PROOF OF INSURANCE (2023) CLOSEDDATE (MMIDDNYYY)
A� CERTIFICATE OF LIABILITY INSURANCE
03/28/2023
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 NAMNTACT
E. Ken Noden, CPCU
Wigmore Insurance Agency Inc. PRONr (714) 979-6543 FAX
NO: (714)54e-2943
880 W. 19th St. pgss,commercial@wigmoreins.com
License #0811959 INSURERS AFFORDING COVERAGE NAIC #
Costa Mesa CA 92627 INSURERA:Philadelphia Indemnity Ins. Com an 18058
INSURED INSURER B: Hartford Casualty Insurance Com an 29424
Alliance Resource Consulting, LLC. INSURER Ca
1 Centerpointe Drive INSURERD:
Suite 440 INSURERE:
La Palma CA 90623 INSURERF:
11f1VF92Af2FC CERTIFICATE NI IMRFR• 22 /23 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.
VLT R I
TYPE OF INSURANCE
POLICY NUMBER.
'.. MM/DDY EFF
MMIDU EXP
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
M bIV �
'PREMISES
100,000
A
',
CLAIMS -MADE OCCUR
Fa oo Morvcra
$
MED EXP (Any one person)
$ 5,000
PHPK2474542
10/15/2022
10/15/2023
PERSONAL BADV INJURY
'$ 1,000,000
GEN'LAGGREGATE LIMITAPPLIES PER:
GENERALAGGREGATE
$ 2,000,000
PRODUCTS - COMPIOPAGG
$ 2,000,000
RO-
JECT El
POLICY LOC
0THER,
$
AUTOMOBILE LIABILITY
COMBINED S IN LIMIT
'Ea pcca -,nl
$ 1,000,000
BODILY INJURY (Per person)
iT$
ANY AUTO
AH
ALL OWNED SCHEDULED
PHPK2474542
10/15/2022
10/15/2023
BODILY INJURY (Per accident)
$
AUTOS AUTOS
NON -OWNED
PROPERTY'OAMEGE
Per ident
$
HIREDAUTOS E AUTOS
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 1 000,000
I.
]
AGGREGATE
$ 1,000,000
A
EXCESS LIAB
CLAIMS -MADE
DED X RETENTION $ 10,000
$
PHUB835911
10/15/2022
1 10/15/2023
WORKERS COMPENSATION
X V TH
STET TE ER
_.
YIN
ANY PROPRIETORIPARTNER/EXECUTIVE
ANFCER/M IETOR
E, .L.. EACH ACCIDENT
$ 11000,000
B
EXCLUDED? Y'
(Mandatory m NH)
NIA
72WECAA6BT4
08/11/2022
08/11/2023
E L.. DISEASE - EA EMPLOYEE
$ 11000,000
EL. DISEASE- POLICY LIMIT
$ 11000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
A
Professional Liability
PHPK2474542
10/15/2022
10/15/2023
Each Wrongful AC Limit $1,000,000
Aggregate Limit $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 PER GENERAL LIABILITY DELUXE ENDORSEMENT: TEMPORARY
STAFFING PI-GLD-TS (11/15). BLANKET WAIVER OF SUBROGATION PER WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US CG 24 04 05 09. BLANKET WAIVER OF SUBROGATION (WORKERS COMPENSATION) PER WAIVERS OF
OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA FORM WC040306.
CERTIFICATE HOLDER GANULLL.AI IUN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of El Segundo, CA ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street
El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE
Timothy Wigmore/K140:,° F•
@ 1988-2014 ACORD CORPORATION. All rights reset
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
INS025 (201401)
PI-GLD-TS (11/15)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY..
GENERAL LIABILITY DELUXE ENDORSEMENT:
TEMPORARY STAFFING
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
It is understood and agreed that the following extensions only apply in the event that no other specific
coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies,
the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under
this policy, unless otherwise noted on this endorsement. The following is a summary of the Limits of
Insurance and additional coverage provided by this endorsement. For complete details on specific
coverages, consult the policy contract wording.
Coverage Applicable
Limit of Insurance
Page
Damage to Premises Rented to You
$1,000,000
2
Expected or Intended Injury — Property Damage
Included
2
Limited Rental Lease Agreement Contractual Liability
$50,000
2
Non -Owned Watercraft
Less than 58 feet
3
Damage to Property You Own, Rent or Occupy
$30,000
3
Medical Payments
$20,000
3
Medical Payments Reporting Period
3 Years
3
Athletic Activities
Amended
3
Supplementary Payments - Bail Bonds
$2,500
4
Supplementary Payments — Loss of Earnings
$500 per day
4
Employee Indemnification Defense Coverage
$25,000
4
Who Is An Insured
Additional Insured — Newly Acquired or Formed Organization
Additional Insured — Broadened Named Insured
Additional Insured — Blanket Additional Insureds When Required by
Contract
Included
4
Duties in the Event of Occurrence, Offense, Claim or Suit
Transfer of Rights of Recovery Against Others To Us
Included
Clarification
4
5
Liberalization
Included
5
Unintentional Failure to Disclose Hazards
Included
5
Bodily Injury— Includes Mental Anguish
Included
5
Personal and Advertising Injury — Includes Abuse of Process,
Discrimination
Included
6
Other Insurance — Primary Clarification
Clarification
6
PI-GLD-TS (11/15)
Page 1 of 8
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
PI-GLD-TS (11/15)
Staffing Services Exclusions
Clarification
7
Staffing Services Definitions
Clarification
8
A. Damage to Premises Rented to You
If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part:
1. The Damage To Premises Rented To You Limit section of the Declarations is amended to the
greater of:
a. $1,000,000; or
b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit.
This is the most we will pay for all damage proximately caused by the same event, whether such
damage results from fire, lightning, explosion, smoke, or leaks from automatic fire protective
systems or any combination thereof;
2. The word fire is changed to fire, lightning, explosion, smoke, or leakage from automatic fire
protective systems where it appears in:
a. The last paragraph of SECTION I —COVERAGES, COVERAGE A BODILY INJURY AND
PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions;
b. SECTION III — LIMITS OF INSURANCE, Paragraph 6.; and
c. SECTION V — DEFINITIONS, Paragraph 9.a.; and
3. The words fire insurance are changed to insurance for fire, lightning, explosion, smoke, or
leakage from automatic fire protective systems where it appears in SECTION IV —
COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4. Other Insurance,
Paragraph b. Excess Insurance.
B. Expected or Intended Injury — Property Damage
SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE
LIABILITY, 2. Exclusions, Paragraph a. Expected Or Intended Injury is deleted in its entirety and
replaced by the following:
a. Expected Or Intended Injury
"Bodily injury" or "property damage" expected or intended from the standpoint of the insured.
This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of
reasonable force to protect persons or property.
C. Limited Rental Lease Agreement Contractual Liability
SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE
LIABILITY, 2. Exclusions, Paragraph b. Contractual Liability is amended by adding the following:
Based on the named insured's request at the time of claim, we agree to indemnify the named insured
for their liability assumed in a contract or agreement regarding the rental or lease of a premises on
behalf of their client, up to $50,000.
PI-GLD-TS (11/15)
Page 2 of 8
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
PI-GLD-TS (11/15)
This coverage extension only applies to rental lease agreements and is excess over any renter's
liability insurance of the client.
D. Non -Owned Watercraft
SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE
LIABILITY, 2. Exclusions, g. Aircraft, Auto Or Watercraft, Paragraph (2) is amended to read as
follows:
(2) A watercraft you do not own that is:
(a) Less than 58 feet long; and
(b) Not being used to carry persons or property for a charge;
This provision applies to any person, who with your consent, either uses or is responsible for
the use of a watercraft. This insurance is excess over any other valid and collectible
insurance available to the insured whether primary, excess or contingent.
E. Damage to Property You Own, Rent or Occupy
SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE
LIABILITY, 2. Exclusions, j. Damage To Property, Paragraph (1) is deleted in its entirety and
replaced with the following:
(1) Property you own, rent or occupy, including any costs or expenses incurred by you, or
any other person, organization or entity, for repair, replacement, enhancement,
restoration or maintenance of such property for any reason, including prevention of injury
to a person or damage to another's property, unless the damage to property is caused by
your client, up to a $30,000 limit. A client is defined as a person under your direct care
and supervision.
F. Medical Payments
1. If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part the
Medical Expense Limit is changed subject to all of the terms of SECTION III — LIMITS OF
INSURANCE to the greater of:
a. $20,000; or
b. The Medical Expense Limit shown in the Declarations of this Coverage Part.
2. Under SECTION I — COVERAGES, COVERAGE C MEDICAL PAYMENTS, Subsection 1.
Insuring Agreement, Paragraph a., Item (b) is amended to read:
(b) The expenses are incurred and reported to us within three years of the date of the
accident; and
G. Athletic Activities
SECTION I — COVERAGES, COVERAGE C MEDICAL PAYMENTS, 2. Exclusions, Paragraph e.
Athletics Activities is deleted in its entirety and replaced with the following:
PI-GLD-TS (11/15)
Page 3 of 8
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
PI-GLD-TS (11/15)
e. Athletics Activities
To a person injured while taking part in athletics.
H. Supplementary Payments
SECTION I — COVERAGES, SUPPLEMENTARY PAYMENTS — COVERAGES A AND B, Items 1.b.
and 1.d. are amended as follows:
b. The limit for the cost of bail bonds is changed from $250 to $2,500; and
d. The limit for loss of earnings is changed from $250 a day to $500 a day.
I. Employee Indemnification Defense Coverage
SECTION I — COVERAGES, SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is
amended to include the following:
We will pay, on your behalf, defense costs incurred by an "employee" in a criminal proceeding.
The most we will pay for any "employee" who is directly involved in a criminal proceeding is $25,000
regardless of the numbers of "employees," claims or "suits" brought or persons or organizations
making claims or bringing "suits."
J. Who is An Insured
SECTION II — WHO IS AN INSURED is amended as follows:
1. Newly Acquired or Formed Organization
If coverage for newly acquired or formed organizations is not otherwise excluded from this
Coverage Part, Paragraph 3.a. is amended to read:
a. Coverage under this provision is afforded until the end of the policy period;
2. Each of the following is also an insured:
a. Broadened Named Insured — Any organization and subsidiary thereof which you control
and actively manage on the effective date of this Coverage Part. However, coverage does
not apply to any organization or subsidiary not named in the Declarations as Named Insured,
if they are also insured under another similar policy, but for its termination or the exhaustion
of its limits of insurance.
b. Blanket Additional Insureds When Required by Contract — Any person or organization
where required by a written contract executed prior to the occurrence of a loss. Such person
or organization is an additional insured for "bodily injury," "property damage" or "personal and
advertising injury" but only for liability arising out of the negligence of the named insured. The
limits of insurance applicable to these additional insureds are the lesser of the policy limits or
those limits specified in a contract or agreement. These limits are included within and not in
addition to the limits of insurance shown in the Declarations.
The Additional Insured's limits of insurance do not increase our limits of insurance, as
described in SECTION III — LIMITS OF INSURANCE.
PI-GLD-TS (11/15)
Page 4 of 8
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
PI-GLD-TS (11/15)
c. Interns — Your interns only while performing duties related to the conduct of your business.
d. Contractors — Any individual or organization under written contract or written agreement with
you who provides "staffing services" on your behalf and at your direction for your clients.
K. Duties in the Event of Occurrence, Offense, Claim or Suit
1. SECTION IV —COMMERCIAL GENERAL LIABILITY CONDITIONS, 2.a. the requirement that
you must see to it that we are notified as soon as practicable of an "occurrence" or an offense,
applies only when the "occurrence" or offense is known to:
a. You, if you are an individual;
b. A partner, if you are a partnership; or
c. An "executive officer" or insurance manager, if you are a corporation.
2. SECTION IV —COMMERCIAL GENERAL LIABILITY CONDITIONS, 2. b. the requirement
that you must see to it that we receive notice of a claim or "suit" as soon as practicable will not be
considered breached unless the breach occurs after such claim or "suit" is known to:
a. You, if you are an individual;
b. A partner, if you are a partnership; or
c. An "executive officer" or insurance manager, if you are a corporation.
L. Transfer of Rights of Recovery Against Others To Us
SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us includes the following clarification:
Therefore, the insured can waive the insurer's rights of recovery prior to the occurrence of a loss,
provided the waiver is made in a written contract.
M. Liberalization
SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to include the
following additional condition:
Liberalization
If we revise this endorsement to provide more coverage without additional premium charge, we
will automatically provide the additional coverage to all endorsement holders as of the day the
revision is effective in your state.
N. Unintentional Failure To Disclose Hazards
SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to include the
following additional condition:
Unintentional Failure To Disclose Hazards
It is agreed that, based on our reliance on your representations as to existing hazards, if you
should unintentionally fail to disclose all such hazards prior to the beginning of the policy period
PI-GLD-TS (11/15)
Page 5 of 8
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
PI-GLD-TS (11/15)
of this Coverage Part, we shall not deny coverage under this Coverage Part because of such
failure.
O. Bodily Injury — Mental Anguish
SECTION V — DEFINITIONS, Paragraph 3. is amended to read:
"Bodily injury":
a. Means bodily injury, sickness or disease sustained by a person, and includes mental anguish
resulting from any of these; and
b. Except for mental anguish, includes death resulting from the foregoing (Item a. above) at any
time.
P. Personal and Advertising Injury — Abuse of Process, Discrimination
If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not
otherwise excluded from this Coverage Part, the definition of "personal and advertising injury" is
amended as follows:
1. SECTION V — DEFINITIONS, Paragraph 14., Item b. is revised to read:
b. Malicious prosecution or abuse of process;
2. SECTION V — DEFINITIONS, Paragraph 14. is amended to include the following:
"Personal and advertising injury" also means discrimination based on race, color, religion, sex,
age or national origin, except when:
a. Done intentionally by or at the direction of, or with the knowledge or consent of:
(1) Any insured; or
(2) Any executive officer, director, stockholder, partner or member of the insured; or
b. Directly or indirectly related to the employment, former or prospective employment,
termination of employment, or application for employment of any person or persons by an
insured; or
c. Directly or indirectly related to the sale, rental, lease or sublease or prospective sale, rental,
lease or sub -lease of any room, dwelling or premises by or at the direction of any insured; or
d. Insurance for such discrimination is prohibited by or held in violation of law, public policy,
legislation, court decision or administrative ruling.
The above does not apply to fines or penalties imposed because of discrimination.
Q. Section IV — Commercial General Liability Conditions is amended by the addition of the following:
The following language is added to Item 4. Other Insurance
Insurance under this endorsement is primary to and non-contributory with any other insurance
maintained by the person or organization (Additional Insured), except for loss resulting from the sole
negligence of that person or organization.
PI-GLD-TS (11/15)
Page 6 of 8
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
PI-GLD-TS (11/15)
This condition applies even if other valid and collectible insurance is available to the Additional Insured
for a loss or "occurrence" we cover for this Additional Insured.
R. Staffing Services Exclusions
The following exclusions are added to SECTION I — COVERAGES, COVERAGE A BODILY INJURY
AND PROPERTY DAMAGE:
Actions Or Activities Of PEO Worker
"Bodily injury" or "property damage" arising from the actions or activities of any "PEO worker".
Professional Services Exclusion
"Bodily injury" or "property damage" due to the rendering of or failure to render any professional
service. This exclusion does not apply to your liability for "bodily injury" or "property damage" arising
out of your "employee's" providing or failing to provide professional health care services to another of
your "employees", but no "employee" is an insured for his or her providing or failure to provide such
professional health care services.
Wrongful Acts
"Bodily injury" or "property damage" arising from a wrongful act in the rendering or failure to render
services to or for your client.
For the purposes of this exclusion, wrongful act shall mean any actual or alleged act, error, or
omission, misstatement, or misleading statement in the course of providing "staffing services" to your
clients by you or by any person for whose acts you are legally responsible.
SECTION I — COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY
COVERAGE is amended as follows:
1. Exclusion k. does not apply.
2. Exclusions a., b., e., f., g., h., i., I., and p. do not apply to any insured who did not personally
acquiesce in or remain passive after having personal knowledge of such conduct. Our obligation
to pay shall begin once the full extent of the assets of the responsible insured has been
exhausted and once the Deductible as shown in the Declarations of the policy has been satisfied.
3. The following exclusions are added to Paragraph 2. Exclusions:
Actions Or Activities Of PEO Worker
"Personal and advertising injury" arising from the actions or activities of any "PEO worker'.
Professional Services Exclusion
"Personal and advertising injury" due to the rendering of or failure to render any professional
service.
Wrongful Acts
"Personal and advertising injury" arising from a wrongful act in the rendering or failure to render
services to or for your client.
PI-GLD-TS (11/15)
Page 7 of 8
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
PI-GLD-TS (11/15)
For the purposes of this exclusion, wrongful act shall mean any actual or alleged act, error, or
omission, misstatement, or misleading statement in the course of providing "staffing services" to
your clients by you or by any person for whose acts you are legally responsible.
S. Staffing Services Definitions
1. SECTION V — DEFINITIONS, Paragraph 5. is revised to read:
"Employee" includes but is not limited to a "leased worker" and a "staffing service employee".
"Employee" does not include a "temporary worker" or a "PEO worker'.
2. The following definitions are added to SECTION V — DEFINITIONS:
a. "PEO service" means staffing related services as a Professional Employer Organization
(PEO) you provide to your clients and to "PEO workers" in connection with employment of
such workers.
b. "PEO worker" means a person you lease to your client under a written "PEO service"
agreement or contract.
c. "Staffing Services" means services provided by a staffing company to their clients including
but not limited to:
(1) Fulfillment of any of the administrative functions which would otherwise be normally
fulfilled by an employer's human resource function;
(2) Staffing related administrative services provided by an Administrative Services
Organization (ASO);
(3) "PEO service";
(4) Staffing related services provided to your clients for the recruitment, selection and
placement of a person for employment with a client.
(5) Temporary, contingent or contract placement services;
(6) Vendor Management Service (VMS), means the facilitation, purchase and management
of "staffing services" for clients including the placement and fulfillment of orders for
"staffing service employees";
(7) Services performed on behalf of your client by a "staffing service employee" who is not a
direct hire or permanent placement;
(8) Services performed for a client company to supply that client company with a "staffing
service employee".
d. "Staffing service employee" means a person who is furnished by you to your client to perform
the duties to which you have agreed.
PI-GLD-TS (11/15)
Page 8 of 8
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
In,
,
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: 08/11/22 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
.................
Authorized Representative
Form WC 04 03 06 (1) Printed in U.S.A.
Process Date: 07/02/22 Policy Expiration Date: 08/11/23