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PROOF OF INSURANCE (2008) CLOSEDDATE (MM/DD/WW) ACORD TM. CERTIFICATE OF LIABILITY INSURANCE 10/16/2007 PRODUCER Phone: (800) 395 -8075 Fax: (858) 519 -0822 THIS CERTIFICATE IS ISSUED AS A MATTER OF FITNESS AND WELLNESS INFORMATION 380 STEVENS AVENUE, SUITE 206 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SOLANA BEACH CA 92075 INSURED W SOLUTIONS INC DBA WELLNESS SOLUTIONS 132 N. EL CAMINO REAL, SUITE 311 ENCINITAS CA 92024 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Philadelpia Indemnity Insurance Company INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATELIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD TYPE OF INSURANCE DATE (MMIDD DATE (MMIDD GENERAL LIABILITY PHPK215316 11/12/07 11/12/08 EACH OCCURRENCE $ DAMAGE TO RENTED $ X COMMERCIAL GENERAL LIABILI PREMISES (Ea..U'.nra) CLAIMS MAD OCCUR MED. EXP (Any one person) $ A E X Professional PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 5,000,000 100,000 5,000 5,000,000 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PE PRODUCTS - COMP /OP AGG. $ 5,000,000 X POLICY PRO LOC IrIT 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. AUTHORIZED REPRESENTATIVE El Segundo CA 90245 -3813 - i arlene 9- 4 a Attention: Captain Phipps n AfrnDn CnDDnRATInN 19RR AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ H ANY AUTO $ EACH OCCURRENCE $ EXCESS / UMBRELLA LIABILITY OCCUR 7 CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ I WORKERS COMPENSATION AND EMPLOYERS' IABIL17Y WC STATU- TORY LIMITS OTHER E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? E.L. DISEASE - POLICY LIMIT $ RYee, describe under SPECIAL PROVISIONS below OTHER: DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS It is understood and agreed that the following entity is added as an additional insured Z"D"REPLACES as� spictss the operations of the named insu except that liability resulting from the additional insureds sole negligence. RR IC` *Except 10 days for Non - Payment of Premium. AHD AMENDS E YOU HAV . -NT elncl I ATIAAI CERTIFICATE HOLDER %I^ """ " SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO 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. AUTHORIZED REPRESENTATIVE El Segundo CA 90245 -3813 - i arlene 9- 4 a Attention: Captain Phipps n AfrnDn CnDDnRATInN 19RR ACORD 25 (2001108) Uerinludle ff ofrauo d CG 20 10 11 85 DATE: OCT 16 07 POLICY NUMBER: PHPK215316 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: Job /Project: (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 irsured(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. WAIVER OF SUBROGATION It is agreed that we waive any right of recovery we may have against the person or organization shown in the schedule because of payment we make for injury or damage arising out of "yourwork" done under a contract with that person or organization. The waiver applies only to the person or organization shown in the schedule. SCHEDULE NAME OF PERSON OR ORGANIZATION City of El Segundo 350 Main Street El Segundo CA 90245 -3813 ACORD CERTIFICATE OF LIABILITY INSURANCE LOP LN DATE(MMIDDIYY 7 WELN -2 11 13 07 PRODUCER Murria 6 Frick Insurance 380 Stevens Ave., First Floor Solana Beach CA 92075 Phone: 858- 259 -5800 Fax: 858- 259 -6069 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. INSURERS AFFORDING COVERAGE NAIC 0 INSURED W 11 }ens Solut {gQns Inc 11543 , sunset R }4lga Dr. San Diego CA 9N INSURER A7 Allstate Insurance Company LIMITS INSURER B: INSURER C: INSURER D: INSURER E: S 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER DA MIDOIYY OAT! MMIDDIY LIMITS OENERAL LIABILITY COMMERCIAL GENERAL LLABIL17Y CLAIMS MADE D OCCUR EACH OCCURRENCE S UA PREMISES Eso�nu� S MED EXP (Any one pemn) S PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO• LOC JECT PRODUCTS . COMPIOP AGG S A X AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 048688286 11/05/07 11/05/08 COMBINED SINGLE LIMIT (Eaeoddent) $1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per ecddent) s X PROPERTY DAMAGE (Perecddent) 3 GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT 5 OTHER THAN EA ACC AUTO ONLY: AGG f f EXCESSIUMBRELLA LIABLITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION i EACH OCCURRENCE t AGGREGATE S s !< : WORKERS COMPENSATION AND EMPLOYERS' LUABLITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? If yE*, desorlbe under SPECIAL PROVISIONS below _ I TORY LIMITS ER E.L. EACH ACCIDENT i E.L. DISEASE - EA EMPLOYEE f E.L. DISEASE - POLICY LIMIT i OTHER DESCRIPTION OF OPERATION$ I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *Except 10 days for non payment of premium. City of El Segundo, its Officials, employees and certified Volunteers are listed as additional insureds. CERTIFICATE HOLDER CITYOFS City of El Segundo Attn: Police Chief 350 Main Street E1 Segundo CA 90245 ACORD 25 (2001108) L:AIYGCLL %I1yn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATIOI DATE THEREOF, THE ISSUING INSURER WILL NOWNeRWWMAL Sox DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, B JL1 CORPORATION CERTHOLDER COPY so STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04 -01 -2008 GROUP: 000623 POLICY NUMBER: 0000913 -2007 CERTIFICATE ID: 15 CERTIFICATE EXPIRES: 04 -01 -2009 04 -01- 2008/04 -01 -2009 CITY OF EL SEGUNDO ATTN POLICE CHIEF 350 MAIN ST EL SEGUNDO CA 90245 SO 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 upon 30 days advance written notice to the employer. We will also give you 30 days 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. S�,� �� THORIZED REPRESENTATIVF.J PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT X1600 - RHONDA RYAN TERBEST, P,S - EXCLUDED. ENDORSEMENT X1600 - 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 132 N EL CAMINO REAL STE 311 ENCINITAS CA 92024 SD [B15,SD1 PRINTED : 03- 20-2008 (REV.2 -05)