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PROOF OF INSURANCE (2024) CLOSEDLISAGAL-01 CHAMPLIN A�oRo CERTIFICATE OF LIABILITY INSURANCE FDA10/9/2023 ) 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(les) 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 CT PayneWest Insurance -TAG PHONE , Ext): (866 276 3775 " r q e 5018 l ) NAMEA 14900 SW Barrows Rd, Ste 202 No)35?15- Beaverton, OR 97007 ppra 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; � POLICY EFF POLICY EXP INSR A. Q SUBR P TYPE OF INSURANCE POLICY NUMBER /nnM. �� m„„ _ _.. LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 . CLAIMS -MADE X. OCCUR X X RBS0255466 8/7/2023 8/7/2024 DAMAaaE T�z RENTCD 100,000 9 Afa9� c1,L*11�rI ej § 5,000 ................ MED EXP,�Any ane,pervn.". ...- 2,000,000 PERSONAL B ADV INJURY $ GEN (. AGGREGATE .. LIMIT APPLIES PER: GENERALAGGREGATF $ tuPR�l.. X POLVCY6 LOG . 4,000�000' _ 0� JEC"f° PR,OOUrTS rOMPlOP nr,r• $ OTHER, $ AUTOMOBILE LIABILITY _ COMBINED SINGLE UM1T $ ANY AUTO BODILY „INJURY Per OWNED SCHEDULED AUTOS ONLY AUTOS NJURY 1 er accidenll I"„„,.W _, (..�,�.,,� $ .. ,,,„„ ..............i NON-OWNED HUTOS ONLY _"BODILY f .0PERTYKMdMCxE". Per ONLY q _ ewfr9rtmr),I ........ .. ..,...... UMBRELLA LIAB OCCUR EA� K.00CURRENCFu .,.m.......EXCESS LIAB CLAIMS -MADE. .."„A,,,GGREGATE .............................. ........._..,_............� .�.� _....m..,.. DED RETENTION $ WORKERS COMPENSATION �AND EMPLOYERS' LIABILITY PER OTH- .STF��T.IT .....,...Fg _- _ - ................. YIN ANY PROPRIETORIPARTNERIEXECUTIVE F L EACH CCIDENT 1''I''1C„ER/MEMBER EXCLUDED? E••- N / A ' , s.nd�atory in NH) _EMPI .... ...., ,,,, describe DIf Ees, SCRIPTION OE ePERATIONS belounr E.L. DISEASE - POLICY U T�-.$... & Omissions X X RBS0255466 8/7/2023 8/7/2024 each claim 2,000,000 LAAErrors Errors & Omissions X X RBS0255466 8/7/2023 8/7/2024 aggregate 4,000,0100 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schodule„ may be attached if more space is requJlred) The City, its elected or appointed officers, officials„ employees, agents, and volunteers are additional insured with respect to Liability arising out of work performed by or on behalf of the consultant per GLS578. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 4GbCalifornia Casualty questions on your policy or to report a IQSS, call 800-800-9410_ This document can be viewed o Office: ' n Mateo, CA at calcas.com/My-Account. Coverage provided by: CALIFORNIA CASUALTY INDEMNITY EXCHANGE AUTOMOBILE POLICY DECLARATIONS AMENDED NAMED INSURED Gallatin„ Usa Residence Type: e: Your policy Is billed by E-Z Pay. Billing information will be mailed separately. This replaces all previous declarations_ POLICY NUMBER: POLICY PERIOD: 102 3968514 Effective 01/19/23 Expiration 01/19/24 12:01 A.M. Standard Time at the Named Insured's address of record Amendment Effective: 07/29/2023 Outline of Coverage for the 2019 TOYOT PRIUS Vehicle Type: Automobile Garaged at: Loss Pa(s): Annual Mileage on current policy term: 10,000 Annual Mileage on previous policy term: 15,000 Vehicle ID Number: ��9693 Vehicle Usage: Pleasure Coverage is provided where a premium Is shown. See your Policy Contract for coverage details. Coverage Bodily Injury Liability Property Damage Liability Medical Payments Uninsured Motorists Other Than Collision Collision Towing and Labor Costs Transportation Expense Vehicle Premium Subtotal CA Anti -Fraud Fee Total Vehicle Premium with Fees Limits Deductible Premium $100,000/$300,000 Each Person/Each Accident $195.00 $50,000 Each Accident $131.00 $5,000 Each Person $24.00 $100,000/$300,000 Each Person/Each Accident $43.00 Actual Cash Value Subject to Deductible $1,000 $95.00 Actual Cash Value Subject to Deductible $1,000 $347.00 Broad Coverage Applies $15.00 Optional Urnits Apply $30 Per Day/$900 Maximum $8.00 $858.04 The following discounted factors have been applied to this vehicle: Platinum Discount $1.76 $859.76 UP-1176 CA (09/22) Page:1 of 6 Underwritten by Scottsdale Insurance Company ENDORSEMENT NO. ATTACHED TO AND ENDORSEMENT EFFECTIVE DATE FORMING A PART OF (12:01 A.M. STANDARD TIME) NAMED INSURED AGENT NO. POLICY NUMBER RBS0255466 8/7/2023 Gallatin Investigations, LLC 46722 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED AND WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ERRORS AND OMISSIONS COVERAGE PART A. With respect to this endorsement, SECTION II —WHO IS AN INSURED is amended to include as an additional insured any person or organization whom you are required to add as an additional insured on this policy under a written contract, written agreement or written permit which must be: 1. Currently in effect or becoming effective during the term of the policy; and 2. Executed prior to the "bodily injury," "property damage," "personal and advertising injury" or "damages." B. The insurance provided to these additional insureds is limited as follows: 1. That person or organization is an additional insured only with respect to liability for "bodily injury," "property damage," "personal and advertising injury" or "damages" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. 2. With respect to the insurance afforded to these additional insureds, the following exclusions are added to SECTION I —COVERAGES, paragraph 2. Exclusions: This insurance does not apply to "bodily injury," "property damage," "personal and advertising in- jury" or "damages" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 3. The limits of insurance applicable to the additional insured are those specified in the written con- tract, written agreement or written permit or in the Declarations for this policy, whichever is less. Includes copyrighted material of ISO Properties, Inc., with its permission. Copyright, ISO Properties, Inc., 2004 (' Naiianvxide` GLS-578-TAG (05-21) Page 1 of 2 „. These limits of insurance are inclusive of, and not in addition to, the Limits of Insurance shown in the Declarations for this policy. 4. Coverage is not provided for "bodily injury," "property damage," "personal and advertising injury" or "damages" arising out of the sole negligence of the additional insured. 6. The insurance provided to the additional insured does not apply to "bodily injury," "property dam- age," "personal and advertising injury" or "damages" arising out of an architect's, engineer's or surveyor's rendering of or failure to render any professional services including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, re- ports, surveys, field orders, change orders or drawings and specifications; and b. Supervisory, inspection, architectural or engineering activities. 6. Any coverage provided hereunder will be excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless a written contract specifically requires that this insurance be primary. When this insurance is excess, we will have no duty under SECTION I —COVERAGES to defend the additional insured against any "suit" if any other insurer has a duty to defend the additional insured against that "suit." If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured's rights against all those other insurers. C. With respect to the insurance afforded to these additional insureds, the following is added to paragraph 8. Transfer Of Rights Of Recovery Against Others To Us Condition of the Commercial General Liability Coverage Form and Errors And Omissions Coverage Form: We waive any right of recovery we may have against an additional insured because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery. Such waiver by us applies only to the extent that the insured has waived its right of recovery against an additional insured prior to loss, but only with respect to liability for "bodily injury," "property damage," "personal and advertising injury" or "damages" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations. GLS-578-TAG (05-21) AUTHORIZED REPRESENTATIVE Includes copyrighted material of ISO Properties, Inc., with its permission. Copyright, ISO Properties, Inc., 2004 Page 2 of 2 DATE t" Nationwide° 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' ADDIITION' TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 370, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: (� 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. U I have and will maintain workers' compensation in surance p e as required b Labor Code 3 q y § 700 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 Policy Number Expiration Date Name of Agent 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 immediatelycomply with those r p y � � provisions or the agreement will automatically become void. Signature of Applicant._ .. y..µ Date' Agreement for: Dated: Reviewed by: