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PROOF OF INSURANCE (2017) CLOSED 00 DATE(MMIDDIYYYY)
AC'' 'R" CERTIFICATE OF LIABILITY INSURANCE
4/3,/2017
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 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).
PRODUCER CONTACT
NAME: Staci Thistlewhite
CPC No,Extl: Al
Insurance Solutions E (949)348-7400 (AI FAX"
License #0746539 EMAIL StaciT @ins-solutions.com
AI�pE� s :
..........
33302 Valle Rd Suite 200 n t
Rd, INSURER(S),AFF,ORDI NG COVERAGE NAIC
San Juan Ca istrano CA 92675
..,.P wsuRERA Iiiscox Insurance„ Company Inc 10200
INSURED INSURER B:
Emergency Management Consulting Solutions Inc. INSURERC:
21520 Yorba Linda Blvd. Ste. G560 INSURER
INSURER E:
Yorba Linda CA 92887 INSURER F:
COVERAGES CERTIFICATE NUMBER:16-17 All REVISION NUMBER:
THIS IS TO CERTIFYTHAT 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.
'LTR TYPE OF INSURANCE AN,S" POLICY NUMBER fMMIDDDIYYYYY) (MMIDD YYYY) LIMITS
X COMMERCIAL GENERAL LIABILITY G A(I"I oa CURRENCI $ 3,000,000
A I°.'ll..il°Uri°tl'I FX1OCCUP cVCIM1,111 411,1,ic;cj $ 100,000
��ImPo�I tl
� I
X UDC-1487197-CGL-16 8/28/2016 8/28/2017 MED EXP(Arnv une I.)erbun) $ 5,000
P11R::',ONVAL&AI')VINA111T'v $ 3,000,000
GEN'L.AGGREGATE LIMIT APPLIES PER .. L..I�VP..Po;lr,l
....
c;I ,A,II- $ 3,000,000
V':YV Ir'.'i FI JI •.:T � 9 11)1' C', $ 3,DOD,000
X I
',�I'I fl,R $
AUTOMOBILE LIABILITY 1,:�A,71�1'�Po.91uJk:Lb�I:�PohRd,:�l.d',i I IMV f $
tl.I!:,y rasp:,wr9aial,l
ANY AUTO BODILY INJURY(Per persun) $
ALL OWNED `"t�'I IFnr II F IH:�I?II 0'Ih.L Vl,u�{'Y ff'n't,pri E(Vnnl $
AUTOS AlI 0'-, A
HIREDAUTOS PRCJPER'TY C)AR(AGF......... .
AI ITu,"ir,;; (,PKr aCndenfl
$
UMBRELLA LIAR " 'liiVt I A'.1l I
,.......... ..............
EXCESS LIAB 'lli r4111F AGGREGATE
................,...�...........................................,,,,,,,,,,,,,,,,,,.
r �,�,d'.",
V,?Y-I..� I•'L.1 L.I.IT Pu rL.l`Cl , $
WORKERSCOMPE:NSATION �II,.Irr,ll)rl°,
AND EMPLOYERS;,LIABILITY Y 1 N
ANY PROF'P.IETORIPART19EPIEXECLI"TIVE II E L EAC14 ACCIDE1,11
OFFICERIMEMt3ER EX.CL.WED9 NIA
N............. ...................................
(Mandatory in INIH) I- I 71:C"f1::N -V A I-Mr'V !YI-I
11 ves,describe under
DESCRIPTION!OF OPERAT IONS belnw I-V I�:-,I,A;V F'rA 1, Y I NO I $
A Errors and Omissions UDC-1487197-EO-16 8/28/2016 8/28/2017 Limit 'G Ill91t!?nui Ded: $500
°,q)yr sn h.rl° :T,I iullp,l?r?fr
DESCRIPTION OF OPERATIONS!LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required)
RE: Management Consulting @ City of E1 Segundo. Description of Work: Emergency Preparedness planning and
training
Certificate Holder is included as additional insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: Fire Chief Chris Donovan ACCORDANCE WITH THE POLICY PROVISIONS.
314 Main St.
El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE
`I' Al.essandra/PETERS
©1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
I NS025(201401)
elto
HI SCX Hiscox Insurance Company Inc.
Policy Number: UDC-1487197-CGL-16
Named Insured: Emergency Management Consulting Solutions Inc.
Endorsement Number: 9
Endorsement Effective: August 28, 2016
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED! - AUTOMATIC STATUS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II — Who Is An Insured is amended
to Include as an additional insured any per-
sons) or organizatlon(s) for whom you are
performing operations or leasing a premises
when you and such person(s) or organiza-
tions) have agreed in writing in a contract or
agreement that such person(s) or organiza-
tion(s) be added as an additional Insured on
your policy. Such person or organization is
an additional insured only with respect to lia-
bility for "bodily Injury", "property damage" or
"personal and advertising injury" caused, in
whole or in part, by your acts or omissions or
the acts or omissions of those acting on your
behalf:
1. In the performance of your ongoing opera-
tions; or
2. In connection with your premises owned by or
rented to you.
A person's or organization's status as an addi-
tional insured under this endorsement ends
when your operations or lease agreement for
that additional Insured are completed.
CGL E5421 OW (02/14) Includes copyrighted material of Insurance Services Office, Inc.,with its Page t of t
permission.
ACSC 4/4/2017 2 : 34 : 19 PM PAGE 4/009 Fax Server
so Interinsurance IExchange of the ,Automobile Club
Automobile Insurance Policy Coverages and Limits
Renewal Declarations
We are pleased to offer you a renewal for your automobile insurance policy. To renew your policy,send at least the minimum payment on or
before the due dote. Insurance is in effect only for the vehicles,coverages,and limits of liability shown on this declarations page and as set forth
In the Insurance policy and endorsements. These declarations,together with the contract and the endorsements In effect,complete your policy, If
any change to your policy or to the Information we have on flle results In a premium decrease during the policy period,the Interinsurance
Exchange reserves the right to apply any refund due to your outstanding balance,
NAMED INSURN OQLo 11 IJ
AUTO POLICY NUMBEPC CAA ON9Te54017
BIRRELL,JAMES AND BIRRELL, CARMEN POLICY PERIOD'(PACIFIC STANDARD TIME)
17568 CLOVERDALE WAY POLICY EPPEOTIVI DATE: 01.26.17 12;01 A.M.
YORBA LINDA CA 92586-1948
POLICY EXPIRATION DATM 01.25.16 12;01 A.M.
VEHICLE6
VEH. IDENTIFICATION VEHICLE GARAGE ANNUAL- VERIFIED
NO. YEAR MAKE MODEL NUMBER USE ZIP CODE MILES MILEAGE SALVAGE
4 2000 FLEE DISCOVERY 4UZAOWDT38CZ04420 PLEASURE 02688 2,501 - 3,500 VERIFIED
8 2015 LINO NAVIGATOR 5LMJJ2HT2FEJ13710 PLEASURE 92666 12,501 •15,000 VERIFIED NO
7 2010 JEEP WRANGLER UNLIMITED 1J49A5H12AL1e9317 PLEASURE 92866 2,501 - 3,500 VERIFIED NO
8 2016 FORD F160 CREW C SUPER IFTFWlSFOOF844134 PLEASURE 02886 20,001 •25,000 VERIFIED NO
CCVEWE$AND LIMITS ANNUAL PREMIUMS
Coverage In not In effect unless a premium or the word"Included"In shown.
COVERAGES LIMITS OF LIABIUTY Vehicle 4 Vehicle 6 Vehicle 7 Vehlele 8 Vehicle
Liability
I I
Bodily Injury $1,000,000 each person/ $1,000,000 each occurrence $80 j $353 1 $213 1 $407
Properly Damage 51,000,000 eaoh ocourrenos $45 j. $181 11 $101 1. $213
Madloal
No Coverage!No Coverage!No Coveraga�No Coverage!
I
PhYra14a11 Domrtgle (ACIUeI Utah value unless othwwtse stated,less Ceduotlble) ;
Vehlele 4 VaNcle 6 Vehlele 7 Vehlele B Vehlele
Comprehenelve $125000 ACV ACV ACV $174 ° $30 1 $41 1 $106
(Leas Deductlble) $250 $500 $500 $500 l
Colllslon $125000 ACV ACV ACV $341 $520 $191 $700
(Lees Deductlble) $250 $500 $500 $500 I
Car Rental Expense
Per Do No Coverage No Coverage No Coverage No Coverage Ac Coverage;No CoverogeMo Coverage*Coverege
Uninsured Motorlst
Bodily Injury- $1,000,000 each personl $1,000,000 each accident $33 p $149 k $60 k $131
Uninsured&Underinsured Vehlclee X
Uninsured DeductlnleWelver Included I Included Included B Included
Uninsured Collision No CovaragaiNo CoveragaiNo CovsrmiI Coverall
Total Premium $685 $1262 I $826 ; $1640
PREMIUM DISCOUNTS "No Coverage"Indicates coverage not purchased.
Phase Wer to the enclosed deoument entitled"Premlum Dleocurlts A,ppl*to Your Automobile Molloy," Total Annual Premium" $4222
"' If at any time you choose to pay less than the full balance outstanding, (Includes all appllcabledlaccunis.)
finance chargea of up to 1.6% per month of the balance outstanding will apply Less Policyholder Savings Dividend 111311
as explained In your billing statements,which are part of these declarations. Ntt Pr mium" 3811
To sea the annual mileage for your expiring policy, please refer to the
„Notice of Annual Mileage"'page contained In your renewal package.
PROCESS DATE 12.11546 PLEASE ATTACH TO YOUR POLICY (8EE REVERIE)