Loading...
PROOF OF INSURANCE (2024 - 2024) CLOSEDDATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 19/11 /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 be endorsed. If SUBROGATIONIS 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 HAYS COMPANIES INC/OHS 41716730 PHONE (866)467-8730 FAX (A/C, No, Ext): (WC, No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio, TX 78251 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURERA: Sentinel Insurance Company Ltd, 11000 HR DYNAMICS & PERFORAMANCE & MANAGEMENT INSURERB: 461 GREEN ORCHARD PL RIVERSIDE CA 92506-7590 INSURERC: INSURER D INSURER E I INSURER F COVERAGES CERTIFICATE NUMBER: 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 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP IMMfDDfY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 CLAIMS -MADE FX IOCCUR DAMAGE TO RENTED n $1,000,000 General Liability X MED EXP (Any one person) $10,000 A 41 SBANN0763 01/09/2023 01/09/2024 PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY PRO- LOC JECT PRODUCTS -COMP/OPAGG $4,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $2,000,000 ANY AUTO BODILY INJURY (Per person) A ALL OWNED SCHEDULED AUTOS '.AUTOS 41 SBANN0763 01/09/2023 01/09/2024 1 BODILY INJURY (Per accident) X HIRED NON -OWNED AUTOS X AUTOS PROPERTY DAMAGE (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- MADE AGGREGATE D RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY TA7UTE E.L, EACH ACCIDENT ANY YIN PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E.L. DISEASE -EA EMPLOYEE (Mandatory in NH) If yes, describe under E..L.. DISEASE - POLICY LIMIT DESCRIPTION QF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Master Certificate SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED HR Dynamics & Performance Management, I BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED Henry T Garcia IN ACCORDANCE WITH THE POLICY PROVISIONS. 461 GREEN ORCHARD PL AUTHORIZED REPRESENTATIVE RIVERSIDE CA 92506 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(03/22/2023YYYY, 023 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 ON NAME:, BIBERK PHONE 844-472-0967 _ (Ac N�... 203 654 3613 P.O. Box 113247 E 11AIt "" A iw _.... Stamford, 13 47 AD_.tr customerservice@biBERK.com com customerservlce@bIBERK. _ ....._. _. INSURER S AFFORDING COVERAGE NAIC A INSURER A: National Liability & Fire InsuranceWCorn pany 20052 INSURED INSURER B : HR Dynamics & Performance Management, Inc,. _ INSURERCmi�_......................................................................... 461 Green Orchard PI INSURERD: Riverside, CA 92506 INSURERE: INSURER F C: r0VFRAr.Fs CERTIFICATE NUMBER: 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 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. TYPE OF INSU.................................... m..............., .,-.., . INSRLTR RANCE ADDLSLrSR POLICYNUMBER MMIDOMY MM1DDffYIXY LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ......... _ CLAIMS -MADE E] OCCUR Maur ec� .. ................ .. ,,,,,,,,w-..�.. MED IXP (,Any one person) .. ...............�.... PERSONAL & ADV INJURY $ GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- ❑ LOC iEC'I" PRODUCTS COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ..19 .A 0R91) .....___. ...... $ .... ANY AUTO BODILY INJURY (Per on) person) $ OWNEDL SCHEDULED BODILY INJURY (Per acc id. "e, t) $ AUTOS ONLY AUTOS , NON-OWNEDHIRED DAMAGE $ AUTOS ONLY AUTOS ONLY .......n $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $���� DED RETENTION $ $ WORKERS COMPENSATION I PER OTH- STATUTE XR__ AND EMPLOYERS' LIABILITY y 1 N .. ............ ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A .--..,.�-____ ....,,m............................................._...� (Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $ �.................... If describe under DESORIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ Professional Liability (Errors & Per Occurrence/ $2,000,000/ A Omissions): Claims -Made N9PL832476 02/20/2023 02/20/2024 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / 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 El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: U I have and will maintain a certificate of consent of self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code § 3700 for the performance of the work set forth the agreement with the City of El Segundo. Policy No. (_) I have and will maintain workers' compensation insurance as required by Labor Code § 3700 for the performance of the work for which the agreement with the City of El Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Name of Agent Policy Number Expiration Date Phone # certify that, in the performance of the work set forth in the agreement with the City of El Segundo, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Labor Code § 3700 1 must immediately comply with those provisions or th will automatically become void. .9Date 1 a- x3 /12 Signature of Applicant Print Name Agreement for: Dated: Reviewed f