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PROOF OF INSURANCE (2012) CLOSEDSequoia Insurance Comp€i<..y P.O. Box 15030, Las Vegas, NV 89114 -5030 NCCI Carrler Cade 1Y/55 x -dlicy Number: SWP208148 -2 Boiling Point Gieati've Groin WORKERS COMPENSATION and EMPLOYERS LIABILITY INSURANCE POLICY Effective 09/13/2011 Declaration Number 001 INFORMATION PAGE Item 1. Named Insured Agency: 91209 Boiling Point Creative Group Jones and Maulding Insurance 204 West Grand Avenue Agency El Segundo, CA 90245 P.O Box 1312 Oxnard, CA 93030 (805) 486 -4701 Prior Polley Number: SWP208148 -01 Form of Business: Corporation Risk ID Number: FEIN 1 SSN: 850485528 Other Work Places Not Shown Above: 204-206 West Grand Avenue Item Z. POLICY PERIOD » 12 :01 A.M standard time at the insured's mailing address from 09/13/2011 to 09113/2012. Item 3. A. WORKERS COMPL?N•SATION INSURANCL: Part One of the policy applies to the Workers Compensation Law of the states listed here: California D. EMPLOYERS LIABILITY INSURANCE: Paid Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 1,000,000 Each Accident Bodily Injury by Disease $ 1,000,000 Policy Limit Bodily Injury by Disease $ 1,000,000 Each Employee C. OTHER STATES INSURANCE: Part Three of thepolicy applies to all States, other tlum the monopolistic states of North Dakota, Wyoming, Washington, Ohio, and any future declared monopolistic state. D. This policy includes these endorsements and schedules: Refer to Extension of Information Page - Endorsements and Schedules Made Part of This Policy Item 4. The Premium for this policy will be detennined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Refer to Extension of Information Page for itemization of WiP. $ 500 Minimum Premiums (CA): $ 291 Taxes and Surcharges: $ 28 Premium Adjustment Period: $ 28 Total Estimated Cost: $ 528 Billing Plan: Seuu Annual - I payment Deposit Premium: $ 317 Countersigned at Las Vegas by Date: September 13, 2011 Authorized Representative SWC 99 04 01 INSURED Date Pxiated 0911312011 Includes eapyrightmatedol of tdeNallonal Council on Compeusalion Insurance, used with lis perm,ssiou. 0 1996 National Council on Componsation insurance, Tno. Declaration Number: 001 roliey Number: SWP20814$ 2 Effective Date: 09113/2011 Boiling Point Creative Group POLICY INDEX Description Page Workers Compensation and Employers Liability Insurance Policy - Information Page Policy Index Extension of Information Page - Named Insured with Workplaces and Locations 2 Extension of Information Page - Endorsements and Schedules Made Part of This Policy 3 Extension of information Page - Premium Callibmia (04) 4 Extension of Information Page - Billing Plan 5 $WC 99 04 01a INSURED Date Printed 09/I3/2011 Declaration Number: 001 Effective Date: 09/13/2011 Page 2 ,rolicy Number: SWP208148 -2 Boiling Point Creative Group EXTENSION OF INFORMATION PAGE SWC 99 04 02 INSURED Date Printed 09/13/2011 Declaration Number: 001 Effective Date: 09/1312011 Page 4 x0ey Number: SZ7VP208149 -2 Boiling Point Creative Group EXTENSION OF INFORMATION PAGE Item 4. - Premium California (04) Location Code Number Number Classification of Operations 001 4297 Graphic Design -All Operations - Including Clerical Office Employees Location 001 Total Payroll & Manual Premium of All Locations California Territorial Factor 1.00 Total Manual Premium 9812 Employers Liability Increased Units Total Subject Premium 9898 Experience Modification Total Modified Premium 0990 Minimum Premium Adjustment TotalStnudnrd Premium 0900 Expense Constant 9740 Terrorism Risk Insurance Act of 2002 Charge R+stJmated Annual 1'remuinr Policy Surcharges Estimated Annual Cost Premium Basis TotalRstlmated Rate Per Estimated Annual $100 of Annual Remuneration Remuneration Premium $ 50,000 067 $ 335 $ 50,000 $ 335 $ 50,000 $ 335 $0 $ 335 $0 $ 335 $0 $ 335 $a $ 335 $150 $ 50,000 0.03 $15 $ 500 $ 28 $ 523 SWG 99 04 04 INSURED Date Printed 09/13/2011 Declaration Number: - 01.1 Policy' Number: SWP209148 -2 Lffective Dates Boiling Point Creative Group page 16 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY OFFICERS AND DIRECTORS COVERAGE / EXCLUSION ENDORSEMENT - CALIFORNIA If the employer named in item 1 of the Information Page Is a private corporation whose officers and directors are the sole shareholders, this policy applies to all such officers and directors, as employees, except those excluded below or named as excluded In Item 4 of the Information Page. Officers and Directors Excluded Joseph Natoli Paul Slocum Troy Stephens Title president Vice President Secretary WC 04 03 03 Page 9 of 7 Declaration Number-, 001 )Effective Date: 09/13/2011 Page 3 rvlicy Number: SWP208148 -2 Boiling Point Creative Group EXTENSION OF INFORMATION PAGE Reau 3.D. - Eudorseinents and Schedules Marie Part of This Policy It is agreed that the following endorsements and sclredules are included under item 3.D, of the Workers Compensation and Employers Liability Policy Information Page: Form Number PN049901C 'VN049902B "PN049904 WC000000A WC040104 WC040301A WC040303 WC040310 WC040360A WC040416 WC040421 WC040601A Description Your Right to Rating and Dividend Information California Workers' Compensation Insurance Rating Laws California Insurance Guarantee Association (CICGA) Surcharge Workers Compensation and Employers Liability Insurance Policy Terrorism Risk Insurance Program Re-Authorization Act Endorsement - California Policy Amendatory Endorsement - California Officers and Directors Coverage / Exclusion Endorsement - Ca 11forrria Duty to Defend - California Employers' Liability Coverage Amendatory )indorsement - California Terrorism. Premium Endorsement - California Optional Premium Increase Endorscrawit - California California Cancellation Endorsement Page SWC 99 04 03 INSURED Date Printed 09/13/2011 Allied Insurance 1100 INSURANCE COMPANY 1100 LOCUST ST DEPT 1109 a Nationwide• company DES MOINES, IA 60301 -2000 On YourSlde• PREMIER BUSINESSOWNERS POLICY PREMIER OFFICE COMMON DECLARATIONS Policy Number: ACP SPO 70145901111 Named Insured: BOILING POINT CREATIVE GROUP Malling Address: 204 w GRAND AVE EL SEGUNDO, CA 90246.3738 Agency: JONES & MAULDING INS AGENCY Address: OXNARD CA 93032-1312 Agency Phone Number: (803}488.4701 RENEWAL Policy Period: Effective From o9 -21.11 TO 092142 12:01 AM Standard Time at your principal place of business. Form Of your business entity: CORPORATION Description of your business: GRAPHIC DESIGN 84 10986 IN RETURN FOR THE PAYMENT OF THE PREMIUM AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE TO PROVIDE THE INSURANCE STATED iN THiS POLICY. CONTINUATION PROVISION: If we offer to continue your coverage and you or your representative do not accept, this policy will automatically terminate on the expiration date of the current policy period stated above. Failure to pay the required premium when due shalt mean that you have not accepted our offer to continue your coverage. This policy will terminate sooner if any portion of the current policy period premium In not paid when due. RENEWAL POLICY NOTICE: In an effort to keep Insurance premiums as low as possible, we have streamlined your renewal policy by not Including printed copies of policy forms or endorsements that have hot changed from your expiring policies, unless they Include variable Information that Is unique to you. defer to your prior policies for printed copies of thas forms. If you have a heed for any form, they are available by request from your agent IMPORTANT INFORMATION FOR CALIFORNIA POLICYHOLDERS: Companies writing properly and casualty Insuranoe In California are required to participate In the California Insurance Guarantee Association. If a company becomes Insolvent, the California Insurance Guarantee Association settles unpaid claims and assesses each Insurance company for Its fair share. California law requires ail companies to surcharge policies to recover theca assessments. If your policy Is surcharged, "CA Surcharge" with an amount will appear on your premium notice, If you should have any questions or problems with lhia policy, please first contaot your agent or a Company representative. If after doing so, we have failed to produce a satisfactory solution to your problem, you may contact the CALIFORNIA DEPARTMENT OF INSURANCE at 1.800- 927.4357 (for TOO, 1- 800.402 -4033) or write them at: Callfornla Department of Insurance, Consumer Communication Bureau, 300 South spring Street, South Tower, Los Angeles, CA 90013, TOTAL POLICY PREMIUM $ 827.00 Previous Policy Number STATUS 11 ACP BPO 7804500111 ENTRY DATE 07 -12.11 Countersignature Date These Common Policy Declarations, together with the Common Policy Conditions, Coverage Form Declarations, Coverage Forms and any endorsements Issued to form a part thereof, complete the Policy numbered above. PB $100 (01.01) Page 1 of 2 DIRECT BILL LN172 TLS AGENT COPY UID M7 78 17840 PREMIER BUSINESSOWNERS POLICY PREMIER OFFICE SCHEDULE OF NAMED INSUREDS Policy period: Pollcy Number: ACP BPO 78145901111 From 00.2441 TO 09.21 -12 Named Insured: ROILING POINT CREATIVE GROUP Ps $100 (01 -01) Page 2 of 2 AGENT COPY 78 17846 PREMIER BUSINESSOWNERS POLICY PREMIER OFFICE PROPERTY DECLARATIONS Polley Period: Policy Number. ACP SPO 7814590111 From 00 -21.11 To 09.2112 Description of Premises Number: 001 Building Number: 001 Construction: FRAME Premises Address 204 W GRAND AVE EL SEGUNDO CA 90245.3739 Occupancy T Classification: ARTISTS - COMMERCIAL & GRAPHIC Described as: 204 TO 206 GRAND AVE WF PROVIDE INSURANCE ONLY FOR THOSE COVERAGES INDICATED BY A LIMIT OR BY 'INCLUDED". The Property Coverage provided at this promisos Is subject to a $1,000 Deductible, unless otherwise stated. COVERAGES LIMITS OF INSURANCE Building - NOT PROVIDED Business Personal Property - Replacement cost $131,600 ADDITIONAL COVERAGES - the Coverage Form Includes other Additional Coverages not shown. Businesslncome -ALS- 12 Months- NO Hour Waiting Period- 60 Day Ordinary Payroll Limit INCLUDED Extra Expense - Actual Loss Sustained (ALS) - 12 Months - NOHour Waitfng Period INCLUDED Equipment Breakdown INCLUDED Automatic Increase In Insurance - Bu)lding q% Automatic Increase in Insurance - Business Personal Property 2.9% Back Up of Sewer and Drain Water (limit shown per Building, subject to $25,000 policy aggregate) $5,000 OPTIONAL INCREASED LIMITS Account Receivable Valuable Papers and Records (At the Described Premises) Forgery and Alteration Money and Securities - Inside the Premises outdoor Signs Outside the Premises (Limited) Outdoor Trees, Shrubs, Plants and Lawns Business Personal Property Away From Premises Business Personal Property Away From Premises - Transit OPTIONAL COVERAGES - Other frequently purchased Employee Dishonesty Ordinance or Law - 1 - Loss to Undamaged Portion 2 - Demolition Cost and Broadenec Included Limit Additional Limit $25,000 $25,000 $10,000 $10,000 $10,000 $2,500 $'10,000 $15,000 $15,000 coverage options. Increased Cost of Construction $25,000 $25,000 $10,000 $10,000 $10,000 $2,500 $10,000 $15,000 $15,000 NOT PROVIDED NOT PROVIDED NOT PROVIDED PROTECTIVE SAFEGUARDS This premise has Protective Safeguards Identified by symbols below, insu ,alrc, for Fire or Burglary and Robbery at this premise will be excluded if you do not notify us Immediately If an oftho .e safeguards are impaired. See PS 04 30 for a description of each symbol. APPLICAKE SYMBOLS: 'P -71 P13 8101 (04.11) Page 1 of 2 DIRECT MLL LNF2 TES AGENT COPY UID M1 78 17848 PREMIER BUSINESSOWNERS POLICY Interest: PR $101 (04.11) Page 2 of 2 11849 PREMIER OFFICE MORTGAGEE ASSIGNMENT INFORMATION Policy Period: Policy Number; ACP SPO 7814590111 From 09- 21417o 09.21 -12 Additional Interest: Interest Number: Loan Number: Interest: Additional Interest: Interest Number: Loan Number: Interest: Additional Interest: Interest Number: Loan Number: Interest: Additional Interest: Interest Number: Loan Number: Interest: Additional Interest: Interest Number: Loan Number: Interest: Additional Interest: Interest Number: Loan Number: Interest: Additional Interest: Interest Number: Loan Number: Interest: Additional Interest; Interest Number. Loan Number: Interest: Additional Interest: Interest Number: Loan Number: Interest: Additional Interest; Interest Number: Loan Number: Interest: PR $101 (04.11) Page 2 of 2 11849 PREMIER BUSINESSOWNERS POLICY PREMIER OFFICE LIABILITY DECLARATIONS Polley Period; Policy Number: ACP SPO 7814500111 From 09.21.11 To 09.21.12 WE PROVIDE INSURANCE ONLY FOR THOSE COVERAGES INDICATED BY A LIMIT OR BY "INCLUDED", COVERAGES LIMITS OF INSURANCE Liability and Medical Payments Medical Payments Coverage Sub Limit Tenants Property Damage Legal Liability Sub Personal and Advertising Injury Products - Completed Operations Aggregate General Aggregate (Other than Products - Completed Operations) AUTOMATIC ADDITIONAL INSUREDS STATUS Per Occurrence $3,1000,000 Per Person $5,000 -Imit Per Covered Loss $300,000 Per Person Or Organization $1,,0001000 All Occurrences $2,000,000 All Occurrences $2,000,000 The following persons or organizations are automatically Insureds when you and they have agreed in a written contract or agreement that such person or organization be added as an additional insured on your policy. Co- Owners of Insured Premises Controlling Interest Grantor of Franchise or license Lessors of Leased Equipment Managers or Lessors of Leased Premises Mortgagee, Assignee or Receiver Owners or Other Interest from Whom Land has been Leased State or Political Subdivisions - Permits Relating to Promises PROPERTY DAMAGE DEDUCTIBLE NONE OPTIONAL COVERAGES Hired Auto Liability Coverage Nonowned Auto Liability Coverage Included In Liability & Medical Payments Limit Included in Liability & Medical Payments Limit Included In Liability & Medical Payments Limit Included In liability & Medical Payments Limit Included In Liability & Medical Payments Limit Included In Liability & Medical Payments Limit Included In Liability & Medical Payments Limit Included in Liability & Medical Payments Limit Included in Liability a Medical Payments Limit Included in Liability & Medical Paymento Limit PB 8103 (01 -01) DIRECT BILL LNF2 Us AGENT COPY UID 1911 78 17860 PREMIER BUSINESSOWNERS POLICY PREMIER OFFICE FORMS AND ENDORSEMENTS SUMMARY Polley Period: Policy Number: ACP BPO 7814550111 From 09 -21 -11 To 09 -21 -12 FORM NUMBER TITLE L10021 0101 NUCLEAR ENERGY LIABILITY EXCLUSION P130002 0411 PREMIER BUSINESSOWNERS PROPERTY COVERAGE FORM PB0006 0411 PREMIER BUSINESSOWNERS LIABILITY COVERAGE FORM P130009 0411 PREMIER BUSINESSOWNERS COMMON POLICY CONDITIONS 'PB0404 0101 }TIRED AUTO AND NON -OWNED AUTO LIABILITY PB0430 0411 PROTECTIVE SAFEGUARDS ,PB0534 0708 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM EXCLUSION TERRORISM PB2998 0908 EXCLUSION - VIOLATION OF CONSUMER PROTECTION PB2999 0411 EXCLUSION - FUNGI OR BACTERIA PB9004 0411 CALIFORNIA AMENDATORY ENDORSEMENT PB 8103 (01.01) AGENT COPY 78 17861