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PROOF OF INSURANCE (2023 - 2024) CLOSED
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 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 . PRODUCER I.,,mu�.e'..T COMPLETE EQUITY MARKETS INC 1190 Flex Court Lake Zurich, IL 60047 In CA dba Complete Equity Markets Insurance Agency, Inc. CASL#OD44077 .INSURED .................................................... Truth Be Told Polygraph, LLC INSURERC.,p 407 W Imperial Highway Suite E-10 INSURERD: Brea, CA 92821 INSURER E 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. NNS ..............__.............................__�__........ ... AI TL S�(d ......___ POUCCY EFF POLICY E�XIa _.. ..�.................. LTR TYPE OF INSURANCE POLICY NUMBER M MMI LIMITS COMMERCIAL GENERAL LIABILITY EACHC RENCE $OO IA X 1. f CLAIMS -MADE E...mm] OCCUR PREMISES iEe-oggynencei . �I 5,..... 60 Q00 one person) $ 5000 A _ _.__._........__ x 1701566 11/01/22 11/01/23 PE SONAL&�ADVNJURY $ 1,000-AW GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2..000,.000 PRO- POUCY JET LOC PRODUCTS COMP/OPAGG $.... �t QQtQOQ„ OTHER: MOBILE LIABILITYl�ea.9�'9I COMBINEDAU iN 1.1 LIMIT $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident)..5 .................................�.,....�-.� HIRED NON -OWNED DAMAGE $ AUTOS ONLY AUTOS ONLY [PRQPERT"Y tmaciq?g]) ,....m.. UMBRELLA LIAB OCCUR EACH OCCURRENCE .��........................_.................. E..................: $ ...e........,,....................... EXCESS LIAB CLAIMS -MADE AGGREGATE S DE RETENTIONS $ WORKERS COMPENSATION PER OT - I,,,,.,., TAT;I,J,TE. AND EMPLOYERS' LIABILITY Y / N OFFICEMEMBER EXCLUDED? ANY ECUTIVE F N / A I�..E IFS, ..$........................,...... (Mandatory ) L,. DISEASE EMPLOYE yy describe under mDISEASE m-POLICY DESCRIPTION OF OPERATIONS below EL, LIMIT A Professional Liability TBA 06/05/23 06/05/24 Each Claim $1,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Subject to all policy terms, conditions, exclusions and endorsements of each respective policy. City of El Segundo/Police/Fire is an additional insured (only on General Liability policy) but only per the terms & conditions of the endorsement generated and subject to all policy terms, conditions, exclusions and endorsements. Rease .see pages 7. and 3 for additional I-ntarmation. *Contingent Upon Receipt of Premium* ■":424112Of-\1=1111*]1151=1 h,1�LOfa\A_\Il0 ' City of El Segundo/Police/Fire Attn: Human Resources 350 Main Street El Segundo, CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE zrx4ely ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD IMPORTANT NOTICE: 1. The insurance policy that you have purchased is being issued by an insurer that is not licensed by the State of California. These companies are called "nonadmitted" or "surplus line" insurers. 2. The insurer is not subject to the financial solvency regulation and enforcement that apply to California licensed insurers. 3. The insurer does not participate in any of the insurance guarantee funds created by California law. Therefore, these funds will not pay your claims or protect your assets if the insurer becomes insolvent and is unable to make payments as promised. 4. The insurer should be licensed either as a foreign insurer in another state in the United States or as a non -United States (alien) insurer. You should ask questions of your insurance agent, broker, or "surplus line" broker or contact the California department of Insurance at the toll -free number 1-800-927-4357 or internet website www.insurance.ca.gov. Ask whether or not the insurer is licensed as a foreign or non -United States (alien) insurer and for additional information about the insurer. You may also visit the NAIC's internet website at www.naic.org. The NAIC—the National Association of Insurance Commissioners —is the regulatory support organization created and governed by the chief insurance regulators in the United States. 5. Foreign insurers should be licensed by a state in the United States and you may contact that state's department of insurance to obtain more information about that insurer. You can find a link to each state from this NAIC internet website: https://naic.org/state_web_map.htm. 6. For non -United States (alien) insurers, the insurer should be licensed by a country outside of the United States and should be on the NAIC's International Insurers Department (IID) listing of approved nonadmitted non -United States insurers. Ask your agent, broker, or "surplus line" broker to obtain more information about that insurer. 7. California maintains a "List of Approved Surplus Line Insurers (LASLI)." Ask your agent or broker if the insurer is on that list, or view that list at the internet website of the California Department of Insurance: www.insurance.ca.gov/01-consumers/120-company/07- lasli/lasli.cfm. 8. If you, as the applicant, required that the insurance policy you have purchased be effective immediately, either because existing coverage was going to lapse within two business days or because you were required to have coverage within two business days, and you did not receive this disclosure form and a request for your signature until after coverage became effective, you have the right to cancel this policy within five days of receiving this disclosure. If you cancel coverage, the premium will be prorated and any broker's fee charged for this insurance will be returned to you. D-2 (Effective January 1, 2020) , IICc�►r a► CERTIFICATE OF LIABILITY INSURANCE DATE 21/2023Y) ��" 06/21 /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 endorsements . PRODUCER CONTACT PHILGAUSEPOHL CAL COAST INSURANCE AGENCY PO BOX 1150 FALLBROOK CA 92088 INSURED TRUTH BE TOLD POLYGRAPH, INC. 407 W IMPERIAL HWY SUITE H-213 BREA CA 92821 NAME: PHO760-731-3214AIC No FAt 760-731-3215 A RES,S PHIL@CALCOASTINS.COM INSURERA: CALIFORNIAAUTOMOBILE INS. CO. INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CFR'Tl ICATF NI IIMRFR- RFVICInN NI IMRII 36342 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 INSURANCE INSR WV0 POLICY NUMBER 'MlWDD;YYYYl MR2=1 LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY 7ry" R)T PREMI E " JEa wcurrence $ ]CLAIMS-MADEmm• OCCUR MED EXP (Any one person) $ PERSONALBADVINJURY ''.$ GENERAL AGGREGATE ''..$ GEN'LAGGREGATELIMIT APPLIES PER: PRODUCTS -COMP/OPAGG '$ POLICY PRTOJ- LOC ECf AUTOMOBILE • LIABILITY ANY AUTO ALL OWNEDAUTOS COMBINED SINGLE LIMIT (Ea accident) - -- BODILY INJURY (Per person) $ 1,000,000 - $ BODILY INJURY (Per accident) $ A SCHEDULED AUTOS Y BA040000021221 03/26/2022 03/26/2023 PROPERTY (Per accident) DAMAGE HIRED AUTOS S NON-OWNEDAUTOS $ UMBRELLA LIAR EACH OCCURRENCE $ AGGREGATE $ �_JOCCUR EXCESSLIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND '.. EMPLOYERS' LIABILITY Y/ N ` - TORY LIMITS ER � ANY PROPRIETOR/PARTNER/EXECUTIVE r —I OFFICERIMEMBER EXCLUDED? N I A E.L. EACH ACCIDENT $ (Mandatory In NH) E.L DISEASE- EA EMPLOYEE $ If yes, desc6be under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) THE CITY OF EL SEGUNDO AND THE CITY OF EL SEGUNDO POLICE DEPARTMENTAND ITS OFFICIALS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSUREDS IF REQUIRED BY WRITTEN CONTRACT V CR I If-1 VM I C 1-1 V LUCK THE CITY OF EL SEGUNDO AND THE CITY OF EL SEGUNDO POLICE DEPARTMENT 348 MAIN STREET EL SEGUNDO CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TH EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITI THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE PHIL GALISEPOHL ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD STATE OF CALIFORNIA tTOMOBILE INSURANCE LIABILITY IDENTIFICATION CARD POLICY NUMBER EFFECTIVE DATE 03/26/2023 California Automobile Insurance Company This insurance complies with CVC 16056 or 16500.5.. NAMED INSURED TRUTH BE TOLD POLYGRAPH, LLC YEAR MAKE TOYOTA MODEL AGENT: CAL COAST INS AGENCY, INC. AGENT'S PHONE NUMBER: (760) 731-3214 EXPIRATION DATE 03/26/2024 NAIC # 38342 VIN TO REPORT A CLAIM, 24 HOURS A DAY, 7 DAYS A WEEK, PLEASE CALL (800) 503-3724 For access to ROADSIDE ASSISTANCE ONLY, please call (866) 519-6478 THE COVERAGE PROVIDED BY THIS POLICY MEETS THE MINIMUM LIABILITY LIMITS PRESCRIBED !BY LAW IF YOU HAVE AN ACCIDENT * Notify the police immediately. * Write down names, addresses, telephone numbers, driver license numbers and license plate numbers of all persons involved and of witnesses. * Please note any damage to other vehicles. * Do not admit fault. Do not discuss the accident with anyone except your agent, Mercury or the police. * Immediately report all claims to Mercury at (800) 503-3724. * Please take photos if possible. ID -CA (0721) MERCURY Policy Number: BA040000021221 4/ 'J INSURANCE Effective Date: 03/26/2023 Renewal Declarations BUSINESS AUTO DECLARATIONS RAwwTIOI S For resolving issues or other information you can contact your agent or Mercury using the below phone numbers: Issued By: Agent: California Automobile Insurance Company CAL COAST INS AGENCY, INC. P.O. BOX 10730 P 0 BOX 1150 SANTA ANA, CA 92711-0730 FALLBROOK, CA 92088 Billing: (888) 637-2176 Agent Number: 044317 Claims: (800) 503-3724 Agent Phone: (760) 731-3214 ITEM ONE , � GENERAL .IN OAMA DN' Named Insured: TRUTH BE TOLD POLYGRAPH, LLC Mailing Address: 407 W IMPERIALIHWY, SUITE H-213 BREA, CA 92821 Policy Period: From 03/26/2023 to 03/26/2024 at 12:01 AM Standard Time at your mailing address Business Type: Polygraph Services Business Category: Services Form of Business: Limited Liability Company Total Policy Premium: $2,485.76 This policy may be subject to final audit. In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. . . ENDORSEMENTS ATTACHED TO THIS POLICY IL 00 17 1198 - Common Policy Conditions MCANONFAC0516 - Permanently Attached Non -Factory IL 00 2109 08 - Nuclear Energy Liability Exclusion MCA20760112 - Exclusion of Named Driver IL 00 03 09 08 - Calculation of Premium MCA 2154 0419 - California Uninsured Motorists - Bodily CA 00 0110 13 - Business Auto Coverage Form CA 2155 10 13 - California Uninsured Motorists Coverage - CA 0121 10 13 - Limited Mexico Coverage CA 03 05 10 13 - California Changes - Waiver of Collision CA 0143 05 17 - California Changes CA 99 23 10 13 - Rental Reimbursement Coverage MIL 02 70 04 19 - California Changes - Cancellation and MCA86100617 - Roadside Assistance Coverage CA 23 941013 - Silica or Silica Related Dust Exclusion CA 99 4410 13 - Loss Payable Clause IL N 119 10 15 - California Auto Body Repair Consumer Bill of MCAU010112 - Uninsured Motorists Coverage Selection - MCA85100817-CA - Mercury Broadening Endorsement MCA AM END 04 19 - Amendatory Endorsement CA 20 48 10 13 - Designated Insured MCH VEHSHARE 0619 - Vehicle Sharing Exclusion MCA 23 4S 0619 - Public or LiveryPassenger Conveyance MDS030621-CA Page 1 of 5 03/26/2023 12:01 AM PT Policy Number: BA040000021221 Effective Date: 03/26/2023 ITEM *waQ SCHE DULE Q CQ�VEltJ16ES AND COVIF ©AEJTOS' MERCURY INSURANCE This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those "autos" shown as covered "autos". "Autos" are shown as covered "autos" for a particular coverage by the entry of one or more of the symbols from the Covered Autos Section of the Business Auto Coverage Form next to the name of the coverage. Coverage Coverages Limit Premium Symbol The Most We Will Pay For Any One Accident Or Loss Liability 1 $1,000,000 CSL $1,516 Medical Payments Uninsured Motorists Bodily 2 $50,000 CSL $51 Injury Uninsured Motorists Property Damage Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Deductible Shown in ITEM THREE For Each Covered Comprehensive 7 Auto, But No Deductible Applies To Loss Caused By Fire $130 Or Lightning. See ITEM FOUR For Hired Or Borrowed Autos. Actual Cash Value Or Cost Of Repair, Whichever Is Less, Specified Causes of Loss Minus Deductible Shown in ITEM THREE For Each Covered Auto For Loss Caused By Mischief Or Vandalism. See ITEM FOUR For Hired Or Borrowed Autos. Actual Cash Value Or Cost Of Repair, Whichever Is Less, Collision 7 Minus Deductible Shown in ITEM THREE For Each Covered $232 Auto. See ITEM FOUR For Hired Or Borrowed Autos. Premium For ITEM FOUR (Hired Auto Coverage) $125.00 Premium For ITEM FIVE (Non -Ownership Liability) $199.00 Premium For Endorsements $231.00 Miscellaneous Fees and Expense California Consumer Services and Fraud Program Fees $1.76 Total Policy Premium $2,485.76 MDS030621-CA Page 2 of 5 Policy Number: BA040000021221 Effective Date: 03/26/2023 ,Aoo`MERCURY INSURANCE TEEM THREE „ SCf�IiWLE OF COHERED AUTOS YOu OWN Covered Description Body Type VIN Garaging Auto No. City ST Zip Code 1 Light Trucks Placentia CA 92870 ...••...._• _. ............ ...... Covered iRadius (In Miles) Vehicle Use Business Use *Stated Amount Non -Factory Loss Payee Auto No. E uiment Limit 1 Up to 200 Miles Personal & Business Service AMERICAN FIRST CU ......... * Stated Amount coverage lists your vehicle's actual cash value, including the actual cash value of any Non -Factory Equipment permanently attached to the vehicle that you disclose to us, and is the most we will pay for a loss. Non -Factory Equipment coverage is subject to a sub -limit shown on the Declarations. Be sure to check the Stated Amount and Non -Factory Equipment sub -limit at every renewal in order to receive the best value from your Mercury Business Auto policy. COVERAGES, PREMIUMS, LIMITS, AND DEDUCTIBLES (Absence of a deductible or limit entry in any column below means that the limit or deductible entry in the corresponding ITEM TWO column applies instead.) Auto Medical UM Property Comprehensive Covered Liability Premium Payments UM Bodily Injury Damage Auto No. Premium Premium Premium Deductible Premium 1 $1,516 $51 $250 $130 _. ........................... ....•... _....._-.._._......------------ -------- _..._._..._. Covered Auto No. Specified Causes Of Loss Deductible Premium - Collision CDW Deductible Premium Premium Roadside Assistance Limit Per Premium Occurrence 1 $500 $232 $8 $100 per $20 Rental Reimbursement Audio, Visual, & Data Equipment Covered Auto Loan/Lease Total Vehicle Auto No. Maximum Payment Gap Premium Premium Each Covered Auto Premium Lima Premium 1 $30 per day/30 days $28 $1,985.00 MDS030621-CA Page 3 of 5 04 Policy Number: BA040000021221 MERCURYINSURANCE Effective Date: 03/26/2023 A6,A TOTAL PREIVIN S%: , Liability $1,516 Medical Payments Uninsured Motorists Bodily Injury $51 Uninsured Motorists Property Damage Collision Deductible Waiver $8 Comprehensive $130 Specified Causes of Loss Collision $232 Roadside Assistance $20 Rental Reimbursement $28 Loan/Lease Gap Audio, Visual and Data Electronic Equipment ff'EI 'F0UI" SCHEDULEOF114* S%C1R6bkdWEI CC1fi/EItE[�AtJ1Cr I� ANDPREMfUIVIS� Cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you borrow or rent from your partners or "employees" or their family members). Cost of hire does not include charges for services performed by motor carriers of property or passengers. Estimated Liability Coverage Physical Damage Coverage Total ITEM Annual FOUR Cost Of Hire Premium Limit Of Insurance Premium Premium Actual Cash Value Or Cost Of Repair, $125 Whichever Is Less, Minus $500 Deductible $125 For Each Covered Auto. AiDW ONAIL,14 k �ICIIW Discounts • Personal Auto Policy • Multi -Line Driver Information Listed Drivers Excluded Drivers Additional Insureds CITY OF LONG BEACH BOARD OF HARBOR COMMISSIONERS PO Box 570 Long Beach, California 90801-0570 CITY OF PALM SPRINGS 3200 E Tahquitz Canyon Way MDS030621-CA Page 4 of 5 Policy Number: BA040000021221 Effective Date: 03/26/2023 Palm Springs, California 92262-6959 CITY OF CYPRESS 5275 Orange Ave Cypress, California 90630-2957 THE CITY OF WESTMINSTER 8200 Westminster Blvd Westminster, California 92683-3366 Aoo" MERCURY INSURANCE Other Endorsements Premium Broadening Endorsement $175 MDS030621-CA Page 5 of 5 NOTICE OF INFORMATION PRACTICES Thank you for applying to Mercury. As part of our normal underwriting procedure. we need to obtain information to determine an applicant's eligibility for insurance. Much of that Information will come from you; however. we may obtain additional information or verify information through other sources. COLLECTION Your application is our main source of information. We may also obtain information about your transactions with us and our affiliates. However, we may need to obtain additional information from other sources. We may obtain this information from: Public Record Database Department of Motor Vehicles Consumer reporting agencies Other insurance companies Insurer databases authorized to collect claims and other information. We may collect information: by electronic inquiries of public records in person by telephone by exchanges of correspondence DISCLOSURES We will not disclose to others the information which we obtain about you without your prior authorization except as necessary to conduct our business (and then only if disclosure is permitted by law). For example, if necessary, we may disclose information to: - Other insurance companies to which you have applied for coverage - Insurance companies, law enforcement agencies or insurance support organizations to help detect or prevent insurance fraud or misrepresentation. - Insurance departments or commissions in connection with audits or examinations of our company. -A research or actuarial organization. ACCESS TO INFORMATION You have the right of access to recorded personal information which is in our files about you which is reasonably locatable. To ensure the security of your information in our files, we will require positive identification before we will allow access to that information. To obtain access to recorded personal Information about you, send a signed, written request to the policy issuing Mercury office. Give your full name, address, telephone number. Within 30 business days after we receive your request, we will inform you of the nature and substance of the information in our files which is reasonably locatable and retrievable. If you wish we can show you the information at our policy issuing office or we will mail copies to you. You may have to pay a reasonable charge to cover the cost of the copies. CORRECTION OF INFORMATION If you believe any of our Information is not correct, please notify us and explain why you believe it is inaccurate or incomplete- If we agree with you.. we will correct the information. If we disagree with you we will tell you that we will not make the requested change. Then you may submit to us information and your reasons for disagreeing with our decision not to change the information. We will then furnish your statement to any person designated by you to whom we disclosed the information in the prior two years and to anyone else who may receive the information from us in the future. INVESTIGATIVE CONSUMER REPORTS As a part of our normal underwriting procedure for the processing of applications an investigative consumer report may be made as to your insurability. This information will be obtained through personal interviews with you or your neighbors. Additional information as to the nature and scope of any such report will be furnished to you upon written request. If we obtain information through a consumer reporting agency,. it will collect information and submit a report to us. That agency may keep the report on file and disclose its content to others who request its services. You may receive a copy of the report from the consumer reporting agency if you request it and give proper identification„ ADVERSE UNDERWRITING DECISION In the event of an adverse underwriting decision. you are entitled, upon written request to know The specific items of information concerning you that support the company's decision and the sources of information. Your written request must be received by us within 90 business days of the date or the notice. We will respond within 21 business days of the receipt of your request. If you have received notice from us that an adverse underwriting decision has been made based on information contained in a consumer report. you are entitled to a free copy of the report. To receive a copy of the report. you must contact the consumer reporting agency within 60 days from the date you receive notice of the adverse decision. Mercury receives consumer reports from two different agencies: American Driving Records LexisNexis 2680 Tailings Ct. PO Box 105108 Rancho Cordova, CA 95670 Atlanta. GA 30348 (800) 766-6877. EX. 380 www,consume rdisclosure com Your declarations page identifies the agency or agencies that provided your information to us. If you believe the information your report(s) is inaccurate or incomplete, you are entitled to dispute the information. Other than providing information, the agency or agencies played no part in our decision and will not be able to provide specific reasons for our decision. ADDITIONAL INFORMATION We restrict access to nonpublic personal and financial information about you to those employees who need to know that information to provide service to you. We maintain physical, electronic and procedural safeguards that comply with Federal and State law to guard your nonpublic personal and financial information. If you have any other questions about our information practices, send them to: your Mercury policy issuing office your Producer U-139 (01 /2012) CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 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 E Jennifer Roberts Caruso Insurance Services_-------- PHONE.-- 650 E. Parkridge Ave., Ste. 105 . (I- (951)547-6770 0 , ... IL Corona, CA 92879 APPRES,% Jno"q carttsi lns co .._ .......... License #: OD44419------- INSURER,ISI,AFFORDINNAIc a GwCOVERAGE ..�.................,,,n.. INSURED TRUTH BE TOLD POLYGRAPH LLC 407 W Imperial Hwy Brea, CA 92821-4832 COVERAGES CERTIFICATE NUMBER: 00022571-0 C: REVISION NUMBER: 11 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. —. ....... ti ... IN512 ADD L.' UBR POLICYEFF POP.WCY Yy LIMITS TR TYPE OF INSURANCE POLICY NUMBER M'I ,fYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ m .. -------------- CLAIMS -MADE r 1 OCCUR PREMISES Eaoccurrence) _ $__ „-- MED EXP (Any one person)__w, $ ..., .............�.. _ PERSONAL & ADV INJURY $ GEN"L, AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ .,,.] JECT POLICY �IPRO- LOC PRODUCTS COMP/ OPAGG $ AUTOMOBILE LIABILITY COMBINED SINGLE UMI I _iFA a&!1,gn11. $ a, ......... __ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS .-� .......... D HIRED NON-OWNED Y AGE $ AUTOS ONLY ONLY ( 1 q 3 _................. ..... ..-----...... ,,..,....... UMBRELLA LIAB OCCUR EACH OCCURRENCE ........................................................ $ EXCESS LIAB _ _ CLAIMS -MADE AGGREGATE $ DED._. RETENTION$m,,,,m...,.m.._..._..... $ A WORKERS Y 72WECAE9Z88 01@0/2023 0120/2024 . x STATUTE ER� AND EMPLO ERS'L ABIILOITY / N ANY PROPRIETOR/PARTNER/EXECUTIVE E..L EACH ACCIDENT $ 1,000OFFICEOOO EMBER EXCLUDED? ❑ (Mandatory ( ry 1 NIA ,00 0,000 If es, describe under D ON OF OPERATIONS below E,L DISEASE -POLICY LIMIT $ 110001000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached tf more space is required) 30 Days Written Notice of Cancellation. City of El Segundo Fire Department its officials and emplyees are named as certificate holder. Waiver of Subrogation applies. CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo Fire Department ACCORDANCE WITH THE POLICY PROVISIONS. 314 Main Street El Segundo, CA 90245 AUTHOFUZEIIREPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by JLR on 06/21/2023 at 10:32AM THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 72 WEC AE9Z88 Endorsement Number: Effective Date: 01 /20/23 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Truth Be Told Polygraph, LLC 407 W IMPERIAL HWY BREA CA 92821 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: 12/11/22 Policy Expiration Date: 01/20/24