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PROOF OF INSURANCE (2017 - 2018) CLOSED �1 OP ID: DR 0 / Y)CERTIFICATE OF LIABILITY INSURANCE, 06/14/2017 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 Alliance Mgt.&Insurance Sery ..NAA NE 355 Via Vera Cruz#7 c HONE...........M►Chelle ANowell X711-7 c No) 760-471-9378 CA A enUBroker Llc#0737966 E-MAIL No, () San garcos, 0140b(1 7 ANINA-1rnlisG rp.COm M 0192078 ADDRESS Michelle A.NowellaITIyg,LD a: ..__............... mnowe a ►a, INSURER(S)AFFORDING COVERAGE Ale III INSURED Barry Aninag Investigations INSURER A:ACCaptance„"Casualty Ins Comp 10349 LLC Bang Aninag INBURERB. 27758 Santa Margarita Pkwy 594 INSURERC Mission Viejo,CA 92691 INSURER D: INSURER E: INSURER F; COVERAGES CERTIFICATE NUMBER- REVISION NUMBER: THIS 1S TO CERTIFY THAT 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. NLR GENERAL LIABILITY 'iA'----1 POUCY NUMBER IMW4RpJYYYY'1 N PD�'DIYYdY3OCCURR,ENCE LIMITS 1,00000 TYPE OF INSURANCE A X COMMERCIAL aMSartADe�X LIABILITY ocOCCUR MED X iCP00961685 H 111 1/2016 11!1112017 MExP parson) $ 5'0 100, 0 CL X Erros 8 Omis SIOn � GR Y ,1,000,00 GENERAL is 5,000,000 X N POLICY LIMIT APPLIES LOC PER: _ PRODUCTS-COMPIO'P AGO $ 1,000,000 � PRO- AUTOMOBILE LIABILITY l 'COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO � BODILY INJURY(Per person) $ ALL OWNED AUTOS I BODILY INJURY(Per accidenl � $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (PER ACCIDENT) NON-OWNED AUTOS $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE I AGGREGATE DEDUCTIBLE $ RETENTION $ I " �..r.__...._................_ I$ WORKERS COMPENSATION""—ITITIT.. _. .m .M.........�VuC _ __.... STATU- ', O")Fd•i AND EMPLOYERS'UABIUTY YIN T(.,RY IMIT r$i E:H . ANY PRO'PRIETORMARTNER'PE'XECUTIVE E.L EACH ACCIDENT $ OFFICERMEMB'ER,EXCLUDE 07 E7 N/A (Mandatory In NH) E-L DISEASE-,EA EMPLOYEE $ cle IS RIPSTN'ONtlOOPCRATIOPJSbelow. mmITIT m mm.k:L DISEASE-"POLICY LIMIT $ r ..� _,.............. ._ tSITAAe�ti)e DESCRIPTION OF OPERATIONS!LOCATIONS f VEHICLES(Attach ACORD Remarks Schedule,K more space Is required)ie krrr (�ginn tts O ucer a, ff aIs,IEnr1 I'o, ee ,a d VoI to nlingbr a � onoN Gasan ran arpl( N� rarmery t p y qq nvesticl� ons«CA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo,CA 90245 AUTHORIZED REPRESENTATIVE Q1�o . ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CP00961685 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURE - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Or Organization(s) Automatic Status Included Where Required by Written Contract. All Where Required by Written Contract. "It is agreed, as respects the Policy, thirty (30) days notice of cancellation, except as respects non- payment of premium,for which ten(10)days notice will apply,or other regulatory requirements that may I apply,will be given as respects the indicated certificate holder." i Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Q Section 11 — Who Is An Insured is amended to in- clude as an additional insured the person(s)or organ- ization(s) shown in the Schedule, but only with re- spect to liability 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: A. In the performance of your ongoing operations;or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART To the extent that this insurance is afforded to any additional insured under this policy, SECTION Ili' — COWAERCIAL GENERAL LIABILITY CONDITIONS,4.Other Insurance,is deleted in its entirety and replaced with the following condition: 4. Otherinsurance It all of the other insurance permits contribution by equal shares, we will follow this method unless the insured is required by written contract signed by both parties,to provide insurance that is primary and non-contributory,and the "Insured contract" is executed prior to any loss. Where required by a written contract signed by both parties„ this insurance will be primary end non-contributing only when and to the specific extent required by that contract. However,under the contributory approach each insurer contributes equal amounts until it ties paid Its applicable"t of Insurance or none of the loss remains,whichever comes first. It any of the other insurance does not permit contribution by equal shares„we will contdbute by iirntts.Under this method,each insurer's sham is based on the proportional ratio of b applicable limit of insurance to the total applicable limits of insurance of all insurers, ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. This endorsement forms a part of the Policy to which attached, effective on the inception date of the Policy unless otherwise stated herein. (The following information is required only when this endorsement is issued subsequent to preparation of the Policy.) Endorsement effective Policy No.CPo096i6s5 Endorsement No. Named Insured Barry Aninag Investigations,LLC Countersigned by _ ,,,,,,,,, ,_„ CIGL 30 0114 r. Interinsurance Exchange of the Automobile C lub 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 minimurn payment on or before the due date. 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 file 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 INSURED file m 1.) AUTO POLICY NUMBER:CAA 062277413 ANIN,AG, BARRY POLICY PERIOD(PACIFIC STANDARD TIME) POLICY EFFECTIVE DATE: 01-20-17 12:01 A.M. POLICY EXPIRATION DATE: 01-20-18 12:01 A.M. VEHICLES VEH IDENTIFICATION VEHICLE GARAGE ANNUAL- VERIFIED SALVAGE NO.' YEAR MAKE MODEL NUMBER USE ZIP CODE MILES MILEAGE 2 7,501-10,000 VERIFIED NO 4 2015 HOND ACCORD SPORT IHGCR2F5IFAI68431 COMMUTE 15,001-17,500 VERIFIED NO 5 15,001-17,500 VERIFIED NO '-COVERAGES AND LIMITS ANNUAL PREMIUMS coverage is not in effect unless a premium or the word"Included"Is shown. COVERAGES LIMITS OF LIABILITY Vehicle 2 Vehicle 4 Vehicle 5 Vehicle Vehicle Liability Bodily Injury $100,000 each persorif $300,000 each occurrence $202 Property Damage $100,000 each occurrence S V4 Medical y i f No Coverage No Coverage No Coverage Physical Damage (Actual Cash Value unless othenwise stated,less deductible) Vehicle 2 Vehicle 4 Vehicle 5 Vehicle Vehicle Comprehensive ACV ACV ACV $42 (Less Deductible) $250 $500 $500 Collision ACV ACV ACV $520 (Less Deductible) $250 $500 $500 Car Rental Expense (Per Day) NoCoverage No Coverage NoCoveTape 1 No Coverage 1 No Covera,2 'No Coverage Uninsured Motorist Bodily Injury- $100.000 each person/ $300,000 each accident $74 Uninsured 8 Underinsured Vehicles Uninsured Deductible Waiver Included I Included I Included Uninsured Collision No Coverage No Coverage!No Coverage Total Premium $1012 PREMIUM DISCOUNTS "No Coverage"indicates coverage not purchased. Please refer to the enclosed document entitled"Premium Discounts Applied to Your Automobile Policy." Total Annual Premium* (includes all applicable discounts.) If at any time you choose to pay less than the full balance outstanding, finance charges of up to 1.5% per month of the balance outstanding will apply Less Policyholder Savings Dividend as explained In your billing statements,which are part of these declarations. Net Premium' -.. To see the annual mileage for your expiring policy, please refer to the I"Notice of Annual Mileage"page contained In your renewal packsge� PROCESS DATE 12-13-16 PLEASE ATTACH TO YOUR POLICY (SEE REVERSE) 14% CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE-COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: (_)I have and will maintain a certificate of consent of self-insure for workers'compensation,issued by the Director of Industrial Relations as provided for by Labor Code§3700 for the performance of the work set forth the agreement with the City of El Segundo. Policy No. (_)I have and will maintain workers'compensation insurance as required by Labor Code§3700 for the performance of the work for which the agreement with the City of El Segundo is executed. My workers'compensation insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone# (ZI certify that, in the performance of the work set forth in the agreement with the City of El Segundo, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to a workers' compensation provisions of Labor Code § 3700 1 must immediately comply with th e provislop or eement will automatically become void. Signature of Applicant he agr' Date , Agreement for , Av, Dated: ' y Reviewed by: 1