF INSURANCE
IN
WAD
POLICY NUMBER
MM/DD/YYYY
MM/DD/YYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $
A9A_ .w ........... .._.�,.�,........ _.._..._.
CLAIMS -MADE 17 OCCUR
PREMISES Ea occurrence $
'.. MED EXP (Any one person) $
'.. PERSONAL& ADV INJURY $
E 'LAGGREGATE LIMITAPPLIES PER:
EN
GENERALAGGREGATE $
PRO,
7
POLICY JEC'r LOC
PRODUCTS - COMP/OPAGG $
OTHER:
$
AUTOMOBILE LIABILITY
_.
..._.
A ....... .......... ....._... _.��..
COMBINED SINGLE LIMIT $
,,"{Ea accideMl __
ANYAUTO
BODILY INJURY (Per person) $
OWNED SCHEDULED
BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
............
.,$............._�..,_.,_
HIRED NON -OWNED
PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY
{Per aocidentl
UMBRELLA LIAR OCCUR
__.....................................
EACH OCCURRENCE $
...... ................... ......._..�.
EXCESS LIAB CLAIMS -MADE
AGGREGATE $
DED RETENTION $
$
WORKERS COMPENSATION
PER OTH
AND EMPLOYERS' LIABILITY YIN
_ STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE �I
N/A
E.L. EACH ACCIDENT
$
OFFICER/MEMBER EXCLUDED?
E L. DISEASE - EA EMPLOYEE
$
(Mandatory in NH) N
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
,_,__
..........
����
LIMT PER OCC
$2,000,000
PROFESSIONAL LIABILITY
A
V1307D211001
10/04/2021
10/04/2022
DEDUCTIBLE
$15.000
RETRO DATE
08-04-2011
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
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
AUTHORIZED REPRESENTATIVE
ElSegundo CA 90245 d Z�)W-"p
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