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PROOF OF INSURANCE (2023 - 2023) CLOSEDCERTIFICATE OF LIABILITY INSURANCEDAT10/18/2022YYY) 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: Ifthe certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed IfSUBROGATION 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, EXT): 877-472-2517 (A/C, NO): 714-257-2522 E-MAIL Brea CA 92821-4504 ADDRESS: jekno@farmersagent.com INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A. Truck Insurance Excliange 21709 INSURERS Farmers Insurance Exchange 21652 CROSSROADS SOFTWARE INC INSURERC: Mid Century Insurance Company 21687 210 W BIRCH ST INSURER D: STE 207 INSURER E: BREA CA 92821 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: T-iISISTOC.EiRNFYTEi,h" _ . r...V.F.Y..:'C71.ICIE��;C�3�(Y�IS INSURANCE I�V.rFSE'ICiUVI1AVL':Eit:I�NI..+`'�iU'I�C).d.G..l_FiE.�::IfVGiU(tF:[:7h1A.hJdF:LekbCJt/I�fQ1211...1EFC'aI.IC.YF'I::f'ICi()(rill'7IC'.64�fEC).PdQ�GW'dITHa�FACJDINGA.NY REQUIREMENY , TEAM ORCONDI.I.ONOFANY CON ..fRACTOR OP�F21DOCUMENUWIRIRE.SPEC:.E.PCmfiC'.i-R..I1ISCE:RTii::ICI:,IEMAYBE ISSUED ORMAY PEiRfAIN,'lL..iEINSURANC;fAFFOR(7EDBYT'F.NE °k POUCIE:SD SCRIBEDr IIE.REINIe SUBJECTT'C7ALL..TEIE:'IP.RMSr,Ei:XCLUSIONSANDCONDIUIONS OFSCSI IIPOLICIES L.IWfSESHOVVNMAY HAVE BEEN REDLICEE)BYPAII:7CIAIMS, INSR TYPE OF INSURANCE ADDTL SUUll ITI POLICY NUMBER POLICY EFF 1 POLICY EXP LIMITS LTR W INSD VIC) ' (MM/DD/YYYY) i (MM/DD/YYYY) " COMMERCIAL GENERAL LIA BILITY ...-.._-_ OCCUR........ CLAWS -MADE C Y N 604395845 TE ILIMI U APPIJES PER AGGREGATE POLICYPROJECT... L.QC'. CY I U-II E R.. AUTOMOBILE LIABILITY �......... AN`f AU PO r......— OVO,lE:fDAUTOS SCHE.IN.R.::1D NL`' AUICIS ....___ N 604395845 HIiRE.DAUUOS X.. NON OWNED '.. ONLY AUTOSC}NLY UMBRELLA LIAB 1,11::"1"911R .,. _... .._. EXCESS LIAB CLAIMS -MADE ril:D '', RETENTION$ _..... WORKERS COMPENSATION ......... _.... ......... AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNEUR/ EXECUTIVEOFFICER/MEMBER N/A A09465956 C EACLUE)E::D7(MwWatoryhi11411-1) Ifyes, desc6be under D(:. CRIPi ON OF OPERA) IONS he.Mw EEACkIOCCURRENCE. $ 2,000,000; DAMAGETO RE Y V C D MI i s (Ea Occur?ence) 100,000, ,PRE MEO EXP (=uroL RrraF=E,e°wof ...... S+ 5,000 08/27/2022 08/27/2023 PERSONAL a$ A0V eNJURY 2,000,000 <ttr ErA ncl rRtEic„ S 4 000,000` P(¢CbDUC..i..S-COMP/QPAGG $ 2,000,000:1 COMBINED SINGLE LIMI I $ 2,000,000: (E:iaaccldenI:) I'J 11";IIf IGIJLJi lI s�In i9„i rr) 5 N11 II INJU i (P(,i Icom) 08/27/2022 08/27/2023 PROPERTY DAMAGE. $ (Perac.codent) J rE A0I OCCURRENCE ACCREGA,I'E $ _ ........ .. _... ..... $ ....... ............. Imo^ PER �° Q STATUTE VINEfR $ 1::1. EACH ACCIDEN1 ., 1,000,000 08/13/2022 08/13/2023 EI DISEASE EiAFMPLOYLE $ 1000000, E.A.-DISEASE POLICvl_IMIf $ 11,000,0001 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) 1210 W BIRCH ST STE 207. BREA„ CA 92821 (Professional E&O Coverage Policy#: UDC-4733564-EO-21 Effective Date: 02/10/2022 to 02/10/2023 Limit Ea.. Claim: $1,000,000 Aggregate Limit:$1,000,000. City of El Segundo Police Department is listed as an additional insured CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO POLICE DEPARTMENT 1 SHOULDA I N I Y OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I THE EXPIRATION 348 MAIN ST I DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AukWRR&EPRESENTATIVE ....... ......... ......... ......... ............ EL SEGUNDO. ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All Rights Reserved 31-1 69 11-15 The ACORD name and logo are registered marks ofACORD 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: j7238 1 st Edition Any person(s) or organi2ation(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-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 RIGHTTO 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 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 -,% of the California workers compensation premium otherwise due on such remuneration, subject to a minimum charge of $250. Schedule Person or Organization Job Description COMPUTER SERVICES 210 W BIRCH STSTE 207 BREA, CA92821 • me .0 1 ELSEGUNDO, CA90245 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 thisendorsement is issued subsequent to preparation ofthe policy.) Endorsement Effective 08/13/21 Insured CROSSROADS SOFTWARE, INC (DBA) CROSSROADS SOFTWARE 210 W BIRCH STSTE 207 BREA CA 928214504 Policy No. A0946-59-56 Endorsement No. Insurance Company MID-CENTURY INSURANCE COMPANY Countersigned By WC990630 (Ed. 6-20) Includes copyright material of the Workers Compensation Insurance Rating Bureau of California. All rights reserved.