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PROOF OF INSURANCE (2018) CLOSED i DATE(MM/DD/YYYY) C"'R " CERTIFICATE OF LIABILITY INSURANCE 0712512017 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 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 endorsenlent(s), CONTACT Tina Cowie -PRODUCER NAME; - .,.. Cornerstone Specialty Insurance Services,Inc, PHONE (714)731-7700 FAx (714)731-7750 i P Y ����A���,8 Baku t:xa (AMS No'): - 14252 Culver Drive,A299 IE Aleti `1,S,, tina@cornerstonespecialty.com At?ORESS: _ IN$QRERJS)AFFORDING COVERAGE NAIC_# Irvine CA 92604 INSURER A: Travelers Indernnily Go of Conn 25682 INSURED INSURER B: Travelers Indemnity Company - JASON ADDISON SMITH CONSULTING SERVICES,INC, INSURER C, Travelers Property Casualty Co 25674 DBA:JAS PACIFIC INSURER D: Continental Casualty Company 20443 P.O.Box 2002 INSURER E Upland CA 91786 INSURER F t 17/18 COVERAGES REVISION NUMBER: COVERAGES CERTIFICATE 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 AuauaC.SSUOR POLICY EFF POLICY'E XN" LIMITS TYPE OF INSURANCE Ilkgg WV0 POLICY NUMBER jMMMDdYYYY) (MMIDO/YYYY) .. COMMERCIAL GENERAL LIABILITY ! ddd EAVr H C';;CUR58ENC C ,r. 1,000,000 VAMACIE 10 RENTED 1,000,000 CLAIMS-MADE OCCUR PREMISES WaoccurrcncO $ _ . ADDITIONAL INSURED MED PXP(,Any one pwsonj $ 5,000 A BLNKT WVR OF SUBRO 660-11-1359042-16-47 08108/2017 08/08/2018 PERSONAL&ADV INJURY $ 1,000,000 Ci E�Y'Q'7..A'GGREC'yATE.LIMIT APPLIES PER: d;,3ENEv:RAI..AGC'ard.E'G'A'rE $ 2,000,000 PRt'b- PRWLCTS,COMPe'OP AGG $ 2,000,000 POLICY JECT I--....J COC OTHER $ AUTOMOBILE LIABILITY CONWINED SINGLE WAIT $ 1,000,000 Ea arctsYcrwY4 54 ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED 8A-OC906515 08/08/2017 08/08/201 B BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PftC'aPFR"%'Y'9'3Ah!AC;E: $ AUTOS ONLY AUTOS ONLY IPer accidoot) � • 'UMBRELLA LIAR OCCUR EACH OCCURRENCES 5,000,000 B EXCESS LIA13 CLMMS„NIADE CUP-3429T370 08/08/2017 08/08/2018 AGGREGA:Pi,_ t 5,000,000 _ q:]EO V V RETENTION 5 r1�,� {{ $ WORKERS COMPENSATION 'I"'wl STAT"U)"E" 1 �OTH, AND EMPLOYERS'LIABILITY YIN1,000,000 AN'''rPROPRIkclOR'w'ARrNFF4fE,<ECIUI'iVt% I N/A XJUB-3642T261 08/08/2017 08/08/2018 EL r6cy+ACCUDE¢I'r" s C 4',rFCC,EReMEMB'E�F'i k kCI.UDC;D`r” I�,,,.�I 1,000,000 IMantdatory in NH) E L DYSFASE•EIA E:Mi"LOYCE It yes,daiscnibo under 1,000,000 - C°ES4'MPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT 5 Each Claim $2,000,000 Professional Liability AEH114007309 08/08/2017 06/08/2018 Annual Aggrgate $2,000,000 D Claims Made DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 1101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is Additional Insured for General Liability but only if required by written contract with the Named Insured prior to an occurrence and as per attached endorsement.Coverage is subject to all policy terms and conditions.*30 days notice of cancellation,except for 10 days notice for non-payment of premium.For Professional Liability coverage,the aggregate limit is the total insurance available for j all covered claims reported within the policy period. 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. 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 r ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 680~7384P218 COMMERCIAL GENERALLIABILITY NAMED INSURED: Jason Addison Smith Consulting POLICY PERIOD: 818/2017 to Services, Inc. dba JAS Pacific, Inc' 8/8/2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ ITCAREFULLY. BLANKET ADDITIONAL INSURED ������U������ �����80����� ����� �KU��������� (ARCHITECTS,' —" ---'--'----- '— — �� ' This endorsement modifies insunanoeprnAded under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The hd|mwin0 is added \nWHO IS AN INSURED INSURANCE (Section UU /or this Coverage (Section III: Pert. Any person or organization that you agree in a B. The following is added to Poou0noph u. of 4. .,contract or agreement requiring insurance"to |n' Other Insurance in COMMERCIAL GENERAL dude as an additional insured on this Coverage LIABILITY CONDITIONS(Section IV): Part, but only with respect tuliability for"bodily in- However,ifyou specifically agree inm"contract o, jury", "property damage" or "personal injury" agreement requiring insurance"that the insurance cauued, in whole or in port. by you/ ads nromis' provided to an additional insured under this Cn+ miona or the acts or omissions of those acting on omgo part must apply on o phmaq/ buois, or e your behalf: primary and non-contributory basis,this insurance u' In the performance of your ongoing upnxm' in primary to other insurance that is available to tions; such additional insured which covers suohaddi' b' In connection with premises owned by or tiona| insumdusonomeU|nsumd' and wewill not shamv�NtU�o!herinsurance, provided that: mm�od�oyou� n/ ' c' In connection with "your work" and included (1) The "bodily injury" or "property damage" for wUiokoovanagnieoough1ocoum�' end within the "products-completed operations hazard". (2) The ^posnna| injury" for which coverage is Such person ororganization does not qualify mu sought arises out ofonoffense committed; on additional insured for "bodily in/ury^. "property after you have entered into that "contract or damage" or "personal injury" for which that pep agreement requiring insurance" But this imsu+ oonoru@onizo*\onhmsemmumed |iabUi1yinaoum' oncnstill\nexcess over valid and collectible other tract nragreement. insurance,whether primary, excess, contingent ur The insurance provided 1osuch additional insured on any other basis,that is available tothe insured islimited wmfollows: when the insured is an additional insured under d. Thinsurance any other insurance. any person or organization for which cover- C. The following is added to PomQnuph 8. Transfer age as an additional insured spodhnaUv is Of Rights Of Recovery Against Others To Ws added byanother endorsement to this Cover- in COMMERCIAL GENERAL LIABILITY CON- age Part. ON'agoPort. QIT|ONS(Section l*): e' This insurance doom not apply to the render- We waive any rights of recovery we may have ing nfurfailure to render any "professional against any person or organization because of services". payments we make for "bodily injury", ''pmpady t The limits of insurance afforded to the agd|' damage" or "personal injury" arising out of "your home| insured shoo be (he |imits which you work" performed by you, or on your behalf, under agreed inthat ~onmtnoctor, agreement rmqmir- a"contract oragreement requiring insurance"with ^n,g insurance" to provide for that agd}Uona| that person or organization. We waive +hnmo insured, or the limits shown in the Dndmm' rights only where you have agreed to do so as tions for this Coverage Part, whichever are part ufthe"contract nragreement requiring inxur- lomn.TNsondnrmomentdoesnoi)num+ammtUe unpo^ with such person or organization entered limits of insurance stated in the LIMITS OF into by you befnva,and in effect when,the"bodily Pago1mf2 @TheTravelers Companies,Inc. CGD3801O0O7 Includes the copyrighted material of Insurance Ser\Aces Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY injury" or "property damage" occurs, mthe 1per- erage Pail, provided that the "bodily injury" and sonalinjury"offense is committed. "property daxnage~ uouwcs, and the °pmomumm| in- D. The following definition inadded 0mDEFINITIONS jury^iscaused Uymnoffense committed: (Section V): a. After you have entered into that contract or "Contract or agreement requiring insurance" egmnm*m$; means that part ufany contract oragreement tin- b. While that part nfthe contract oragreement is der which you are required(uinclude eperson or inmffeoi�and organization msonadditional insured onthis Cov- o. Before the end ofthe policy period. Page 2of2 (QThe Travelers Companies,Inc. CGD388109O7 Includes the copyrighted material of Insurance Services Office,Inc.with its permission. POLICY NUMBER: BA-OC906515 INSURED: Jason Addison Smith Consulting Services, Inc. dba JAS Pacific EFFECTIVE DATE: 8//8/2017 to 8/8/2018 ITUMMERCAL AUTO INUS ENDORSEMENT CHANGES THE 1!!1O1-ICY, IN EASE READ 1T CAJRE�JIFUI I Y, B1-jkP4KE r ADD11 111i110NA1 INSURIED Ms asommm mucus Ihrlisnaraniumm j.xcwiiidi(,,4d cindeir Chis fdlamag� BUMNESS AUTO COVERAGE FORIM &110T01Fk CAIMqlER: CADVIERAGIE FORM irpIL)GIKEIRS F:(,)1R: M W0 r0ped to aNervage 11:x1ovidmiiiid 1:iy ffiUs endorse. a maincn caini�xaici or agirmnent flhM lis sk.y)iad and amiiA, Me pray'usiorc,,; id Me CwwAp Fmm appy exemAed by youbefixio the"b(Afly dn�uql`or llpirqp,dy rininddlied lby the einidiorsernen l, darrage'cxturs arKJ 111mat ys 61 olect 111iiie pdi-cy flie foflkywvOg ii!ls xwcd ki Wo Seoffon P — L41blifity pemoc:� Naul "O'slure(j,to:r LcWbMjy (,ovoiragal, L.Wt 01111y Coverage, Peragimp, AN Who Is Aiirn finsuired Pro- for datnages to wliiich Oil Ammme q*Ws wo ao,� Mon: to, die exilqr� H'IM pefsainor nirgairiNzaHapi iqa..uafifies as an 1irisuireld" under Uie ')Nll-w IIs An ris,L,uiroid pwooMirin Any piersein or oirqanUzatiryjn yoo awe rei::jubred lo rxinialinied min Siection H, Unr.A4a 2:S-ai(Jidftk.wfN,,A insuirLA oira lixi Cireerage,Form dire CA 14 370 ' 9)1'1110 111hc 11'P:P:IINV!1111� Page 1 011 INSURED: Jason Addison Smith Consulting POLICY DATES: 8/8/2017 to 8/8/2018 Services, Inc. dba JAS Pacific, Inc. WORKERS COMPENSATION TRAVELERSJ AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 (00) - 001 POLICY NUMBER: UB-3642T261 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT— CALIFORNIA (BLANKET WAIVER) 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. 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 3 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description ALL PERSONS OR ORGANIZATIONS THAT ARE PARTIES TO A CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT, PROVIDED YOU EXECUTED THE CONTRACT BEFORE THE LOSS.