Loading...
PROOF OF INSURANCE (2017) CLOSED DATE(MM/DDIYYYY) AYCC'RV CERTIFICATE OF LIABILITY INSURANCE ,,,✓" 10/06/2017 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 CONTACT Alyssa Wilkinson - NAP.ME: ( )225-2442 f ........................................................... L.A.Bowen AI'D�N �xt (801}225-2428 I 1345 West 1600rance Northlnc E:='Ilii"w 1"al ssa.w@laboweninsurance.com tAtr.Not: alyssa.w@laboweninsurance.com BOX 67 INSURERS)AFFORDING COVERAGE NAIC W .��............................................................................_.,........,._.......................... Orem UT 84059 INSURER A: Hartford Casualty Ins.Co. 29424 _......................................................................... INSURED INSURER B: Hartford Fire Ins.Co. 19682 .._........................................................: Decisionwise,LLC INSURER C: United States Liability Ins Co 25895 815 W 450 S INSURER D; INSURER E Springville UT 84663 INSURER F COVERAGES CERTIFICATE NUMBER: 10/6/2017 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, YNSR COMMERCIAL GENERAL LIABILITY NSD DN/VD�...... ...............IT .,.,.,.....�MM DDIYYYY),((h1nLICY.,EXP,.,. .t:A(A I'f LC;4':'4.Ib'tF>;Y'(f`"vC'M!i $ 2,000,000 LTR TYPE OF INSURANCE POLICY NUMBER MIDD/YYYY LIMITS �. 300,000....................................... b7no -TC"a•ttE7ST5tr CLAIMS-MADE X OCCUR PREMISES(Es occurrence) $ MED EXP(Any one person)... PERSONAnl $ 10,000 A I Y 34SBARU1392 12/27/2016 12/27/2017 DV INJURY $ 2,000,000 �.................. GEN'L AGGREGATE LIMIT APPLIES ........ PLIES PER: �GENERAL AGGREGATE $ 4,000,000 ,.X POLICY ❑µ'w0•�.'Cp• ❑ I ,.,,. 00 fit'+,O�' LOC PRODUCTS-COMP/OP AGO $ ............. OT MkIF.fR, —........._...................................................., COIMBINED';~INGLf UMP AUTOMOBILE LIABILITY $ (Erb ta�om�idr§tntlb ANY AUTO ' I BODILY INJURY(Per person) $ A OWNED SCHEDULED 34SBARU1392 12/27/2016 12/27/2017 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED k{'dY'S'I;",Ri'q'1Y DAMAGE „ AUTOS ONLY X' AUTOS ONLY (Per arx'idri[10 $ Non-Owned Auto $ 2,000,000 �.....•_ ... ............... ............ ........................... .......... ............,........... ..,., X AB EACH OCCURRENCE $� occuR 1,000,000 A EXCESS L ARCLAIMS-MADE 34SBARU1392 ..1 _ .. 2/27/2016 12/27/2017 AGGREGATE $ 1,000,000 DED I X1 RETENTION$ 0 $ B ,.. ,-._. ...�. N I A.............__,..�.,.,.,...�,,... NiA OFF PROPRIETOR PARTNER/EXECUTIVE 34WECIC5120 12/27/2016 12/27/2017 EL.EACH ACC PER OTH EMPLOYERS'LIABILITY YIN AND ATI,,ITF ACCIDENT -��� ANY � � ��._.__._.___�___.a $ 1,000,000 ICERIMEMBER EXCLUDED? (Mandatory in NH) """" E,L,DISEASE-A EMPLOYEE $ 1,000,000 If Yes,describe under DES'C'RYPTYk:nCrp V:�F q'pr�F;Yr"�A"IIOCJS tseYr,�nw E.L DISEASE-POLICY LIMIT $ 1,000,000 ERRORS&OMISSIONS.-.....m..._.......................mW_ w__._w ._.w ._._. GENERAL AGGREGATE i 1,000,000 C SP1010305J 12/27/2016 12/27/2017 DEDUCTIBLE 1,000 _....�............... .. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CYBER LIABILITY POI#:106759980 06/21/2017-06/21/2018 GENERAL AGGREGATE 1,000,000 PER CLAIM 10,000 The City of EI Segundo,CA has been added as additional insured in regards to the general liability. 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 ) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Select Customer Insurance Center ssno wzoEMAw oLvo SAN Am7uwzo rx 7e251 Policyholder, please call umot� (aaa) 467 873 Agent, please call usat: <866> «67 973 sERvzcu.xX@zHoyAozFozo.Com INSURANCE ENDORSEMENT ATTACHED +^* PLEASE REVIEW THE CHANGE *+* Enclosed iaanendorsement for your business insurance policy. Please review itotyour convenience. |fyou have questions o/need homake further changes: Policyholder, please call usat: (Vao) 467-8730 Agent, please call uoat: (»sa) «s7 8730 between 7A.M. and 7P.K4. CST . The premium billing will bemailed toyou separately. You can expect toreceive itsoon. Thank you for allowing unhoservice your business needs. L A aowEm zmaoeuaxcE AoEmcr zmc/esa THE HARTFORD SELECT CUSTOMER INSURANCE CENTER The Hartford Hartford Fire Insurance Company and its Affiliates One Hartford Plaza, Hartford,Connecticut nmnn THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: Policy Number: 34 SBA RU13 92 DX Named Insured and Mailing Address; DECTSTONWTSF, LLC W 4'.)0 31 IT'll N(JV 1.1uY,X UT 84663 Policy Change Effective Date: 10/05/17 Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: 006 AgentName: 1, A BOWEN INSURANCE AGENCY INC/PHS Code: 470386 POLICY CHANGES: HARTFORD CASUALTY INSURANCE COMPANY ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT.TF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANCES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS, THIS IS NOT A BILL. N(,-) PIRLVHCJM DA,: AS OF .PPL IICY' (".HANP ,E EFFRC'.T1.VR FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE: IH12001185 ADDITIONAL INSURED PF�P�S(.)N ORGANT'.�.NTTON PRO RATA FACTOR: 0.504 1'11PS [�NDOP [,W ,NT DOP0 NOT (21TANGF, 1.11jpojI.JCY AS' C',,[pOWN. Form SS 12 11 04 05 T Page ooi Process Date: 10/09/17 Policy Effective Date: 12/27/16 Policy Expiration Date: 12/27/17 Il'0I ICY NUMBER: ')4 SRA RU1392 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, APMTU)NAh 11,V-3URFD PHRSC)N C)W'l�;ANT',,;A.TD-)N ARAPAHOE (-'OJN,ry 133,1 PRINC'E R ET hX'TON' ("0 SOCIFTY P(")R HUMAN RESOURCR MANAGRVIIV'1.' (SIIRM) 1.800 DUKE STR HET Ahl,; 'AND RIA, VA 22,H/l To 00.2 BLDG 001 UNIVERS19'Y' OP AhASKA ('AfR.RANK`' 110 BOX 7579/1(..) VAHZBANKS, AK 95875 13ANK OF THE WE,131", l.S,.AOA C/0 INSURANCH CHNTER SFIK S11A LENDING DIVISION PO BOX 4260 NAPA, CA. 94558 UTAN COUNTY, U'l.' 100 EAST CENTHR STRERT PROVO, UT 84606 GfL(JRAF, SPHCTRUM, LP 36(.71 SOOTH BROAD STREET Pffl.hADHhP141A, PA 19148 COUNTY OF BOULDER, s,r/\.'rL OF COFk)RADO, A HODY CORPORATE MD POLITIc, PO BOX /1111 ROM.F.)HR., CO 80306 Form IH 12 00 11 85 T SEQ. NO. 002 Printed in U.S.A. Page 001 (CONTINUED ON NEXT PAGE) Process Date: 10/09/17 Expiration Date: 12/27/17 POLICYNUMBER: 34 SBA RU1392 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. w Form IH 12 00 11 85 T SEQ. NO. 002 Printed in U.S.A. Page 002 (CONTINUED ON NEXT PAGE) Process Date: 10/09/17 Expiration Date: 12/27/17