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PROOF OF INSURANCE (2018 - 2018) CLOSED OP ID: SMP D YY)CERTIFICATE OF LIABILITY INSURANCE 05125/20/7 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 Alliance Mgt.&Insurance Sery ( T F 355 Via Vera Cruz#7 R O,mAG MI! ___. l.. _........... .. nrAME Michelle A Nowell � FAX I 60-471-9378 CA Agent/Broker Lic#0737966 E-�M 760-47 c) tamiscorp,com PddG No San Marcos,CA 92078 mnoweli@a,miscorp.com . Michelle A.Nowell P0TQWR IP C MESS 1-1 INSURER(S)AFFORDING COVERAGE NAIC# INSURED Messina&Associates Inc INSURER A:Acceptance Casualty Ins Comp 10349 814 Forbes Drive .. : Brea,CA 92821 INSUUREERCR INSURER G INSURER D: INSURER E: 11 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 ILTR p0 TYPE OF INSURANCE I yK POLICY EFF PO POLICY NUMBER 'f POLICY Eft LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO REN'T'ED A X COMMERCIAL GENERAL ABILITY X ICP00961045 06/01/2017 06/01/2018 PREMISES(Fa occurrence) $ 100,000 V _ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 X Errors&Omission PERSONAL&ADV INJURY $ 1,000,000 GENERAL 0 GE I,I _ LIMIT APPLIES PER: PRODUCTSGCOMP/ OP $ 1,000,000 N'LAGGREGATE U X Y POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (PER ACCIDENT) NON-OWNEDAUTOS $ UMBRELLA LIAR OCCUR EACH EXCESS LIAB CLAIMS-MADE AGGREGATE RRENCE $ .... DEDUCTIBLE $, RETENTION $ $ WORKERS COMPENSATION I WCSTATU- I OTH- ANDEMPLOYERS'LIABILITY YIN ..„��.,TORY,�MM.ITS���...........�L..FR. ..... .. ANY OIM HRE L DISEASE E /EXCLUDE/D�EXECUTIVE '� N I A C ACCIDENT $ (Mandatory M ry ) A EMPLOYE-; $ If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS E LOCATIONS 1 VEHICLE'S IA1tach ACORD 101,AddlHonal Remarks Schodule,If more space Is required) City of El Se undo its off icers,vol'unteer's,e'Enplo ees and re resentatives are named as adclltional insure with r s ect to v�f or performeby the named insured With,and 30 Days otice oancellation. Investigation,CA-- canderson(Relsegundo.org CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Attn Christopher Donovan 314 Main Street AUTHORIZED REPRESENTATIVE EI Segundo,CA n I LJ� ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CP00961045 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - 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 Orqlanization(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 apply,will be given as respects the indicated certificate holder." 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 organ- ization(s) shown in the Schedule, but only with re- spect P liability for "bodily jury'�y"property damage" � or "personal and advertisinginjury" caused, in wholes, or in art, b our acts or omissions or the acts or omissions of those acting on your behalf: a 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 ❑ c. You and any other involved insured must: b. Excess Insurance (1) Immediately send us copies of any de- This insurance is excess over any of the other mands, notices, summonses or legal pa- insurance, whether primary, excess, contingent pers received in connection with the claim or on any other basis: or"suit"; (1) That is Fire, Extended Coverage, Builder's (2) Authorize us to obtain records and other Risk, Installation Risk or similar coverage information; for"your work"; (3) Cooperate with us in the investigation or (2) That is Fire insurance for premises rented settlement of the claim or defense against to you or temporarily occupied by you with the"suit"; and permission of the owner; or (4) Assist us, upon our request, in the en- (3) If the loss arises out of the maintenance or forcement of any right against any person or use of aircraft, "autos" or watercraft to the organization which may be liable to the in- extent not subject to Exclusion g. of Cover- sured because of injury or damage to which age A(Section 1). this insurance may also apply. When this insurance is excess, we will have no d. No insured will, except at that insured's own duty under Coverages A or B to defend the in- cost, voluntarily make a payment, assume any sured against any"suit" if any other insurer has obligation, or incur any expense, other than for a duty to defend the insured against that "suit". first aid, without our consent. If no other insurer defends, we will undertake to 3. Legal Action Against Us do so, but we will be entitled to the insured's No person or organization has a right under this rights against all those other insurers. Coverage Part: When this insurance is excess over other in- surance, we will pay only our share of the a. To join us as a party or otherwise bring us into amount of the loss, if any, that exceeds the a"suit"asking for damages from an insured; or sum of: b. To sue us on this Coverage Part unless all of (1) The total amount that all such other insur- its terms have been fully complied with. ance would pay for the loss in the absence A person or organization may sue us to recover on of this insurance; and an agreed settlement or on a final judgment (2) The total of all deductible and self-insured against an insured obtained after an actual trial; amounts under all that other insurance. but we will not be liable for damages that are not payable under the terms of this Coverage Part or We will share the remaining loss, if any, with that are in excess of the applicable limit of insur- any other insurance that is not described in this ance. An agreed settlement means a settlement Excess Insurance provision and was not and release of liability signed by us, the insured bought specifically to apply in excess of the and the claimant or the claimant's legal repre- Limits of Insurance shown in the Declarations sentative. of this Coverage Part. 4. Other Insurance c. Method of Sharing If other valid and collectible insurance is available If all of the other insurance permits contribution to the insured for a loss we cover under Coverag- by equal shares, we will follow this method al- es A or B of this Coverage Part, our obligations are so. Under this approach each insurer contrib- limited as follows: utes equal amounts until it has paid its applica- ble limit of insurance or none of the loss a. Primary Insurance remains, whichever comes first. This insurance is primary except when b. below If any of the other insurance does not permit applies. If this insurance is primary, our obliga- contribution by equal shares, we will contribute tions are not affected unless any of the other by limits. Under this method, each insurer's insurance is also primary. Then, we will share share is based on the ratio of its applicable limit with all that other insurance by the method de- of insurance to the total applicable limits of in- scribed in c. below. surance of all insurers. Messina&Associates, Inc CP00961045 Acceptance Casualty Insurance Company 06-01-2017 to 06-01-2018 CG 00 01 01 96 Copyright, Insurance Services Office, Inc., 1994 Page 9 of 13 ❑ w r» Interinsurance Exchange 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 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 orange to your policy or to the information we have on file I°esultS in a premium decrease during the policy period, the Int':erinsurance Exchange reserves the right to apply any refund due to your outstanding balance. NAMED INSURED(Item 1.) _ AUTO POLICY NUMBER:CAA 065044011 MESSINA, MICHAEL AND CAROLYNA POLICY PERIOD("PACIFIC STANDARD TIME) 814 FORBES DR POLICY EFFECTIVE DATE: 03-25-17 12:01 AM BREA CA 92821-7306 POLICY EXPIRATION DATE: 03-25-18 12:01 AM. VEHICLES VEH. IDENTIFICATION VEHICLE GARAGE ANNUAL" VERIFIED NO YEAR MAKE MODEL NUMBER USE ZIP CODE MILES MILEAGE SALVAGE ............� 2 2005 AMGL HUMMER H2 5GRGN23U55H108695 COMMUTE 92821 5,501 - 7,500 VERIFIED NO 5 2012 KIA SOUL SW/I/SPORT KNDJT2A65C7474113 PLEASURE 92821 3,501 - 4,500 VERIFIED NO 7 2009 JEEP WRANGLER UNLIMITED 1J4GA391591-745955 PLEASURE 92821 10,001 -12,500 VERIFIED NO 8 2016 MBNZ E CLASS 550 WDDKJ7DBOGF314383 PLEASURE 92821 5,501 - 7,500 VERIFIED NO 9 2016 CHEV SLVRDO 1500 CR NEW 3GCUKSEC3GG285230 PLEASURE 92821 10,001 -12,500 VERIFIED NO COVERAGES AND LIMITS Coverage is not in effect unless a premium or the word"included"is shown. ANNUAL PREMIUMS COVERAGES LIMITS OF LIABILITY Vehicle 2 Vehicle 5 Vehicle 7 Vehicle 8 Vehicle 9 Liability Bodily Injury $100,000 each person/ $300,000 each occurrence $219 $298 $420 $164 $269 Propelty Damage $50,000 each occurrence $143 $191 $264 $98 y $198 Medical No Coverage No Coverage I No Coverage;No Coverage i No Coverage Physical Damage (Actual Cash Value unless otherwise skated,less deductible) Vehicle 2 Vehicle 5 Vehicle 7 Vehicle 8 Vehicle 9 Comprehensive ACV ACV ACV ACV ACV $73 $65 $65 $136 $60 (Less Deductible) $250 $250 $250 $250 $250 Collision ACV ACV ACV ACV ACV $306 $674 i $386 $841 $644 (Less Deductible) $250 $250 $250 $250 $250 Car Rental Expense (Per Day) $35 $35 $35 $35 $35 $27 $64 $58 $31 $28 Uninsured Motorist Bodily Injury- $30,000 each person/ $60,000 each accident $41 $42 $48 $34 $27 Uninsured&Underinsured Vehicles Uninsured Deductible Waiver Included Included Included Included Included Uninsured Collision No Coverage r No Coverage No Coverage No Coverage No Coverage Total Premium $809 $1324 $1231 $1304 $1226 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* * If at any time you choose to pay less than the full balance outstanding, (Includes all applicable discounts.) $5894 finance charges of up to 1.5% per month of the balance outstanding will apply Less Policyholder Savings Dividend $ 794 as explained in your billing statements, which are part of these declarations. Net Premium* ium* $5100 "* To see the annual mileage for your expiring policy, please refer to the „ "Notice of Annual Mileage" page contained in your renewal package, E2014111A PROCESS DATE 02-14-17 PLEASE ATTACH TO YOUR POLICY (SEE REVERSE) 02517014 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 EI 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 EI Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone# ( )� I certify that, in the performance of the work set forth in the agreement with the City of EI 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 the workers' compensation provisions of Labor Code § 3700 1 must immediately comply with those provisions or the agreement will automatically become void. 7/12/2016 Signature of Applicant Date Agreement for: Dated.. ,' w ,.. ,:..m, ... .. Reviewed by: 1