The URL can be used to link to this page

PROOF OF INSURANCE (2007) CLOSEDACORD CERTIFICATE OF LIABILITY INSURANCE DAT021072007YYY) PRODUCER Phone: (800) 395.8075 Fax: (S58) 519.0822 THIS CERTIFICATE IS ISSUED AS A MATTER OF FITNESS AND WELLNESS INSURANCE AGENCY INFORMATION 380 STEVENS AVENUE, SUITE 200 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SOLANA BEACH CA 92075 INSURERS AFFORDING COVERAGE I NAIC # INSURED W SOLUTIONS INC DBA WELLNESS SOLUTIONS 132 N. EL CAMINO REAL, SUITE 311 ENCINITAS CA 92024 INSURER A: INSURER B: INSURER C: INSURER D: VVVW1 WV- 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iTSR New TYPE OF INSURANCE POLICY NUMBER POUCYEFPPCT rva .Y�MTM LIMITS 350 Main Street INSURER, ITS AGENTS OR REPRESENTATIVES. GENERAL LIABILITY EOL9012328.02 11112JOS 11/12/07 EACH OCCURRENCE : AMPSaoW = 100,000 X COMMERCIAL GENERAL UABILI MED. EXP (Any one person) $ 6,000 CLAIMS MADt�X OCCUR PERSONAL 3 ADV INJURY E 11000,000 A X Profemlonal GENERAL AGGREGATE 5 5,000,000 PRODUCTS-COMP/OP AGG. $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PEF X POLICY PR4 LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) i BODILY INJURY (Perperaon) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) § HIREDAUTOS NON-OWNED AUTOS PROPERTY DAMAGE aracddent $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO S AUTO ONLY: AGG EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE i AGGREGATE 5 OCCUR F' I CLAIMS MADE 8 S DEDUCTIBLE L RETENTION: WORKERS COMPENSATION AND E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY AMY PROPRIETOMPARTNERIM MUTIn oPnceROMMRaR EXCLUOeo7 E.L. DISEASE-EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ fP rmodPROVNI�oaa- - OTHER: DESCRIPTION OF OPERATIONS ILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS It is understood and agreed that the following entity is added as an additional insured but only as respects the operations of the named Insu except that liability resulting from the additional Insureds sate negligence. Additional Insured Endorsement Is Effective: 01/29/07 "Except 10 days for Non - Payment of Premium. Ur.KIIrIUAICnWLL0CK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING. INSURER WILL ENDEAVORTO MAIL '30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT City of El Segundo FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 350 Main Street INSURER, ITS AGENTS OR REPRESENTATIVES. El Segundo CA 90245.3813 AUTHORIZED REPRESENTATIVE Attention: Police Chief Sandra Eloount Executive ACORD 26 (2001108) Certificate # 53191 Q ACurcu CORPORAMn saoo o & _yam CG 20 10 11 85 DATE: FEB 7 07 POLICY NUMBER: EOL9012328 -02 INSURED NAME: W SOLUTIONS INC DBA WELLNESS SOLUTIONS 132 N. EL CAMINO REAL, SUITE 311 ENCINITAS CA 92024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: THE CITY OF EL SEGUNDO, IT'S OFFICERS, OFFICALS. EMPLOYEES, AGENTS & VOLUNTEERS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section 11) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. Primary Insurance it is agreed that such insurance as is afforded by this policy for the benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and non - contributory, but only as respects any claim, loss or liability arising out of the operations of the named insured(s) or its subcontractors, and only if such claim, loss or liability is determined to be solely the negligence or responsibility of the named insured. Notice of Cancellation or Non - renewal it is agreed that the company will provide the additional insured shown below with 30 days notice of cancellation of this policy in the event of cancellation due to company election only. SCHEDULE NAME OF PERSON OR ORGANIZATION City of El Segundo 350 Main Street El Segundo CA 90245 -3813 0 Ic <�. FROM : WELLNESSUSOLUTIONS PHONE NO. : 858 635 9064 Jan. 23 2007 01:43PM P3 ACRD. CERTIFICATE OF LIABILITY INSURANCE wrLLN 2 DA 11 1On061 PRODUCER Murri a 4 Frick Insurance 380 Stevens 'Ave . , First Floor THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE. HOLDER. THIS CERTIFICATE DOES NOT AMEND,-EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_ MAY PFkrAIN. THE INSUkANCF AFFORDED IIY I HF POLICIES DESCRIBED HEREIN IS SUR.IECT TO Ali TI IF TFRMS, FXOI tiRION$ AND C.ONDITIONB Or SUCH Solana Beach CA`92075 Phone1858= 259 -5800 FaxiSSO -259 -6069 INSURERS AFFORDINO COVEMOE tNAIC# ...-•-----_._-- INSURED INS(URGRA; Allstate Insurance Cowan3► -1r ••_,,,,,,_,• INSUKEH B: _ OFNERAI. LAMILITY Wellness SOlut Qno Inc 10963 guns et R d Dr. San Diego CA 92131 INS ----- INSURER 0: „•, ___...___.._.,.... . . t: EACH pfrGURRENCE i ' TOM Poo ICIGS Or INSIIRANCF. I ISTF0IIFI OW HAVF AF•F,N ISSUF.0 TO TIC INSURED NAMED ADnVr. FOR 71 117 POLICV PCRIOD INDICAT'L'D. NUl WITHSI ANOINO ANY RC.OUIRCMCNT, TrRM OR CONOITInN Or ANY CONTRACT OR OTI ICR DOCIMCNT WITH KL'S'PECT TL) WHICH I HIS CtK) IF ICATE MAY BE ISSU170 OR MAY PFkrAIN. THE INSUkANCF AFFORDED IIY I HF POLICIES DESCRIBED HEREIN IS SUR.IECT TO Ali TI IF TFRMS, FXOI tiRION$ AND C.ONDITIONB Or SUCH POLICIES. AGGRCGAI'C LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IASN' DIYf pOLICYEFRECT1�Tt tI� 5_ LTR NSR TYPE OF INSURANCE POUCY NUMBER pAT� IMMiEY(,M , Y LIMITS _ OFNERAI. LAMILITY EACH pfrGURRENCE i ' COMMERCIAL GGNMI. LIAOILITY PRAMS S {Fji gCCln'Bfl $ CLAIMS MADE �] UCCUH MEDEXP (+►IIY ON perwn) PERSONAL d AOV INJURY S S - . - -• --- --__ -- OFNFRAI AGGREGATE ` G EN' L AGGRE_GA'11 LIM17 APPL IES POC 1'RODUC'I6 • COMPIOP AGO III ..M. POLICY c LOU .. AUTOMOBILE LIABILITY COM1140 SINGLE LIMR 1&3.,000,000- A X X ANY AUTO 048688286 11/05/06 11/05/07 (Eeaoaoenl) — N AI.LOWNEOAUIOS nODILYINJURY _ SCHEDLILEOAUTOS S ; X HIREn AUTOS BODILY��FFWWURY ]� NON- OWNFIIAUTOS (PMVCCIpOrd) ......« ...._. PROPCRTYOAMAGE _..... _.. _......._...... .. (Pw nIC16M11) AUTO ONLY • EA ACCIDENT GARAGE LIABILITY 1 OTHER "AN EA ACC ANYAUTO S AUTO ONLY: AGO S ERCESSIUMBRELLALIABILITY: EACHOCCURRI NCIE S - OCCUR I CLAIMS MADE AGGREGATF. ...� 5 DEDUCTIBLE - -- RETENTION , S WORKERS COMPENSATION AND — TO `/LIMITS ERA BMPLOYRRV LIABILITY C.L. EACH ACCIDENT ANY PHOPKIEYOR(I'AHTNH;VMCU'IIVE orf•ICER/MEMBEA EXCLUDEO7 E.L. DISEASE- EA EMPLOYEE 1 _ If s. desddbo undor C.L. DIP�ASE - POLICY LIMR' S - SPL- VAL_J'RUVISIONS Below _ �_ -_.. -- _ �•• •^' _ .__..,_......_�., .. OTHER -.. ..,.._._.. . DESCRIPTION OF OPERATIONS I LOCATIONS I VG BOLES I EXCLUSIONS ADDED BY ENDORSP.MF.NT 18PE- AL PROIARIONS ^ *Except 10 days for non payment Of premium. City of E1 8egundo, its Officials, employees and certified Volunteers are listed as additional insureds. City of 81 Segundo Attn: t'olicea Chief 350 Main Street S1 Segundo CA 90245 ACORD CITYOr6 I SHOULD ANY OF THE ABOVE DESCRISFO PDfiCIrS BE CANCELLED BEFORE THE EKPIRATION DA7 E YKLtNI`Or, THE ISSUING INSURER WILL � MAIL 3 Ox - pAYB WNITTEN NOTICE TO THE CERTIFICATP HOI.PEk NAMEU 1'0 TIIE LEFT, 0 ACORD CORPORATION 1988 rdjg a!\Cil- CERTHOLDER COPY SD STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04 -01 -2007 GROUP: 000623 POLICY NUMBER: 0000913 -2006 CERTIFICATE ID: 15 CERTIFICATE EXPIRES: 04 -01 -2008 04- 01- 2007/04 -01 -2008 CITY OF EL SEGUNDO SD ATTN POLICE CHIEF 350 MAIN ST EL SEGUNDO CA 90245 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon30 days advance written notice to the employer. We will also give you 30days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. THORIZED REPRESENTATINkJ PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - RHONDA RYAN TERSEST, P,S - EXCLUDED. ENDORSEMENT #1600 - LYNETTE HELMER, VICE PRESIDENT T - EXCLUDED. ENDORSEMENT X2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04 -01 -2006 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER WELLNESS SOLUTIONS SD 132 N EL CAMINO REAL STE 311 ENCINITAS CA 92024 [B15,SDI PRINTED : 03 -26 -2007 (REV.2-05)