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PROOF OF INSURANCE (2018) CLOSED DATE(MM/DDIMY) �.., CERTIFICATE OF LIABILITY INSURANCE I 06/25/2017 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(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). PRODUCER CONTACT NAME: Hiscox Inc„d/b/a/Hiscox Insurance Agency In CA Extl: (888)202-3007 FaX E-MAIL 520 Madison Avenue ADDRESS: contact@hiscox.com 32nd Floor INSURERS)AF FORDING COVERAGE NAIC# New York,NY 10022 INSURER A: Hiscox Insurance Company Inc 10200.............. INSURED INSURER B GOVInveSt Inc. INSURERC: 3625 Del Amo Blvd INSURER D: Ste 110 INSURER E: Torrance CA 90503 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS 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 'AID CLAIMS. ITS TYPE OF INSURANCE . �d.DIS@ Sal)(. POLICY NUMBER (MM/LICY EFF... MMIDPOUCY EXP . IDDIYYYIl1 I'MMfDDfY'YYY) LIMITS ...., X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 3,000,000 .................. CLAIMS-MADE � ..GC. _O I_ E_,r�EC �I�W�hMaY�E?"d"c7ItL'Nsu�rrerrc'rzJ.____ $ 100,000 X OCCUR ........ MED EXP(Any one person) $ 5,000 A Y Y UDC-1542150-CGL-17 02/10/2017 02/10/2018 PERSONAL&ADV INJURY $ 3,000,000 LIMIT PER: GENERAI-AGGREOATC s 3,000,000 XN POLICYE❑PE OT APP❑OC I PRODUCTS-COMP/OP AGG $ S/T Gen.Age,...___. O"MER. I $ COMBINED S INGL E:�LIMIT AUTOMOBILE LIABILITY 'CE aem"tdr�nt) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED ASCHEDULED AUTOS UTOS I BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE: HIRED AUTOS AUTOS (Per accidpn11 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE I AGGREGATE $ .......... .PED ........, RETENTION$ I $ WORKERS COMPENSATION PER,,,,,,,,,,,,,,,,,,,,,,,�„STATUTE I,,,, ,,EORH- AND EMPLOYERS'LIABILITY Y/N E.L.EACH ACIDENT OFFICER/MEMBER (Mandatory ICER/ry in NH)EXCLUDED?ECUTIVE NIA E.L.DISEASE-C SEASEC A EMPLOYEE..$....................................... IF yes,describe under DESCRIPTION OF OPERATIONS Wow E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of EI Segundo is named as Additional Insured on the Hiscox Commercial General Liability Policy subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION City of EI Segundo 350 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EI Segundo,CA 90245 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE II ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 040 SCOXHiscox Insurance Company Inc. Policy Number: UDC-1542150-CGL-17 Named Insured: Govinvest Inc. Endorsement Number: 23 Endorsement Effective: August 25, 2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ................. ADDITIONAL INSURED - DESIGNATED PERSON O ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) City of EI Segundo 350 Main Street EI Segundo,CA 90245 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(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 your acts or omissions or the acts or omis- sions 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 CERTIFICATE OF LIABILITY INSURANCE D8,,31f/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), AUT'HORIZ'ED 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). PRODUCER CONTACT GEICO GEICO NAME One GEICO Boulevard PHONE 1-86&509-9W fl FAX Fredericksburg,VA 22412 (N Email .Ext): (A✓C.Not: Address: R1M@GEICO.CW INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:GOVERNMENT EMPLOYEES INSURANCE COMPANY 22063 INSURED INSURER B: GOV INVEST, INC 3625 DEL AMO BLVD STE 110 INSURER C: TORRANCE CA 90503-1668 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS 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. INSR ADD'L SUBR POLICY EFF I POLICY EXP LTR TYPE OF INSURANCE INSRD WVD POLICYNUMBER (MM/DD/YY) (MM/DD/YY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED $ P t MED.EXP(Any one person) $ PERSONAL&ADV.INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY L�I PROJECT L-1 LOC PRODUCTS–COMP/OP AGG_ $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A ANY AUTO 9100082601 02 4/17/2017 4/17/2018 BODILY INJURY $ AUTOS AUTOS I,BODILYperson) J ALL OWNED X SCHEDULED BODILYINJURY $ Per accident) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS I(Per accident) UMBRELLA LIAR OCCUR 1"E'AGH OCCURRENCE EXCESS LIAR CLAIMS-MADE I AGGREGATE DIED I I... ION$ $ WORKERS! KERS'COMPENSATION AND EMPLOYERS'N .... .... .... M STATUTE ! OER ANY PROPRIETOR/PARTNER/EXECUTIVE [:] N/ A EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory NH) EL DISEASE-EACH EMPLOYEE $ r If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRI PTION OF OPERATIONS below . I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,maybe attached I more space is required) THE CITY OF EL SEGUNDO, ITS OFFICIALS AND EMPLOYEES ARE LISTED AS ADDITIONAL INSURED. COVERAGE IS PRIMARY AND NON—CONTRIBUTORY. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE 350 MAIN ST WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245-3813 AUTHORIZED REPRESENTATIVE 0 19W20114 ACORD CORPORATION,ANI rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD GOVINVE-01 LVA:�QVEZ CERTIFICATE OF LIABILITY INSURANCE D 09 01/201 YY) 09/01/2017 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(ies)must have ADDITIONAL INSURED provisions or 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 C NTACT Lillian Vasquez NRME. Geico Insurance Agency qac..N Ext) ( ) 69-5454 d FAX ,No),(570)825-2990 1 Geico Blvd g y 800 9 Fredericksburg,VA 22412 i%& grip@gtlard.corn INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:AmGUARD Insurance Company 4,2390 INSURED IN,$URFR,B,: ER CUR Gov Invest,Inc. INSURER ... ... ................................................................................................................................................................................................................. 3625 Del Amo Blvd.,Suite 110, INSURER D: Torrance,CA 90503 wsu RER E: INSUR ERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS 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 CONTRAeT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 3OLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY RAID CLAIMS, INSR I TYPE OF INSURANCE ADDU SUER POLICY NUMBER POLICY EFF POLICY EXP I LIMITS 1 TR tNS'D WVD (MMIDDIYYYYt,_tMMWWYYYYt COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE ....,9 OCCURVOIEO 4 EM?ISE$'011 70 I K�1;QrjCe) $ ............. ........ .... .... M ED EXP(Any one person) $ ................................................ .... ,,,, ... PERSONAL&ADV INJURY $ Iu EN't.AGGREGATE{C LOC PRODUCTS-COMP/OP AGG LIMIT APPLIES PER: GENERAL AGGREGATE $ Ipp PRO- [] $ ..... M JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (0_400000 $ ANY AUTO BODILY INJURY(Per persona $ OWNED SCHEDULED AUTOS ONLY AUTOOS BODILY IFNJU�rRY{Per accidenq $ AUTOS ONLY A�OS ONL� C e ���drt , AMAGE $ _........................................................._....................................... m $ UMBRELLA CCUR EACH AB CLAIMS-MADE AGGREOCCURRENCE $ EXCESS AB _ V DED p RETENTION$ $ KERS COMPENSATION PER _A ANYERS'LIABILITY 1116T YPROPROIE OR/PAR NER/EXECUTIVE YIIN GOWC889783 04/22/2017 04/22/2018 XL�EACH IACCIOENT�©TH $ 1'000'000 OFFICER/MEMBER EXCLUDED? Y N/A E L DISEASES EA EMPLOYEE 1,000,000 If (Mandatory m NH) IaFSCRIPTI describeunder F()PER.ATIONS_t elow E L DISEASE-POLICY LIMIT $ 1,000,000 .................m ... .... . IT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Excluded:Jasmine Nachtigall Excluded:Ted Price Excluded:Brett Koetsier CER'T'IFICATE HOLDER CANCELLATION, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE r l rias j,', S Yw. ACORD 25(2016/03) _ ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 1.02 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver-Any person or organization far whothe All CA Operations Named Insured has agreed by written contract to famish this waiver. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. GOWC889783 Endorsement No. Insured Insurance Company Countersigned By ©1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved.