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PROOF OF INSURANCE (2016) CLOSED (2)EDUCFOR -01 COLLIAM '4 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 7/22/2015 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 endorsement(s). - d( NT PRODUCER ACT' NAME' H lant - Toledo PHONE 419 255 -1020 FAX 811 Madison Ave. INCA Not Ext): ( ) (Arc„ No l: Q419) 255 -7557 Toledo, OH 43604 A R1F� , to hmlt hvlant.corn COVERAGES CERTIFICATE NUMBER: µCERTIFY µPOLICIES REVISION NUMBER: THIS IS TO THAT THE OF INSURANCE LISTED BELOW ..- OD HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI 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. INSR' ADOL SUBR .._. .._. LTR TYPE OF INSURANCE : iNCn uwn POLICY NUMBER mmm ..n ...m... ;._ POLICY EF'F POLICY EXP ........ ......... ....... ........ LNVIJZCrNYYM _m(N,IDGYlYYY!P) �...— — LIMITS ........ ........... A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE X OCCUR X PHPK1365939 07/02/2015 07/0212016 D GE1 C0RENTED 1Ce) $ MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 JECT POLICY a PRO_ L LOC PRODUCTS - COMP /OP AGG $ 4,000,000 OTHER a. $' AUTOMOBILE LIABILITY ...... .. ._.. ..._......_.. ................ ...... .. ......,,,...... ... .......... �M—N��� SIIVGLE'LI�II f ._._._.,. e..... 1,000,000 A ANY AUTO PHPK1365939 07/02/2015 07/0212016 BODILY INJURY (Per person) $ ' ALL OWNED " SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ , X X NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS .... AUTOS „(Pefaccidenll ......... ...... .... ...... .. -.�.__ _m...,..,.,� ---- --- .,�.,... .w.w.... .........�.w ... .... .. .. .. ........... UMBRELLA LIAR OCCUR '... .: ........m .. ... .... ....... ,m.___. ------- EACH OCCURRENCE ,...AGGREGATE ._...— .................. .....__.. $ °,,,, ..._ ........ EXCESS LIAB CLAIMS MADE'.... '...... $ PEP !. RETENTION$$ ...� ........ ................ O ... N . .................. ��������� WORKER$ COMPENSATION ...w...�RH.._._. .. ........ .. .......-- ------- Srn I AND EMPLO RS' LIABILITY YIN... ... - IIrF ANY PROPRIETOR /PARTNER /EXECUTIVE " .. EL EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? V �.., N/A ----- - - - - -- - - -- (Mandatory in NH) EL DISEASE- EA EMPLOYEE: $ If yes . describe under '.., DESCRIPTION OF OPERATIONS below . ,,.._ .... .�.....,. ,.....,. _. .... E L DISEASE - POLICY LIMIT $ A SEE Theft $30,000 PHPK1365939 .. ...----- = 07102120151 07/02/2016 Bus. Pers. Property 40,000 A PHPK1365939 07/02/2015 07/02/2016 Abuse /Molestation 1,000,000 _ .._............ ........._.........__.,.,_ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached i if more space is required) ......_..,.,. The City of El Segundo, its officers, officials, employees, agents, and volunteers are listed as additional insured perwritten contract. CERTIFICATE HOLDER mmmmITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITITIT CANCELLATION ITITIT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The 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 ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD / POLICY NUMBER: PHPx1365939 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O CONTRACTORS - SCHEDULED PERSON OIL ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Oraanization(s) Location(s) Of Covered Operations City of E1 Segundo its officers, officials, employees, agents, and volunteers Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations /for the additional insured(s) at the location(s) designated above. However: 2• 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 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 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. CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 C Insurance Services Office, Inc., 2012 CG 20 10 0413 July 9, 2015 To Whom It May Concern: Our company currently does not supply or carry Worker's Compensation. We do not have any employees at the moment. Class instruction will be carried out by one of the owners. If and when we decide to hire employees we will inform you of those changes and obtain Worker's Compensation. Sincerely, Naomi Tirador Reyes Director of Operations A, Will Request for Taxpayer Give I Orm to.) Um IW)Giv (>"wow ;= 7;1 Identification Number and Certiftation rw-,�uv*bw. 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